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296 Occupational Outlook Handbook  Commercial and Industrial Designers (0*NET 27-1021.00) Significant Points  • Commercial and industrial designers usually work closely with a range of specialists including engineers, materials scientists, marketing and corporate strategy staff, cost estimators, and accountants. •  About 30 percent are self-employed; many designers work for services firms. • A bachelor’s degree is usually required to start; many designers pursue a master’s degree. • Keen competition for jobs is expected; those with strong backgrounds in engineering and computer-aid­ ed design and extensive business expertise will have the best prospects. Nature of the Work Commercial and industrial designers combine the fields of art, business, and engineering to design the products people use ev­ ery day. In fact, these designers are responsible for the style, function, quality, and safety of almost every manufactured good. Usually designers specialize in one particular product category, such as automobiles and other transportation vehicles, appli­ ances, technology goods, medical equipment, furniture, toys, tools and construction equipment, or housewares. The first steps in developing a new design, or altering an ex­ isting one, are to determine the requirements of the client, the purpose of the product, and to the tastes of customers or users. When creating a new design, designers often begin by research­ ing the product user or the context in which the product will be used. They ascertain desired product characteristics, such as size, shape, weight, color, materials used, cost, ease of use, fit, and safety. To gather this information, designers meet with cli­ ents, conduct market research, read design and consumer pub­ lications, attend trade shows, and visit potential users, suppliers and manufacturers. Next, designers prepare conceptual sketches or diagrams— by hand or with the aid of a computer—to illustrate their vision of the product. After conducting research and consulting with a creative director or other members of the product development team, designers then create detailed sketches or renderings. Many designers use computer-aided design (CAD) tools to cre­ ate these renderings. Computer models make it easier to adjust designs and to experiment with a greater number of alternatives, speeding and improving the design process. Industrial design­ ers who work for manufacturing firms also use computer-aided industrial design (CAID) tools to create designs and machinereadable instructions that can direct automated production tools to build the designed product to exact specifications. Often, de­ signers will also create physical models out of clay, wood, and other materials to give clients a better idea of what the finished product will look like.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Designers present the designs and prototypes to their client or managers and incorporate any changes and suggestions. De­ signers often work with engineers, accountants, and cost esti­ mators to determine if a product can be made safer, easier to assemble or use, or cheaper to manufacture. Before a product is completed and manufactured, designers may participate in us­ ability and safety tests, watching consumers use prototypes and then making adjustments based on those observations. Increasingly, designers are working with corporate strategy staff to ensure that their designs fit into the company’s business plan and strategic vision. They work with marketing staff to develop plans to best market new product designs to consumers. They work to design products that accurately reflect the com­ pany’s image and values. And although designers have always tried to identify and design products that fit consumers’ needs, more designers are now focused on creating that product before a competitor does. More of today’s designers must also focus on creating innovative products as well as considering the style and technical aspects of the product. Work environment. Designers employed by manufacturing establishments, large corporations, or design firms generally work regular hours in well-lighted and comfortable settings. Designers in smaller design consulting firms, or those who freelance, may work under a contract to do specific tasks or designs. They frequently adjust their workday to suit their cli­ ents’ schedules and deadlines, meeting with the clients evenings  Most commercial and industrial designers use computer-aided software to prepare conceptual diagrams.  Professional and Related Occupations 297  or weekends when necessary. Consultants and self-employed designers tend to work longer hours and in smaller, more con­ gested, environments. Additional hours may be required to meet deadlines. Designers may work in their own offices or studios or in cli­ ents’ homes or offices. They also may travel to other locations, such as testing facilities, design centers, clients’ exhibit sites, users’ homes or workplaces, and manufacturing facilities. With the increased speed and sophistication of computers and ad­ vanced communications networks, designers may form interna­ tional design teams and serve a more geographically dispersed clientele.  Training, Other Qualifications, and Advancement A bachelor’s degree is required for most entry-level commercial and industrial design positions. Many designers also pursue a master’s degree to increase their employment opportunities. Education and training. A bachelor’s degree in industrial design, architecture, or engineering is required for most entrylevel commercial and industrial design jobs. Coursework in­ cludes principles of design, sketching, computer-aided design, industrial materials and processes, manufacturing methods, and some classes in engineering, physical science, mathematics, psychology, and anthropology. Many programs also include internships at design or manufacturing firms. Many aspiring commercial and industrial designers earn a master’s degree in industrial design. Some already have a bachelor’s degree in the field, but an increasing number have degrees and experience in other areas, such as marketing, infor­ mation technology, or engineering, and are hoping to transfer into a design occupation. Also, because of the growing emphasis on strategic design and how products fit into a firm’s overall business plan, an in­ creasing number of designers are pursing a master’s degree in business administration to gain business skills. The National Association of Schools of Art and Design ac­ credits approximately 250 postsecondary colleges, universities, and private institutes with programs in art and design. About 45 of these schools award a degree in industrial design; some offer a bachelor’s of art, some a bachelor’s of science. Many schools require the successful completion of 1 year of basic art and design courses before entry into a bachelor’s degree pro­ gram. Applicants also may be required to submit sketches and other examples of their artistic ability. Other qualifications. Creativity and technical knowledge are crucial in this occupation. People in this field must have a strong sense of the esthetic—an eye for color and detail and a sense of balance and proportion. Despite the advancement of computer-aided design, sketching ability remains an important advantage. Designers must also understand the technical as­ pects of how products function. Most employers also expect  new designers to know computer-aided design software. The deciding factor in getting a job often is a good portfolio—ex­ amples of a person’s best work. Designers must also be imaginative and persistent and must be able to communicate their ideas visually, verbally, and in writing. Because tastes and styles can change quickly, design­ ers need to be well read, open to new ideas and influences, and quick to react to changing trends. Problem-solving skills and the ability to work independently and under pressure also are important traits. People in this field need self-discipline to start projects on their own, to budget their time, and to meet dead­ lines and production schedules. As strategic design becomes more important, employers will seek designers with project management skills and knowledge of accounting, marketing, quality assurance, purchasing, and strategic planning. Good business sense and sales ability are important, especially for those who freelance or run their own business. Advancement. Beginning commercial and industrial design­ ers usually receive on-the-job training and normally need 1 to 3 years of training before they can advance to higher level po­ sitions. Experienced designers in large firms may advance to chief designer, design department head, or other supervisory positions. Some designers leave the occupation to become teachers in design schools or in colleges and universities. Many faculty members continue to consult privately or operate small design studios to complement their classroom activities. Some experienced designers open their own design firms.  Employment Commercial and industrial designers held about 48,000 jobs in 2006. About 30 percent were self-employed. Another 15 per­ cent of designers were employed in either engineering or spe­ cialized design services firms. Manufacturing firms and service providing companies employed most of the rest of commercial and industrial designers.  Job Outlook Employment is expected to grow about as fast as average. Keen competition for jobs is expected; those with strong backgrounds in engineering and computer-aided design and extensive busi­ ness expertise will have the best prospects. Employment change. Employment of commercial and in­ dustrial designers is expected to grow 7 percent between 2006 and 2016, about as fast as the average for all occupations. Em­ ployment growth will arise from an expanding economy and from an increase in consumer and business demand for new or upgraded products. Increasing demand for commercial and industrial designers will also stem from the continued emphasis on the quality and safety of products, the increasing demand for new products  Projections data from the National Employment Matrix Occupational Title Commercial and industrial designers............................ ..............  soc  Code  27-1021  Employment,  2006 48,000  Projected employment,  2016 51,000  Change,  2006-2016  Number  3,400  Percent  7  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  298 Occupational Outlook Handbook  that are easy and comfortable to use, and the development of high-technology products in consumer electronics, medicine, transportation, and other fields. But increasingly, manufactur­ ers have been outsourcing design work to design services firms to cut costs and to find the most qualified design talent, increas­ ing employment in these firms and reducing it in others, such as manufacturing. Additionally, some companies use design firms overseas, especially for the design of high-technology products. These overseas design firms are located closer to their suppliers, which reduces the time it takes to design and sell a product—an important consideration when technology is changing quickly. This offshoring of design work could continue to slow employ­ ment growth of U.S. commercial and industrial designers. Despite the increase in design work performed overseas, most design jobs, particularly jobs not related to high-technol­ ogy product design, will still remain in the U.S. Design is es­ sential to a firm’s success, and firms will want to retain control over the design process. Job prospects. Competition for jobs will be keen because many talented individuals are attracted to the design field. The best job opportunities will be in specialized design firms which are used by manufacturers to design products or parts of prod­ ucts. Designers with strong backgrounds in engineering and computer-aided design and extensive business expertise will have the best prospects. As the demand for design work becomes more consumerdriven, designers who can closely monitor, and react to, chang­ ing customer demands—and who can work with marking and strategic planning staffs to come up with new products—will also improve their job prospects. Employment of designers can be affected by fluctuations in the economy. For example, during periods of economic down­ turns, companies may cut research and development spending, including new product development.  Earnings Median annual wage-and-salary earnings for commercial and industrial designers were $54,560 in May 2006. The middle 50 percent earned between $41,270 and $72,610. The lowest 10 percent earned less than $31,510, and the highest 10 percent earned more than $92,970. Earnings information for the selfemployed are not available. Median annual earnings of salaried commercial and industrial designers in the largest industries that employed them in May 2006 were: Management of companies andenterprises......................... $64,700 Architectural, engineering, and relatedservices.................. 61,890 Engineering services............................................................. 60,440 Specialized design services................................................... 52,500  Related Occupations Workers in other art and design occupations include artists and related workers; fashion designers; floral designers; graphic de­ signers; and interior designers. Some other occupations that require computer-aided design skills are architects, except land­ scape and naval; computer software engineers; desktop publish­ ers; drafters; and engineers.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Sources of Additional Information For general career information on commercial and industrial design, contact: y Industrial Designers Society of America, 45195 Business Court, Suite 250, Dulles, VA 20166. Internet: http://www.idsa.org For general information about art and design and a list of ac­ credited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasad.arts-accredit.org  Fashion Designers (Q*NET 27-1022.00)  Significant Points •  Almost one-forth are self-employed.  •  In 2006, the highest concentrations of fashion design­ ers were employed in New York and California.  •  Employers usually seek designers with a 2- or 4-year degree who are knowledgeable about textiles fabrics, ornamentation, and fashion trends.  •  Slower-than-average job growth is projected, and competition for jobs is expected to be keen.  Nature of the Work Fashion designers help create the billions of dresses, suits, shoes, and other clothing and accessories purchased every year by consumers. Designers study fashion trends, sketch designs of clothing and accessories, select colors and fabrics, and over­ see the final production of their designs. Clothing designers create and help produce men’s, women’s, and children’s appar­ el, including casual wear, suits, sportswear, formalwear, outer­ wear, maternity, and intimate apparel. Footwear designers help create and produce different styles of shoes and boots. Acces­ sory designers help create and produce items such as handbags, belts, scarves, hats, hosiery, and eyewear, which add the finish­ ing touches to an outfit. (The work of jewelers and precious stone and metal workers is described elsewhere in the Hand­ book.) Some fashion designers specialize in clothing, footwear, or accessory design, but others create designs in all three fash­ ion categories. The design process from initial design concept to final pro­ duction takes between 18 and 24 months. The first step in cre­ ating a design is researching current fashion and making pre­ dictions of future trends. Some designers conduct their own research, while others rely on trend reports published by fash­ ion industry trade groups. Trend reports indicate what styles, colors, and fabrics will be popular for a particular season in the future. Textile manufacturers use these trend reports to begin designing fabrics and patterns while fashion designers begin to sketch preliminary designs. Designers then visit manufacturers or trade shows to procure samples of fabrics and decide which fabrics to use with which designs.  Professional and Related Occupations 299  Once designs and fabrics are chosen, a prototype of the article using cheaper materials is created and then tried on a model to see what adjustments to the design need to be made. This also helps designers to narrow their choices of designs to offer for sale. After the final adjustments and selections have been made, samples of the article using the actual materials are sewn and then marketed to clothing retailers. Many designs are shown at fashion and trade shows a few times a year. Retailers at the shows place orders for certain items, which are then manufac­ tured and distributed to stores. Computer-aided design (CAD) is increasingly being used in the fashion design industry. Although most designers initially sketch designs by hand, a growing number also translate these hand sketches to the computer. CAD allows designers to view designs of clothing on virtual models and in various colors and shapes, thus saving time by requiring fewer adjustments of pro­ totypes and samples later. Depending on the size of their design firm and their experi­ ence, fashion designers may have varying levels of involvement in different aspects of design and production. In large design firms, fashion designers often are the lead designers who are responsible for creating the designs, choosing the colors and fabrics, and overseeing technical designers who turn the de­ signs into a final product. They are responsible for creating the prototypes and patterns and work with the manufacturers and suppliers during the production stages. Large design houses also employ their own patternmakers, tailors, and sewers who create the master patterns for the design and sew the prototypes and samples. Designers working in small firms, or those new to the job, usually perform most of the technical, pattemmaking, and sewing tasks, in addition to designing the clothing. (The work of pattern makers, hand sewers, and tailors is covered in the statement on textile, apparel, and furnishings occupations elsewhere in the Handbook.) Fashion designers working for apparel wholesalers or manu­ facturers create designs for the mass market. These designs are manufactured in various sizes and colors. A small number of high-fashion (haute couture) designers are self-employed and create custom designs for individual clients, usually at very high prices. Other high-fashion designers sell their designs in their own retail stores or cater to specialty stores or high-fashion department stores. These designers create a mixture of original garments and those that follow established fashion trends. Some fashion designers specialize in costume design for per­ forming arts, motion picture, and television productions. The work of costume designers is similar to other fashion designers. Costume designers, however, perform extensive research on the styles worn during the period in which the performance takes place, or they work with directors to select and create appro­ priate attire. They make sketches of designs, select fabric and other materials, and oversee the production of the costumes. They also must stay within the costume budget for the particu­ lar production item. Work environment. Fashion designers employed by manu­ facturing establishments, wholesalers, or design firms gener­ ally work regular hours in well-lighted and comfortable set­ tings. Designers who freelance generally work on a contract, or by the job. They frequently adjust their workday to suit their   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  TO  Designers visit manufacturers or trade shows to procure sam­ ples offabrics. clients’ schedules and deadlines, meeting with the clients dur­ ing evenings or weekends when necessary. Freelance design­ ers tend to work longer hours and in smaller, more congested, environments, and are under pressure to please clients and to find new ones in order to maintain a steady income. Regardless of their work setting, all fashion designers occasionally work long hours to meet production deadlines or prepare for fashion shows. The global nature of the fashion business requires constant communication with suppliers, manufacturers, and customers all over the United States and the world. Most fashion design­ ers travel several times a year to trade and fashion shows to leam about the latest fashion trends. Designers also may travel frequently to meet with fabric and materials suppliers and with manufacturers who produce the final apparel products. Training, Other Qualifications, and Advancement In fashion design, employers usually seek individuals with a 2or 4-year degree who are knowledgeable about textiles, fabrics, ornamentation, and fashion trends. Education and training. Bachelor’s of fine arts and associ­ ate degree programs in fashion design are offered at many col­ leges, universities, and private art and design schools. Some fashion designers also combine a fashion design degree with a business, marketing, or fashion merchandising degree, espe­ cially those who want to run their own business or retail store. Basic coursework includes color, textiles, sewing and tailoring, pattern making, fashion history, computer-aided design (CAD), and design of different types of clothing such as menswear or footwear. Coursework in human anatomy, mathematics, and psychology also is useful. The National Association of Schools of Art and Design ac­ credits approximately 250 postsecondary institutions with pro­ grams in art and design. Most of these schools award degrees in fashion design. Many schools do not allow formal entry into a program until a student has successfully completed basic art and design courses. Applicants usually have to submit sketches and other examples of their artistic ability. Aspiring fashion designers can leam these necessary skills through internships with design or manufacturing firms. Some designers also gain valuable experience working in retail stores,  300 Occupational Outlook Handbook  as personal stylists, or as custom tailors. Such experience can help designers gain sales and marketing skills while learning what styles and fabrics look good on different people. Designers also can gain exposure to potential employers by entering their designs in student or amateur contests. Because of the global nature of the fashion industry, experience in one of the international fashion centers, such as Milan or Paris, can be useful. Other qualifications. Designers must have a strong sense of the esthetic—an eye for color and detail, a sense of balance and proportion, and an appreciation for beauty. Fashion designers also need excellent communication and problem-solving skills. Despite the advancement of computer-aided design, sketching ability remains an important advantage in fashion design. A good portfolio—a collection of a person’s best work—often is the deciding factor in getting a job. In addition to creativity, fashion designers also need to have sewing and patternmaking skills, even if they do not perform these tasks themselves. Designers need to be able to under­ stand these skills so they can give proper instruction in how the garment should be constructed. Fashion designers also need strong sales and presentation skills to persuade clients to pur­ chase their designs. Good teamwork and communication skills also are necessary because increasingly the business requires constant contact with suppliers, manufacturers, and buyers around the world. Advancement. Beginning fashion designers usually start out as pattern makers or sketching assistants for more experienced designers before advancing to higher level positions. Experi­ enced designers may advance to chief designer, design depart­ ment head, or another supervisory position. Some designers may start their own design company, or sell their designs in their own retail stores. A few of the most successful designers can work for high-fashion design houses that offer personalized design services to wealthy clients.  Employment change. Employment of fashion designers is projected to grow 5 percent between 2006 and 2016, more slowly than the average for all occupations. Job growth will stem from a growing population demanding more clothing, footwear, and accessories. Demand is increasing for stylish clothing that is affordable, especially among middle income consumers. However, employment declines in cut and sew ap­ parel manufacturing are projected to offset job increases among apparel wholesalers. Job opportunities in cut and sew manufacturing will continue to decline as apparel is increasingly manufactured overseas. However, employment of fashion designers in this industry will not decline as fast as other occupations because firms are more likely to keep design work in-house. Job prospects. Job competition is expected be keen as many designers are attracted to the creativity and glamour associated with the occupation. Relatively few job openings arise because of low job turnover and the small number of new openings cre­ ated every year. The best job opportunities will be in design firms that design mass market clothing sold in department stores and retail chain stores, such as apparel wholesale firms. Few employment op­ portunities are expected in design firms that cater to high-end department stores and specialty boutiques as demand for expen­ sive, high-fashion design declines relative to other luxury goods and services.  Earnings Median annual earnings for salaried fashion designers were $62,610 in May 2006. The middle 50 percent earned between $42,140 and $87,510. The lowest 10 percent earned less than $30,000, and the highest 10 percent earned more than $ 117,120. Median annual earnings of salaried fashion designers in the largest industries that employed them in May 2006 were:  Employment Fashion designers held about 20,000 jobs in 2006. About 28 percent of fashion designers worked for apparel, piece goods, and notions merchant wholesalers; and the remainder worked for corporate offices involved in the management of companies and enterprises, clothing stores, performing arts companies, and specialized design services firms. Another 24 percent were self-employed. Employment of fashion designers tends to be concentrated in regional fashion centers. In 2006, the highest concentrations of fashion designers were employed in New York and California. Job Outlook Slower-than-average job growth is projected. Competition for jobs is expected to be keen as many designers are attracted to the creativity and glamour associated with the occupation.  Management of companies and enterprises........................$70,570 Cut and sew apparel manufacturing...................................... 69,810 Apparel, piece goods, and notions merchant wholesalers............................................. 62,910 Earnings in fashion design can vary widely based on the em­ ployer and years of experience. Starting salaries in fashion de­ sign tend to be very low until designers are established in the industry. Salaried fashion designers usually earn higher and more stable incomes than self-employed or freelance designers. However, a few of the most successful self-employed fashion designers may earn many times the salary of the highest paid salaried designers. Self-employed fashion designers must pro­ vide their own benefits and retirement.  Projections data from the National Employment Matrix Occupational Title Fashion designers..................................................................................  SOC Code 27-1022  Employment, 2006 20,000  Projected employment, 2016 21,000  Change, 2006-2016 Number Percent 1,000  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 301  Related Occupations Workers in other art and design occupations include artists and related workers, commercial and industrial designers, floral designers, graphic designers, and interior designers. Jewelers and precious stone and metal workers also design wearable ac­ cessories. Other common occupations in the fashion industry include demonstrators, product promoters, and models; photog­ raphers; purchasing managers, buyers, and purchasing agents; retail salespersons; and textile, apparel, and furnishings occu­ pations.  Sources of Additional Information For general information about art and design and a list of ac­ credited college-level programs, contact: V National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasad.arts-accredit.org For general information about careers in fashion design, con­ tact: y Fashion Group International, 8 West 40th St., 7th Floor, New York, NY 10018. Internet: http://www.fgi.org  Floral Designers  rations. Floral designers also will prearrange a few displays to have available for walk-in customers or last-minute orders. Some floral designers also assist interior designers in creating live or silk displays for hotels, restaurants, and private resi­ dences. A number of floral designers, also known as florists, work in the floral departments of grocery stores or for Internet florists, which specialize in creating prearranged floral decorations and bouquets. These floral retailers also may fill small custom or­ ders for special occasions and funerals, but some grocery store florists do not deliver to clients or handle large custom orders. Florists who work for wholesale flower distributors assist in the selection of different types of flowers and greenery to pur­ chase and sell to retail florists. Wholesale floral designers also select flowers for displays that they use as examples for retail florists. Self-employed floral designers must handle the various as­ pects of running their own businesses, such as selecting and purchasing flowers, hiring and supervising staff, and maintain­ ing financial records. Self-employed designers also may run gift shops or wedding consultation businesses in addition to providing floral design services. Some conduct design work-  (0*NET 27-1023.00)  Significant Points •  Despite the projected decline in employment, job op­ portunities should be good because of relatively high replacement needs.  •  Floral design is the only design specialty that does not require formal postsecondary training.  •  Many floral designers work long hours on weekends and holidays, filling orders and setting up decorations for weddings and other events.  •  About one-third are self-employed.  r.Hj  *  $  J  i*  Nature of the Work Floral designers, or florists, cut live, dried, or silk flowers and other greenery and arrange them into displays of various sizes and shapes. These workers design these displays by selecting flowers, containers, and ribbons and arranging them into bou­ quets, corsages, centerpieces of tables, wreaths, and the like for weddings, funerals, holidays, and other special occasions. Some floral designers also use accessories such as balloons, candles, toys, candy, and gift baskets as part of their displays. Job duties often vary by employment setting. Most floral designers work in small independent floral shops that special­ ize in custom orders and also handle large orders for weddings, caterers, or interior designers. Floral designers may meet with customers to discuss the arrangement or work from a written order. They note the occasion, the customer’s preferences, the price of the order, the time the floral display or plant is to be ready, and the place to which it is to be delivered. For special occasions, floral designers usually will help set up floral deco­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  h‘i urn  T‘  ■  v.  Floral designers cut live, dried, or silk flowers and other greenery and arrange them into displays of various sizes and shapes.  302 Occupational Outlook Handbook  shops for amateur gardeners or others with an interest in floral design. Work environment. Most floral designers work in comfort­ able and well-lit spaces in retail outlets or at home, although working outdoors sometimes is required. Designers also may frequently make short trips delivering flowers, setting up ar­ rangements for special events, and procuring flowers and other supplies. Floral designers have frequent contact with customers and must work to satisfy their demands, including last-minute holi­ day and funeral orders. Because many flowers are perishable, most orders cannot be completed too far in advance. Conse­ quently, some designers work long hours before and during holidays. Some also work nights and weekends to complete large orders for weddings and other special events. Floral designers may suffer muscle strain from long peri­ ods of standing and from repeated finger and arm movements required to make floral arrangements. They are susceptible to back strain from lifting and carrying heavy flower arrange­ ments. Designers also may suffer allergic reactions to cer­ tain types of pollen when working with flowers. In addition, they frequently use sharp objects—scissors, knives, and metal wire—that can cause injuries if handled improperly.  Certification and other qualifications. The American In­ stitute of Floral Designers offers an accreditation examination as an indication of professional achievement in floral design. The exam consists of a written part covering floral terminology and an onsite floral-arranging part in which candidates have 4 hours to complete five floral designs: funeral tributes, table arrangements, wedding arrangements, wearable flowers, and a category of the candidate’s choosing. Floral designers must be creative, service oriented, and able to communicate their ideas visually and verbally. Because trends in floral design change quickly, designers must be open to new ideas and react quickly to changing trends. Problem­ solving skills and the ability to work independently and under pressure also are important traits. Individuals in this field need self-discipline to budget their time and meet deadlines. Advancement. Many florists gain their initial experience working as cashiers or delivery people in retail floral stores. The completion of formal design training, however, is an asset for floral designers, particularly those interested in advancing to chief floral designer or in opening their own businesses. Advancement in the floral field is limited. After a few years of on-the-job training, designers can either advance to a super­ visory position or open their own floral shop.  Training, Other Qualifications, and Advancement  Employment  Floral design is the only design occupation that does not require formal postsecondary training; most floral designers learn their skills on the job. Employers generally look for high school graduates who have creativity, a flair for arranging flowers, and a desire to learn. Education and training. Floral design is the only design oc­ cupation that does not require formal postsecondary training; most floral designers learn their skills on the job. Private floral schools, vocational schools, and community colleges award certificates in floral design. These programs generally require a high school diploma for admission and last from several weeks to 1 year. Floral design courses teach the basics of arranging flowers, including the different types of flowers, their color and texture, cutting and taping techniques, tying bows and ribbons, proper handling and care of flowers, floral trends, and pricing. Some floral designers also may earn an associate or bach­ elor’s degree at a community college or university. Some programs offer formal degrees in floral design, while others offer degrees in floriculture, horticulture, or ornamental hor­ ticulture. In addition to floral design courses, these programs teach courses in botany, chemistry, hydrology, microbiology, pesticides, and soil management. Since many floral designers manage their own business, ad­ ditional courses in business, accounting, marketing, and com-  Floral designers held about 87,000 jobs in 2006. Approxi­ mately 33 percent were self-employed. About 45 percent of all floral designers worked in florist shops. Another 10 per­ cent worked in the floral departments of grocery stores. Others were employed by miscellaneous nondurable goods merchant wholesalers, other general merchandise stores, and in lawn and garden equipment and supply stores.  puter technology can be helpful.  Job Outlook Despite the projected decline in employment, job opportunities are expected to be good because of the need to replace workers who leave the occupation. Employment change. Employment of floral designers is expected to decline moderately, 9 percent, between 2006 and 2016. The demand for floral decorations will continue to grow as flower sales increase with the population and the lavishness of weddings and other special events that require floral dec­ orations. As disposable incomes rise, more people also will demand fresh flowers in their homes and offices. Increased spending on interior design also is expected to create more de­ mand for stylish artificial arrangements for homes and busi­ nesses. Despite growing demand for floral decorations, few job op­ portunities are expected in floral wholesalers, primarily because an increasing number of shops are purchasing flowers  Projections data from the National Employment Matrix Occupational Title  soc  Code  Employment,  Projected employment,  Change,  2006-2016  2006 Number Percent 2016 Floral designers...................................................................................... 27-1023 87,000 79,000 -7,700 -9 NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 303  and supplies directly from growers in order to cut costs. In addition, the growth of electronic commerce in the floral in­ dustry will make it easier for retail florists to locate their own suppliers. Discretionary spending on flowers and floral prod­ ucts is highly sensitive to the state of the economy, and during economic downturns employment may fall off as floral expen­ ditures decline. Job prospects. Job opportunities should be good because of the relatively high replacement needs in retail florists. Many people leave the occupation after a time because of its com­ paratively low starting pay and limited opportunities for ad­ vancement. Opportunities should be good in grocery store and Internet floral shops as sales of floral arrangements from these outlets grow. The prearranged displays and gifts available in these stores appeal to consumers because of the convenience and because of prices that are lower than can be found in inde­ pendent floral shops. As mass marketers capture more of the small flower orders, independent floral shops are increasingly finding themselves under pressure to remain profitable. Many independent shops have added online ordering systems in order to compete with Internet florists. Others are trying to distinguish their services by specializing in certain areas of floral design or by combin­ ing floral design with event planning and interior design ser­ vices. Some florists also are adding holiday decorating ser­ vices in which they will set up decorations for businesses and residences.  Earnings Median annual earnings for wage and salary floral designers were $21,700 in May 2006. The middle 50 percent earned between $17,690 and $27,330. The lowest 10 percent earned less than $15,040, and the highest 10 percent earned more than $33,650. Median annual earnings were $23,990 in grocery stores and $21,210 in florists.  Related Occupations Other art and design occupations include artists and related workers, commercial and industrial designers, fashion design­ ers, graphic designers, and interior designers. Landscape ar­ chitects also create designs involving plants and flowers. Other occupations involved directly with plants and flowers include soil and plant scientists; and farm workers and laborers, crop, nursery, and greenhouse.  Sources of Additional Information For information about careers in floral design, contact: y American Institute of Floral Designers, 720 Light St., Baltimore, MD 21230. Internet: http://www.aifd.org y Society of American Florists, 1601 Duke St., Alexandria, VA 22314. Internet: http://www.safnow.org To learn more about designing flowers for weddings and fu­ nerals, see “Jobs in weddings and funerals: Working with the betrothed and the bereaved,” in the winter 2006 Occupational Outlook Quarterly and online at: http://www.bls.gov/opub/ooq/2006/winter/art03.pdf  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Graphic Designers (0*NET 27-1024.00) Significant Points  •  About 25 percent are self-employed; many do free­ lance work in addition to holding a salaried job in de­ sign or in another occupation.  •  A bachelor’s degree is required for most entry-level positions; however, an associate degree may be suf­ ficient for some technical positions.  •  Job seekers are expected to face keen competition; individuals with a bachelor’s degree and knowledge of computer design software, particularly those with Web site design and animation experience will have the best opportunities.  Nature of the Work Graphic designers—or graphic artists—plan, analyze, and cre­ ate visual solutions to communications problems. They find the most effective way to get messages across in print, elec­ tronic, and film media using a variety of methods such as color, type, illustration, photography, animation, and various print and layout techniques. Graphic designers develop the overall lay­ out and production design of magazines, newspapers, journals, corporate reports, and other publications. They also produce promotional displays, packaging, and marketing brochures for products and services, design distinctive logos for products and businesses, and develop signs and signage systems—called en­ vironmental graphics—for business and government. An in­ creasing number of graphic designers also develop material for Internet Web pages, interactive media, and multimedia projects. Graphic designers also may produce the credits that appear be­ fore and after television programs and movies. The first step in developing a new design is to determine the needs of the client, the message the design should portray, and its appeal to customers or users. Graphic designers consider cognitive, cultural, physical, and social factors in planning and executing designs for the target audience. Designers gather relevant information by meeting with clients, creative or art directors, and by performing their own research. Identifying the needs of consumers is becoming increasingly important for graphic designers as they continue to develop corporate com­ munication strategies in addition to creating designs and lay­ outs. Graphic designers prepare sketches or layouts—by hand or with the aid of a computer—to illustrate their vision for the design. They select colors, sound, artwork, photography, ani­ mation, style of type, and other visual elements for the design. Designers also select the size and arrangement of the different elements on the page or screen. They may create graphs and charts from data for use in publications, and they often con­ sult with copywriters on any text that accompanies the design. Designers then present the completed design to their clients or  304 Occupational Outlook Handbook  y'..  i;  Graphic designers use specialized software packages to create layouts and graphics. art or creative director for approval. In printing and publishing firms, graphic designers also may assist the printers by select­ ing the type of paper and ink for the publication and reviewing the mock-up design for errors before final publication. Graphic designers use specialized computer software pack­ ages to help them create layouts and design elements and to program animated graphics. Graphic designers sometimes supervise assistants who follow instructions to complete parts of the design process. Designers who run their own businesses also may devote a considerable time to developing new business contacts, choosing equipment, and performing administrative tasks, such as reviewing cata­ logues and ordering samples. The need for up-to-date computer and communications equipment is an ongoing consideration for graphic designers. Work environment. Working conditions and places of em­ ployment vary. Graphic designers employed by large advertis­ ing, publishing, or design firms generally work regular hours in well-lighted and comfortable settings. Designers in smaller design consulting firms and those who freelance generally work on a contract, or job, basis. They frequently adjust their work­ day to suit their clients’ schedules and deadlines. Consultants and self-employed designers tend to work longer hours and in smaller, more congested, environments. Designers may work in their own offices or studios or in cli­ ents’ offices. Designers who are paid by the assignment are under pressure to please existing clients and to find new ones to maintain a steady income. All designers sometimes face frus­ tration when their designs are rejected or when their work is not as creative as they wish. Graphic designers may work evenings or weekends to meet production schedules, especially in the printing and publishing industries where deadlines are shorter and more frequent.  Training, Other Qualifications, and Advancement A bachelor’s or an associate degree in graphic design is usually required for a job as a graphic designer. Creativity, communica­ tion, and problem solving skills and familiarity with computer graphics and design software also are important. Education and training. A bachelor’s degree is required for entry-level and advanced graphic design positions; al­ Digitized formost FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  though some entry-level technical positions may only require an associate degree. Bachelor’s degree programs in fine arts or graphic design are offered at many colleges, universities, and private design schools. Most curriculums include studio art, principles of design, computerized design, commercial graph­ ics production, printing techniques, and Web site design. In addition to design courses, a liberal arts education that includes courses in art history, writing, psychology, sociology, foreign languages and cultural studies, marketing, and business are use­ ful in helping designers work effectively. Associate degrees and certificates in graphic design also are available from 2-year and 3-year professional schools. These programs usually focus on the technical aspects of graphic de­ sign and include few liberal arts courses. Graduates of 2-year programs normally qualify as assistants to graphic designers or for positions requiring technical skills only. Individuals who wish to pursue a career in graphic design—and who already possess a bachelor’s degree in another field—can complete a 2year or 3-year program in graphic design to learn the technical requirements. The National Association of Schools of Art and Design ac­ credits about 250 postsecondary institutions with programs in art and design. Most of these schools award a degree in graphic design. Many schools do not allow formal entry into a bach­ elor’s degree program until a student has successfully finished a year of basic art and design courses. Applicants may be re­ quired to submit sketches and other examples of their artistic ability. Increasingly, employers expect new graphic designers to be familiar with computer graphics and design software. Graphic designers must keep up with new and updated software, on their own or through software training programs. Other qualifications. In addition to postsecondary training in graphic design, creativity, communication, and problem­ solving skills are crucial. Graphic designers must be creative and able to communicate their ideas visually, verbally, and in writing. They also must have an eye for details. Designers show employers these traits by putting together a portfolio—a collection of examples of a person’s best work. A good portfo­ lio often is the deciding factor in getting a job. Because consumer tastes can change quickly, designers also need to be well read, open to new ideas and influences, and quick to react to changing trends. The ability to work indepen­ dently and under pressure are equally important traits. People in this field need self-discipline to start projects on their own, to budget their time, and to meet deadlines and production sched­ ules. Good business sense and sales ability also are important, especially for those who freelance or run their own firms. Advancement. Beginning graphic designers usually receive on-the-job training and normally need 1 to 3 years of train­ ing before they can advance to higher positions. Experienced graphic designers in large firms may advance to chief designer, art or creative director, or other supervisory positions. Some designers leave the occupation to become teachers in design schools or in colleges and universities. Many faculty members continue to consult privately or operate small design studios to complement their classroom activities. Some experienced  Professional and Related Occupations 305  designers open their own firms or choose to specialize in one area of graphic design.  Employment Graphic designers held about 261,000 jobs in 2006. Most graphic designers worked in specialized design services; adver­ tising and related services; printing and related support activi­ ties; or newspaper, periodical, book, and directory publishers. Other designers produced computer graphics for computer sys­ tems design firms or motion picture production firms. A small number of designers also worked in engineering services or for management, scientific, and technical consulting firms. About 25 percent of designers were self-employed. Many did freelance work—full time or part time—in addition to hold­ ing a salaried job in design or in another occupation.  Job Outlook Employment of graphic designers is expected grow about as fast as average. Keen competition for jobs is expected; individuals with a bachelor’s degree and knowledge of computer design software, particularly those with Web site design and animation experience will have the best opportunities. Employment change. Employment of graphic designers is expected to grow 10 percent, about as fast as the average for all occupations from 2006 to 2016, as demand for graphic design continues to increase from advertisers, publishers, and comput­ er design firms. Some of this increase is expected to stem from the expansion of the video entertainment market, including tele­ vision, movies, video, and made-for-Intemet outlets. Moreover, graphic designers with Web site design and ani­ mation experience will especially be needed as demand in­ creases for design projects for interactive media—Web sites, video games, cellular telephones, personal digital assistants, and other technology. Demand for graphic designers also will increase as advertising firms create print and Web marketing and promotional materials for a growing number of products and services. In recent years, some computer, printing, and publishing firms have outsourced basic layout and design work to design firms overseas. This trend is expected to continue and may have a negative impact on employment growth for low-level, techni­ cal graphic design workers. However, most high-level graphic design jobs will remain in the U.S. Strategic design, the work of developing communication strategies for clients and firms to help them to gain competitive advantages in the market, re­ quires close proximity to the consumer in order to identify and target their needs and interests. Job prospects. Graphic designers are expected to face keen competition for available positions. Many talented individuals are attracted to careers as graphic designers. Individuals with a bachelor’s degree and knowledge of computer design software,  particularly those with Web site design and animation experi­ ence will have the best opportunities. Graphic designers with a broad liberal arts education and ex­ perience in marketing and business management will be best suited for positions developing communication strategies.  Earnings Median annual earnings for wage and salary graphic design­ ers were $39,900 in May 2006. The middle 50 percent earned between $30,600 and $53,310. The lowest 10 percent earned less than $24,120, and the highest 10 percent earned more than $69,730. May 2006 median annual earnings in the industries employing the largest numbers of graphic designers were: Specialized design services.................................................$43,410 Advertising and related services.......................................... 41,600 Newspaper, periodical, book, and directory publishers.......34,290 Printing and related support activities..................................33,930 Newspaper publishers...........................................................31,540 According to the American Institute of Graphic Arts, median annual total cash compensation for entry-level designers was $35,000 in 2007. Staff-level graphic designers earned a median of $45,000. Senior designers, who may supervise junior staff or have some decision-making authority that reflects their knowl­ edge of graphic design, earned a median of $62,000. Solo de­ signers who freelanced or worked under contract to another company reported median earnings of $60,000. Design direc­ tors, the creative heads of design firms or in-house corporate design departments, earned $98,600. Graphic designers with ownership or partnership interests in a firm or who were princi­ pals of the firm in some other capacity earned $113,000.  Related Occupations Workers in other occupations in the art and design field include artists and related workers; commercial and industrial design­ ers; fashion designers; floral designers; and interior designers. Other occupations that require computer-aided design skills include computer software engineers, drafters, and desktop publishers. Other occupations involved in the design, layout, and copy of publications include advertising, marketing, pro­ motions, public relations, and sales managers; photographers; writers and editors; and prepress technicians and workers.  Sources of Additional Information For general information about art and design and a list of ac­ credited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190-5248. Internet: http://nasad.arts-accredit.org  Projections data from the National Employment Matrix Projected Change, employment, 2006-2016 Code 2016 Number Percent Graphic designers..................................................... ............................. 27-1024 261,000 286,000 26,000 10 NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2006  306 Occupational Outlook Handbook  For information about graphic, communication, or interac­ tion design careers, contact: y American Institute of Graphic Arts, 164 Fifth Ave., New York, NY 10010. Internet: http://www.aiga.org For information on workshops, scholarships, internships, and competitions for graphic design students interested in advertis­ ing careers, contact: > Art Directors Club, 106 West 29th St., New York, NY 10001. Internet: http://www.adcglobaI.org  Interior Designers (0*NET 27-1025.00) Significant Points •  Keen competition is expected for jobs because many talented individuals are attracted to this occupation.  •  About 26 percent are self-employed.  •  Postsecondary education—especially a bachelor’s degree—is recommended for entry-level positions; some States license interior designers.  Nature of the Work Interior designers draw upon many disciplines to enhance the function, safety, and aesthetics of interior spaces. Their main concerns are with how different colors, textures, furniture, light­ ing, and space work together to meet the needs of a building’s occupants. Designers plan interior spaces of almost every type of building, including offices, airport terminals, theaters, shop­ ping malls, restaurants, hotels, schools, hospitals, and private residences. Good design can boost office productivity, increase sales, attract a more affluent clientele, provide a more relaxing hospital stay, or increase a building’s market value. Traditionally, most interior designers focused on decorat­ ing—choosing a style and color palette and then selecting ap­ propriate furniture, floor and window coverings, artwork, and lighting. However, an increasing number of designers are be­ coming involved in architectural detailing, such as crown mold­ ing and built-in bookshelves, and in planning layouts of build­ ings undergoing renovation, including helping to determine the location of windows, stairways, escalators, and walkways. Interior designers must be able to read blueprints, understand building and fire codes, and know how to make space accessible to people who are disabled. Designers frequently collaborate with architects, electricians, and building contractors to ensure that designs are safe and meet construction requirements. Whatever space they are working on, almost all designers fol­ low the same process. The first step, known as programming, is to determine the client’s needs and wishes. The designer usually meets face-to-face with the client to find out how the space will be used and to get an idea of the client’s preferences and budget. For example, the designer might inquire about a family’s cooking habits if the family is remodeling a kitchen or ask about a store or restaurant’s target customer in order to pick an appropriate motif. The designer also will visit the space to   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  take inventory of existing furniture and equipment and identify positive attributes of the space and potential problems. Then, the designer formulates a design plan and estimates costs. Today, designs often are created with the use of comput­ er-aided design (CAD), which provides more detail and easier corrections than sketches made by hand. Once the designer completes the proposed design, he or she will present it to the client and make revisions based on the client’s input. When the design concept is decided upon, the designer will begin specifying the materials, finishes, and furnishings re­ quired, such as furniture, lighting, flooring, wall covering, and artwork. Depending on the complexity of the project, the de­ signer also might submit drawings for approval by a construc­ tion inspector to ensure that the design meets building codes. If a project requires structural work, the designer works with an architect or engineer for that part of the project. Most designs also require the hiring of contractors to do technical work, such as lighting, plumbing, or electrical wiring. Often designers choose contractors and write work contracts. Finally, the designer develops a timeline for the project, co­ ordinates contractor work schedules, and makes sure work is completed on time. The designer oversees the installation of the design elements, and after the project is complete, the designer, together with the client, pay follow-up visits to the building site to ensure that the client is satisfied. If the client is not satisfied, the designer makes corrections. Designers who work for furniture or home and garden stores sell merchandise in addition to offering design services. In­ store designers provide services, such as selecting a style and color scheme that fits the client’s needs or finding suitable ac­ cessories and lighting, similar to those offered by other inte­ rior designers. However, in-store designers rarely visit clients’ spaces and use only a particular store’s products or catalogs. Interior designers sometimes supervise assistants who carry out their plans and perform administrative tasks, such as review­ ing catalogues and ordering samples. Designers who run their own businesses also may devote considerable time to develop­ ing new business contacts, examining equipment and space needs, and attending to business matters. Although most interior designers do many kinds of projects, some specialize in one area of interior design. Some special­ ize in the type of building space—usually residential or com­ mercial—while others specialize in a certain design element or type of client, such as health care facilities. The most common specialties of this kind are lighting, kitchen and bath, and closet designs. However, designers can specialize in almost any area of design, including acoustics and noise abatement, security, electronics and home theaters, home spas, and indoor gardens. Three areas of design that are becoming increasingly popu­ lar are ergonomic design, elder design, and environmental—or green—design. Ergonomic design involves designing work spaces and furniture that emphasize good posture and minimize muscle strain on the body. Elder design involves planning inte­ rior space to aid in the movement of people who are elderly and disabled. Green design involves selecting furniture and carpets that are free of chemicals and hypoallergenic and selecting con­ struction materials that are energy efficient or are made from renewable resources  Professional and Related Occupations 307  Work environment. Working conditions and places of em­ ployment vary. Interior designers employed by large corpo­ rations or design firms generally work regular hours in welllighted and comfortable settings. Designers in smaller design consulting firms or those who freelance generally work on a contract, or job, basis. They frequently adjust their workday to suit their clients’ schedules and deadlines, meeting with clients during evening or weekend hours when necessary. Consultants and self-employed designers tend to work longer hours and in smaller, more congested environments. Interior designers may work under stress to meet deadlines, stay on budget, and please clients. Self-employed designers also are under pressure to find new clients to maintain a steady income. Designers may work in their own offices or studios or in cli­ ents’ homes or offices. They also may travel to other locations, such as showrooms, design centers, clients’ exhibit sites, and manufacturing facilities. With the increased speed and sophis­ tication of computers and advanced communications networks, designers may form international design teams, serve a more geographically dispersed clientele, research design alternatives by using information on the Internet, and purchase supplies electronically.  -'jr  Wm.  Interior designers often review a large number of samples in to choose an appropriate design for interior spaces. Digitized fororder FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Training, Other Qualifications, and Advancement Postsecondary education, especially a bachelor’s degree, is rec­ ommended for entry-level positions in interior design. Twoyear and 3-year programs also are available. Some States li­ cense interior designers. Education and training. Postsecondary education, espe­ cially a bachelor’s degree, is recommended for entry-level posi­ tions in interior design. Training programs are available from professional design schools or from colleges and universities and usually take 2 to 4 years to complete. Graduates of 2-year or 3-year programs are awarded certificates or associate degrees in interior design and normally qualify as assistants to interior designers upon graduation. Graduates with a bachelor’s degree usually qualify for a formal design apprenticeship program. The National Association of Schools of Art and Design ac­ credits approximately 250 postsecondary institutions with pro­ grams in art and design. Most of these schools award a degree in interior design. Applicants may be required to submit sketches and other examples of their artistic ability. Basic coursework includes computer-aided design (CAD), drawing, perspective, spatial planning, color and fabrics, furniture design, architec­ ture, ergonomics, ethics, and psychology. The National Council for Interior Design Accreditation also accredits interior design programs that lead to a bachelor’s de­ gree. In 2007, there were 145 accredited bachelor’s degree pro­ grams in interior design in the United States; most are part of schools or departments of art, architecture, and home econom­ ics. After the completion of formal training, interior designers will enter a 1-year to 3-year apprenticeship to gain experience before taking a licensing exam. Most apprentices work in de­ sign or architecture firms under the supervision of an experi­ enced designer. Apprentices also may choose to gain experi­ ence working as an in-store designer in furniture stores. The National Council of Interior Design offers the Interior Design Experience Program, which helps entry-level interior designers gain valuable work experience by supervising work experience and offering mentoring services and workshops to new design­ ers. Licensure. Twenty-three States, the District of Columbia, and Puerto Rico register or license interior designers. The Na­ tional Council administers the licensing exam for Interior De­ sign Qualification. To be eligible to take the exam, applicants must have at least 6 years of combined education and experi­ ence in interior design, of which at least 2 years must be post­ secondary education in design. Once candidates have passed the qualifying exam, they are granted the title of Certified, Registered, or Licensed Interior Designer, depending on the State. Continuing education is re­ quired to maintain licensure. Other qualifications. Membership in a professional asso­ ciation is one indication of an interior designer’s qualifications and professional standing. The American Society of Interior Designers is the largest professional association for interior de­ signers in the United States. Interior designers can qualify for membership with at least a 2-year degree and work experience. Employers increasingly prefer interior designers who are fa­ miliar with computer-aided design software and the basics of  308 Occupational Outlook Handbook  architecture and engineering to ensure that their designs meet building safety codes. In addition to possessing technical knowledge, interior de­ signers must be creative, imaginative, and persistent and must be able to communicate their ideas visually, verbally, and in writing. Because tastes in style can change quickly, designers need to be well read, open to new ideas and influences, and quick to react to changing trends. Problem-solving skills and the ability to work independently and under pressure are addi­ tional important traits. People in this field need self-discipline to start projects on their own, to budget their time, and to meet deadlines and production schedules. Good business sense and sales ability also are important, especially for those who free­ lance or run their own business. Certification and advancement. Optional certifications in kitchen and bath design are available from the National Kitchen and Bath Association. The association offers three different lev­ els of certification for kitchen and bath designers, each achieved through training seminars and certification exams. Beginning interior designers receive on-the-job training and normally need 1 to 3 years of training before they can advance to higher level positions. Experienced designers in large firms may advance to chief designer, design department head, or some other supervisory position. Some experienced designers open their own firms or decide to specialize in one aspect of interior design. Other designers leave the occupation to become teach­ ers in schools of design or in colleges and universities. Many faculty members continue to consult privately or operate small design studios to complement their classroom activities.  Employment Interior designers held about 72,000 jobs in 2006. Approxi­ mately 26 percent were self-employed. About 26 percent of interior designers worked in specialized design services. The rest of the interior designers provided design services in ar­ chitectural and landscape architectural services, furniture and home-furnishing stores, building material and supplies dealers, and residential building construction companies. Many interior designers also performed freelance work in addition to holding a salaried job in interior design or another occupation.  Job Outlook Employment of interior designers is expected to be faster than average; however, keen competition for jobs is expected. Employment change. Employment of interior designers is expected to grow 19 percent from 2006 to 2016, faster than the average for all occupations. Economic expansion, growing ho­ meowner wealth, and an increasing interest in interior design will increase demand for designers. Recent increases in homeowner wealth and the growing popu­ larity of home improvement television programs have increased  demand for residential design services. Homeowners have been using the equity in their homes to finance new additions, remodel aging kitchens and bathrooms, and update the general decor of the home. Many homeowners also have requested de­ sign help in creating year-round outdoor living spaces. However, this same growth in home improvement television programs and discount furniture stores has spurred a trend in do-it-yourself design, which could hamper employment growth of designers. Nevertheless, some clients will still hire designers for initial consultations. Demand from businesses in the hospitality industry—hotels, resorts, and restaurants—is expected to be high because of an expected increase in tourism. Demand for interior design ser­ vices from the health care industry also is expected to be high because of an anticipated increase in demand for facilities that will accommodate the aging population. Designers will be needed to make these facilities as comfortable and homelike as possible for patients. Some interior designers choose to specialize in one design element to create a niche for themselves in an increasingly competitive market. The demand for kitchen and bath design is growing in response to the growing demand for home remodel­ ing. Designs using the latest technology in, for example, home theaters, state-of-the-art conference facilities, and security sys­ tems are expected to be especially popular. In addition, demand for home spas, indoor gardens, and outdoor living space should continue to increase. Extensive knowledge of ergonomics and green design are expected to be in demand. Ergonomic design has gained in popularity with the growth in the elderly population and work­ place safety requirements. The public’s growing awareness of environmental quality and the growing number of individuals with allergies and asthma are expected to increase the demand for green design. Job prospects. Interior designers are expected to face keen competition for available positions because many talented indi­ viduals are attracted to this profession. Individuals with little or no formal training in interior design, as well as those lacking creativity and perseverance, will find it very difficult to estab­ lish and maintain a career in this occupation. As the economy grows, more private businesses and consum­ ers will request the services of interior designers. However, design services are considered a luxury expense and may be subject to fluctuations in the economy. For example, decreases in consumer and business income and spending caused by a slow economy can have a detrimental effect on employment of interior designers.  Earnings Median annual earnings for wage and salary interior design­ ers were $42,260 in May 2006. The middle 50 percent earned  Projections data from the National Employment Matrix Occupational Title Interior designers.................................................... .............................  soc  Code 27-1025  Employment, 2006 72,000  Projected employment, 2016 86,000  Change, 2006-2016 Number Percent 14,000 19  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 309  between $31,830 and $57,230. The lowest 10 percent earned less than $24,270, and the highest 10 percent earned more than $78,760. Median annual earnings in the industries employing the largest numbers of interior designers in May 2006 were: Architectural, engineering, and related services.................$46,750 Architectural services............................................................ 46,750 Specialized design services................................................... 43,250 Furniture stores..................................................................... 38,980 Building material and supplies dealers.................................36,650 Interior design salaries vary widely with the specialty, type of employer, number of years of experience, and reputation of the individuals. Among salaried interior designers, those in large specialized design and architectural firms tend to earn higher and more stable salaries. Interior designers working in retail stores usually earn a commission, which can be irregular. For residential design projects, self-employed interior design­ ers and those working in smaller firms usually earn a per-hour consulting fee, plus a percentage of the total cost of furniture, lighting, artwork, and other design elements. For commercial projects, they might charge a per-hour consulting fee, charge by the square footage, or charge a flat fee for the whole project. Also, designers who use specialty contractors usually earn a percentage of the contractor’s earnings on the project in return for hiring the contractor. Self-employed designers must pro­ vide their own benefits.  Related Occupations Workers in other occupations who design or arrange objects to enhance their appearance and function include architects, ex­ cept landscape and naval; artists and related workers; commer­  cial and industrial designers; fashion designers; floral design­ ers; graphic designers; and landscape architects.  Sources of Additional Information For information on degrees, continuing education, and licen­ sure programs in interior design and interior design research, contact; y American Society of Interior Designers, 608 Massachusetts Ave. NE„ Washington, DC 20002. Internet: http://www.asid.org For a list of schools with accredited bachelor’s degree pro­ grams in interior design, contact: y Foundation for Interior Design Education Research, 146 Monroe Center NW, Suite 1318, Grand Rapids, MI 49503. Internet: http://www.fider.org For general information about art and design and a list of ac­ credited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasad.arts-accredit.org For information on State licensing requirements and exams, and the Interior Design Experience Program, contact: y National Council for Interior Design Qualification, 1200 18th St.NW., Suite 1001, Washington, DC 20036-2506. Internet: http://www.ncidq.org For information on careers, continuing education, and certi­ fication programs in the interior design specialty of residential kitchen and bath design, contact: y National Kitchen and Bath Association, 687 Willow Grove St., Hackettstown, NJ 07840. Internet: http://www.nkba.org/student  Entertainers and Performers, Sports and Related Occupations Actors, Producers, and Directors (0*NET 27-2011.00, 27-2012.00, 27-2012.01, 27-2012.02, 27-2012.03, 27-2012.04, 27-2012.05)  Significant Points  •  Actors endure long periods of unemployment, intense competition for roles, and frequent rejections in audi­ tions. • Formal training through a university or acting conser­ vatory is typical; however, many actors, producers, and directors find work on the basis of their experi­ ence and talent alone. • Because earnings may be erratic, many supplement their incomes by holding jobs in other fields; however, the most successful actors, producers, and directors may have extraordinarily high earnings.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Actors, producers, and directors express ideas and create im­ ages in theater, film, radio, television, and other performing arts media. They interpret a writer’s script to entertain, inform, or instruct an audience. Although many actors, producers, and di­ rectors work in New York or Los Angeles, far more work in other places. They perform, direct, and produce in local or re­ gional television studios, theaters, or film production compa­ nies, often creating advertising or training films or small-scale independent movies. Actors perform in stage, radio, television, video, or motion picture productions. They also work in cabarets, nightclubs, and theme parks. Actors portray characters, and, for more complex roles, they research their character’s traits and circum­ stances so that they can better understand a script. Most actors struggle to find steady work and only a few achieve recognition as stars. Some well-known, experienced performers may be cast in supporting roles or make brief, cam­ eo appearances, speaking only one or two lines. Others work as “extras,” with no lines to deliver. Some actors do voiceover and  310 Occupational Outlook Handbook  narration work for advertisements, animated features, books on tape, and other electronic media. They also teach in high school or university drama departments, acting conservatories, or pub­ lic programs. Producers are entrepreneurs who make the business and fi­ nancial decisions involving a motion picture, made-for-television feature, or stage production. They select scripts, approve the development of ideas, arrange financing, and determine the size and cost of the endeavor. Producers hire or approve direc­ tors, principal cast members, and key production staff members. They also negotiate contracts with artistic and design person­ nel in accordance with collective bargaining agreements. They guarantee payment of salaries, rent, and other expenses. Television and radio producers determine which programs, episodes, or news segments get aired. They may research ma­ terial, write scripts, and oversee the production of individual pieces. Producers in any medium coordinate the activities of writers, directors, managers, and agents to ensure that each project stays on schedule and within budget. Directors are responsible for the creative decisions of a pro­ duction. They interpret scripts, audition and select cast mem­ bers, conduct rehearsals, and direct the work of cast and crew. They approve the design elements of a production, including the sets, costumes, choreography, and music. Assistant direc­ tors cue the performers and technicians, telling them when to make entrances or light, sound, or set changes. Work environment. Actors, producers, and directors work under constant pressure. Many face stress from the continual need to find their next job. To succeed, actors, producers, and directors need patience and commitment to their craft. Actors strive to deliver flawless performances, often while working under undesirable and unpleasant conditions. Producers and directors organize rehearsals and meet with writers, designers, financial backers, and production technicians. They experience stress not only from these activities, but also from the need to adhere to budgets, union work rules, and production schedules. Acting assignments typically are short term—ranging from 1 day to a few months—which means that actors frequently experience long periods of unemployment between jobs. The uncertain nature of the work results in unpredictable earnings and intense competition for jobs. Often, actors, producers, and directors must hold other jobs in order to sustain a living. When performing, actors typically work long, irregular hours. For example, stage actors may perform one show at night while rehearsing another during the day. They also might travel with a show when it tours the country. Movie actors may work on lo­ cation, sometimes under adverse weather conditions, and may spend considerable time waiting to perform their scenes. Ac­ tors who perform in a television series often appear on camera with little preparation time, because scripts tend to be revised frequently or even written moments before taping. Those who appear live or before a studio audience must be able to handle impromptu situations and calmly ad lib, or substitute, lines when necessary. Evening and weekend work is a regular part of a stage actor’s life. On weekends, more than one performance may be held per day. Actors and directors working on movies or television programs, especially those who shoot on location, may work in   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  IRK  agjfetj jji  ms  Actors, producers, and directors work in various locations. the early morning or late evening hours to film night scenes or tape scenes inside public facilities outside of normal business hours. Actors should be in good physical condition and have the necessary stamina and coordination to move about theater stag­ es and large movie and television studio lots. They also need to maneuver about complex technical sets while staying in char­ acter and projecting their voices audibly. Actors must be fit to endure heat from stage or studio lights and the weight of heavy costumes. Producers and directors ensure the safety of actors by conducting extra rehearsals on the set so that the actors can learn the layout of set pieces and props, by allowing time for warmups and stretching exercises to guard against physical and vocal injuries, and by providing an adequate number of breaks to prevent heat exhaustion and dehydration.  Training, Other Qualifications, and Advancement People who become actors, producers, and directors follow many paths to employment. The most important qualities em­ ployers look for are creative instincts, innate talent, and the in­ tellectual capacity to perform. The best way to prepare for a career as an actor, especially in the theater, is through formal dramatic training, preferably obtained as part of a bachelor’s degree program. Producers and especially directors need expe­ rience in the field, either as actors or in other related jobs. Education and training. Formal dramatic training, either through an acting conservatory or a university program, gener­ ally is necessary for these jobs, but some people successfully enter the field without it. Most people studying for a bachelor’s degree take courses in radio and television broadcasting, com­ munications, film, theater, drama, or dramatic literature. Many stage actors continue their academic training and receive a Master of Fine Arts (MFA) degree. Advanced curricula may include courses in stage speech and movement, directing, play­ writing, and design, as well as intensive acting workshops. The National Association of Schools of Theatre accredits 150 pro­ grams in theater arts. Most aspiring actors participate in high school and college plays, work in college radio or television stations, or perform with local community theater groups. Local and regional the­ ater experience and work in summer stock, on cruise lines, or in theme parks helps many young actors hone their skills. Mem­  Professional and Related Occupations 311  bership in one of the actors’ unions and work experience in smaller communities may lead to work in larger cities, notably New York, Chicago, or Los Angeles. In television and film, ac­ tors and directors typically start in smaller television markets or with independent movie production companies and then work their way up to larger media markets and major studio produc­ tions. A few people go into acting after successful careers in other fields, such as broadcasting or announcing. Actors, regardless of experience level, may pursue workshop training through acting conservatories or mentoring by a drama coach. Sometimes actors leam a foreign language or train with a dialect coach to develop an accent to make their characters more realistic. There are no specific training requirements for producers. They come from many different backgrounds. Actors, writers, film editors, and business managers commonly enter the field. Producers often start in a theatrical management office, work­ ing for a press agent, managing director, or business manager. Some start in a performing arts union or service organization. Others work behind the scenes with successful directors, serve on the boards of art companies, or promote their own projects. Although there are no formal training programs for producers, a number of colleges and universities offer degree programs in arts management and in managing nonprofit organizations. Directors often start out as actors. Many also have formal training in directing. The Directors Guild of America and the Alliance of Motion Picture and Television Producers jointly sponsor the Assistant Directors Training Program. To be ac­ cepted to this highly competitive program, an individual must have either a bachelor’s or associate degree or 2 years of ex­ perience and must complete a written exam and other assess­ ments. Program graduates are eligible to become a member of the Directors Guild and typically find employment as a second assistant director. Other qualifications. Actors need talent and creativity that will enable them to portray different characters. Because com­ petition for parts is fierce, versatility and a wide range of re­ lated performance skills, such as singing, dancing, skating, jug­ gling, acrobatics, or miming are especially useful. Experience in horseback riding, fencing, linguistics, or stage combat also can lift some actors above the average and get them noticed by producers and directors. Actors must have poise, stage pres­ ence, the ability to affect an audience, and the ability to follow direction. Modeling experience also may be helpful. Physical appearance, such as having certain features and being the speci­ fied size and weight, often is a deciding factor in who gets a particular role. Many professional actors rely on agents or managers to find work, negotiate contracts, and plan their careers. Agents gener­ ally earn a percentage of the pay specified in an actor’s contract. Other actors rely solely on attending open auditions for parts. Trade publications list the times, dates, and locations of these auditions. Some actors begin as movie extras. To become an extra, one usually must be listed by casting agencies that supply extras to the major movie studios in Hollywood. Applicants are accepted only when the numbers of people of a particular type on the list, for example, athletic young women, old men, or small children,   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  falls below what is needed. In recent years, only a very small proportion of applicants have succeeded in being listed. Like actors, directors and producers need talent and creativ­ ity. They also need business acumen. Advancement. As the reputations and box-office draw of ac­ tors, producers, and directors grow, they might work on bigger budget productions, on network or syndicated broadcasts, or in more prestigious theaters. Actors may advance to lead roles and receive star billing. A few actors move into acting-related jobs, such as drama coaches or directors of stage, television, ra­ dio, or motion picture productions. Some teach drama privately or in colleges and universities.  Employment In May 2006, actors, producers, and directors held about 163,000 jobs, primarily in motion picture and video, performing arts, and broadcast industries. Because many others were between jobs, the total number of actors, producers, and directors avail­ able for work was higher. Employment in the theater, and other performing arts companies, is cyclical—higher in the fall and spring seasons—and concentrated in New York and other major cities with large commercial houses for musicals and touring productions. Also, many cities support established professional regional theaters that operate on a seasonal or year-round basis. About 28 percent of actors, producers, and directors were selfemployed. Actors, producers, and directors may find work in summer festivals, on cruise lines, and in theme parks. Many smaller, nonprofit professional companies, such as repertory compa­ nies, dinner theaters, and theaters affiliated with drama schools, acting conservatories, and universities, provide employment opportunities for local amateur talent and professional enter­ tainers. Auditions typically are held in New York for many pro­ ductions across the country and for shows that go on the road. Employment in motion pictures and in films for television is centered in New York and Los Angeles. However, small studios exist throughout the country. Many films are shot on location and may employ local professional and nonprofessional actors. In television, opportunities are concentrated in the network cen­ ters of New York and Los Angeles, but cable television services and local television stations around the country also employ many actors, producers, and directors.  Job Outlook Employment of actors, producers, and directors is expected to grow about as fast as the average for all occupations. Com­ petition for jobs will be keen. Although a growing number of people aspire to enter these professions, many will leave the field early because the work—when it is available—is hard, the hours are long, and the pay may be low. Employment change. Employment in these occupations is expected to grow 11 percent during the 2006-16 decade, about as fast as the average for all occupations. Expanding cable and satellite television operations, increasing production and distribution of major studio and independent films, and rising demand for films in other countries should create more employ­ ment opportunities for actors, producers, and directors. Also fueling job growth is the continued development of interactive media, direct-for-Web movies, and mobile content, produced  312 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2006-2016 employment, Code 2016 Number Percent 11 18,000 163,000 182,000 .......................... 27-2010 Actors, producers, and directors................................ 12 8,100 78,000 70,000 27-2011 Actors....................................................................... .......................... 10,000 11 93,000 103,000 27-2012 Producers and directors.......................................... .......................... NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  soc  Employment, 2006  tion Included in the Handbook.  for cell phones or other portable electronic devices. Howev­ er, greater emphasis on national, rather than local, entertain­ ment productions may restrict employment opportunities in the broadcasting industry. Job prospects. Competition for jobs will be stiff. The large number of highly trained and talented actors auditioning for roles generally exceeds the number of parts that become avail­ able. Only performers with the most stamina and talent will find regular employment. Venues for live entertainment, such as Broadway and OffBroadway theaters, touring productions, and repertory theaters in many major metropolitan areas, as well as theme parks and resorts, are expected to offer many job opportunities. However, prospects in these venues are variable because they fluctuate with economic conditions.  Earnings The most successful actors, producers, and directors may have extraordinarily high earnings but for others, because earnings may be erratic, many supplement their income by holding jobs in other fields. Median hourly earnings of actors were $11.61 in May 2006. The middle 50 percent earned between $8.47 and $22.51. The lowest 10 percent earned less than $7.31, and the highest 10 percent earned more than $51.02. Median hourly earnings were $16.82 in performing arts companies and $10.69 in the motion picture and video industry. Annual earnings data for actors were not available because of the wide variation in the number of hours worked by actors and the short-term nature of many jobs, which may last for 1 day or 1 week; it is extremely rare for actors to have guaranteed employment that exceeded 3 to 6 months. Median annual earnings of salaried producers and directors were $56,310 in 2006. The middle 50 percent earned between $37,980 and $88,700. Median annual earnings were $70,750 in the motion picture and video industry and $47,530 in radio and television broadcasting. Minimum salaries, hours of work, and other conditions of employment are often covered in collective bargaining agree­ ments between the producers and the unions representing work­ ers. The Actors’ Equity Association (AEA) represents stage ac­ tors; the Screen Actors Guild (SAG) covers actors in motion pictures, including television, commercials, and film; and the American Federation of Television and Radio Artists (AFTRA) represents television and radio studio performers. Some actors who regularly work in several media find it advantageous to join multiple unions, while SAG and AFTRA may share juris­ diction for work in additional areas, such as the production of training or educational films not slated for broadcast, television   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  commercial work, and interactive media. While these unions generally determine minimum salaries, any actor or director may negotiate for a salary higher than the minimum. Under terms of a joint SAG and AFTRA contract covering all unionized workers, motion picture and television actors with speaking parts earned a minimum daily rate of $759 or $2,634 for a 5-day week as of July 1, 2007. Actors also receive con­ tributions to their health and pension plans and additional com­ pensation for reruns and foreign telecasts of the productions in which they appear. According to AEA, the minimum weekly salary for actors in Broadway productions as of June 2007 was $1,509. Actors in Off-Broadway theaters received minimums ranging from $516 to $976 a week as of October 29, 2007, depending on the seat­ ing capacity of the theater. Regional theaters that operate under an Equity agreement pay actors $544 to $840 per week. For touring productions, actors receive an additional $113 per day for living expenses ($119 per day in higher cost cities). New terms were negotiated under an “experimental touring program” provision for lower budget musicals that tour to smaller cities or that perform for fewer performances at each stop. In an effort to increase the number of paid workweeks while on tour, actors may be paid less than the full production rate for touring shows in exchange for higher per diems and profit participation. Some well-known actors—stars—earn well above the mini­ mum; their salaries are many times the figures cited, creating the false impression that all actors are highly paid. For exam­ ple, of the nearly 100,000 SAG members, only about 50 might be considered stars. The average income that SAG members earn from acting, less than $5,000 a year, is low because em­ ployment is sporadic. Therefore, most actors must supplement their incomes by holding jobs in other occupations. Many actors who work more than a qualifying number of days, or weeks per year or earn over a set minimum pay, are covered by a union health, welfare, and pension fund, which includes hospitalization insurance to which employers contrib­ ute. Under some employment conditions, Equity and AFTRA members receive paid vacations and sick leave. Many stage directors belong to the Society of Stage Direc­ tors and Choreographers (SSDC), and film and television di­ rectors belong to the Directors Guild of America. Earnings of stage directors vary greatly. The SSDC usually negotiates sal­ ary contracts which include royalties (additional income based on the number of performances) with smaller theaters. Direct­ ing a production at a dinner theater generally will pay less than directing one at a summer theater, but has more potential for generating income from royalties. Regional theaters may hire directors for longer periods, increasing compensation accord­ ingly. The highest-paid directors work on Broadway and com­  Professional and Related Occupations 313  monly earn over $50,000 per show. However, they also receive payment in the form of royalties—a negotiated percentage of gross box office receipts—that can exceed their contract fee for long-running box office successes. Stage producers seldom get a set fee; instead, they get a per­ centage of a show’s earnings or ticket sales.  Related Occupations People who work in performing arts occupations that may require acting skills include announcers; dancers and chore­ ographers; and musicians, singers, and related workers. Oth­ ers working in occupations related to film and theater include makeup artists, theatrical and performance; fashion designers; and set and exhibit designers. Producers share many responsi­ bilities with those who work as top executives.  Sources of Additional Information For general information about theater arts and a list of accred­ ited college-level programs, contact: y National Association of Schools of Theater, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http ://nast.arts-accredit.org For general information on actors, producers, and directors, contact any of the following organizations: y Actors Equity Association, 165 West 46th St., New York, NY 10036. Internet: http://www.actorsequity.org y Screen Actors Guild, 5757 Wilshire Blvd., Los Angeles, CA 90036-3600. Internet: http://www.sag.org y American Federation of Television and Radio Artists— Screen Actors Guild, 4340 East-West Hwy., Suite 204, Bethesda, MD 20814-4411. Internet: http://www.aftra.org or http://www.sag.org  Athletes, Coaches, Umpires, and Related Workers (0*NET 27-2021.00, 27-2022.00, 27-2023.00)  Significant Points  • • •  •  Work hours are often irregular and extensive travel may be required. Career-ending injuries are always a risk for athletes. Job opportunities will be best for part-time coaches, sports instructors, umpires, referees, and sports of­ ficials in high schools, sports clubs, and other set­ tings. Competition to become a professional athlete will continue to be extremely intense; athletes who seek to compete professionally must have extraordinary talent, desire, and dedication to training.  Nature of the Work We are a Nation of sports fans and sports players. Some of those who participate in amateur sports dream of becoming paid professional athletes, coaches, or sports officials, but very   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  few beat the long and daunting odds of making a full-time liv­ ing from professional athletics. Those athletes who make it to the professional level find that careers are short and jobs are insecure. Even though the chances of employment as a professional athlete are slim, there are many opportunities for at least a part-time job as a coach, instructor, referee, or umpire in amateur athletics or in high school, college, or university sports. Athletes and sports competitors compete in organized, of­ ficiated sports events to entertain spectators. When playing a game, athletes are required to understand the strategies of their game while obeying the rules and regulations of the sport. The events in which they compete include both team sports, such as baseball, basketball, football, hockey, and soccer, and individual sports, such as golf, tennis, and bowling. The level of play varies from unpaid high school athletics to professional sports, in which the best from around the world compete in events broadcast on international television. Being an athlete involves more than competing in athletic events. Athletes spend many hours each day practicing skills and improving teamwork under the guidance of a coach or a sports instructor. They view videotapes to critique their own performances and techniques and to learn their opponents’ tendencies and weaknesses to gain a competitive advantage. Some athletes work regularly with strength trainers to gain muscle and stamina and to prevent injury. Many athletes push their bodies to the limit during both practice and play, so ca­ reer-ending injury always is a risk; even minor injuries may put a player at risk of replacement. Because competition at all lev­ els is extremely intense and job security is always precarious, many athletes train year round to maintain excellent form and technique and peak physical condition. Very little downtime from the sport exists at the professional level. Athletes also must conform to regimented diets during their sports season to supplement any physical training program. Coaches organize amateur and professional athletes and teach them the fundamentals of individual and team sports. (In indi­ vidual sports, instructors sometimes may fill this role.) Coach­ es train athletes for competition by holding practice sessions to perform drills that improve the athletes’ form, technique, skills, and stamina. Along with refining athletes’ individual skills, coaches are responsible for instilling good sportsman­ ship, a competitive spirit, and teamwork and for managing their teams during both practice sessions and competitions. Before competition, coaches evaluate or scout the opposing team to determine game strategies and practice specific plays. During competition, coaches may call specific plays intended to surprise or overpower the opponent, and they may substitute players for optimum team chemistry and success. Coaches’ additional tasks may include selecting, storing, issuing, and taking inventory of equipment, materials, and supplies. Many coaches in high schools are primarily teachers of aca­ demic subjects who supplement their income by coaching part time. (For more information on high school teachers, see the statement on teachers—preschool, kindergarten, elementary, middle, and secondary, elsewhere in the Handbook.) College coaches consider coaching a full-time discipline and may be  314 Occupational Outlook Handbook  away from home frequently as they travel to scout and recruit prospective players. Sports instructors teach professional and nonprofessional athletes individually. They organize, instruct, train, and lead athletes in indoor and outdoor sports such as bowling, ten­ nis, golf, and swimming. Because activities are as diverse as weight lifting, gymnastics, scuba diving, and karate, instruc­ tors tend to specialize in one or a few activities. Like coaches, sports instructors also may hold daily practice sessions and be responsible for any needed equipment and supplies. Us­ ing their knowledge of their sport and of physiology, they de­ termine the type and level of difficulty of exercises, prescribe specific drills, and correct athletes’ techniques. Some instruc­ tors also teach and demonstrate the use of training apparatus, such as trampolines or weights, for correcting athletes’ weak­ nesses and enhancing their conditioning. Like coaches, sports instructors evaluate the athlete and the athlete’s opponents to devise a competitive game strategy. Coaches and sports instructors sometimes differ in their ap­ proaches to athletes because of the focus of their work. For example, while coaches manage the team during a game to optimize its chance for victory, sports instructors—such as those who work for professional tennis players—often are not permitted to instruct their athletes during competition. Sports instructors spend more of their time with athletes working one-on-one, which permits them to design customized train­ ing programs for each individual. Motivating athletes to play hard challenges most coaches and sports instructors but is vital for the athlete’s success. Many coaches and instructors derive great satisfaction working with children or young adults, help­ ing them to learn new physical and social skills, improve their physical condition, and achieve success in their sport. Umpires, referees, and other sports officials officiate at com­ petitive athletic and sporting events. They observe the play, detect infractions of rules, and impose penalties established by the rules and regulations of the various sports. Umpires, referees, and sports officials anticipate play and position them­ selves to best see the action, assess the situation, and determine any violations. Some sports officials, such as boxing referees, may work independently, while others such as umpires work in groups. Regardless of the sport, the job is highly stressful because officials are often required to make a decision in a split second, sometimes resulting in strong disagreement among competitors, coaches, and spectators. Professional scouts evaluate the skills of both amateur and professional athletes to determine talent and potential. As a sports intelligence agent, the scout’s primary duty is to seek out top athletic candidates for the team he or she represents. At the professional level, scouts typically work for scouting organizations or as freelance scouts. In locating new talent, scouts perform their work in secrecy so as not to “tip off’ their opponents about their interest in certain players. At the college level, the head scout often is an assistant coach, although free­ lance scouts may aid colleges by reporting to coaches about exceptional players. Scouts at this level seek talented high school athletes by reading newspapers, contacting high school coaches and alumni, attending high school games, and study-   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  : ■'  ■■  Coaches need good communication and leadership skills. ing videotapes of prospects’ performances. They also evalu­ ate potential players’ background and personal characteristics, such as motivation and discipline, by talking to the players’ coaches, parents, and teachers. Work environment. Irregular work hours are the trademark of the athlete. They also are common for coaches, umpires, referees, and other sports officials. Athletes and others in sports related occupations often work Saturdays, Sundays, evenings, and holidays. Athletes and full-time coaches usually work more than 40 hours a week for several months during the sports season, if not most of the year. Some coaches in educa­ tional institutions may coach more than one sport, particularly in high schools. Athletes, coaches, and sports officials who participate in competitions that are held outdoors may be exposed to all weather conditions of the season. Those involved in events that are held indoors tend to work in climate-controlled comfort, often in arenas, enclosed stadiums, or gymnasiums. Athletes, coaches, and some sports officials frequently travel to sporting events by bus or airplane. Scouts also travel extensively in locating talent, often by automobile. Umpires, referees, and other sports officials regularly en­ counter verbal abuse by fans, coaches, and athletes. The offi­ cials also face possible physical assault and, increasingly, law­ suits from injured athletes based on their officiating decisions.  Training, Other Qualifications, and Advancement Education and training requirements for athletes, coaches, um­ pires, and related workers vary greatly by the level and type of sport. Regardless of the sport or occupation, these jobs require immense overall knowledge of the game, usually acquired through years of experience at lower levels. Education and training. Becoming a professional athlete is the culmination of years of effort. Athletes usually be­ gin competing in their sports while in elementary or middle school, and continue through high school and sometimes col­ lege. They play in amateur tournaments and on high school and college teams, where the best attract the attention of pro­ fessional scouts. Most schools require that participating ath­ letes maintain specific academic standards to remain eligible to  Professional and Related Occupations 315  play. Athletes who seek to compete professionally must have extraordinary talent, desire, and dedication to training. Head coaches at public secondary schools and sports instruc­ tors at all levels usually must have a bachelor’s degree. For high school coaching and sports instructor jobs, schools usu­ ally prefer to hire teachers willing to take on the jobs part time. (For information on teachers, including those specializing in physical education, see the section on teachers—preschool, kindergarten, elementary, middle, and secondary elsewhere in the Handbook.) If no suitable teacher is found, schools hire someone from outside. Some entry-level positions for coaches or instructors require only experience derived as a participant in the sport or activity. Those who are not teachers must meet State requirements for certification to become a head coach. Certification, however, may not be required for coaching and sports instructor jobs in private schools. Degree programs spe­ cifically related to coaching include exercise and sports sci­ ence, physiology, kinesiology, nutrition and fitness, physical education, and sports medicine. Each sport has specific requirements for umpires, referees, and other sports officials. Umpires, referees, and other sports officials often begin their careers by volunteering for intramu­ ral, community, and recreational league competitions. Scouting jobs require experience playing a sport at the col­ lege or professional level that makes it possible to spot young players who possess extraordinary athletic ability and skills. Most beginning scouting jobs are as part-time talent spotters in a particular area or region. Hard work and a record of success often lead to full-time jobs responsible for bigger territories. Some scouts advance to scouting director jobs or various ad­ ministrative positions in sports. Certification and other qualifications. Athletes, coaches, umpires, and related workers must relate well to others and possess good communication and leadership skills. Coaches also must be resourceful and flexible to successfully instruct and motivate individuals and groups of athletes. To officiate at high school athletic events, officials must reg­ ister with the State agency that oversees high school athletics and pass an exam on the rules of the particular game. For col­ lege refereeing, candidates must be certified by an officiating school and be evaluated during a probationary period. Some larger college sports conferences require officials to have cer­ tification and other qualifications, such as residence in or near the conference boundaries, along with several years of experi­ ence officiating at high school, community college, or other college conference games. For those interested in becoming a tennis, golf, karate, or other kind of instructor, certification is highly desirable. Of­ ten, one must be at least 18 years old and certified in cardio­ pulmonary resuscitation (CPR). There are many certifying organizations specific to the various sports, and their training requirements vary. Participation in a clinic, camp, or school usually is required for certification. Part-time workers and those in smaller facilities are less likely to need formal educa­ tion or training. Standards for officials become more stringent as the level of competition advances. Whereas umpires for high school baseball need a high school diploma or its equivalent, 20/20   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  vision, and quick reflexes, those seeking to officiate at minor or major league games must attend professional umpire train­ ing school. Top graduates are selected for further evaluation while officiating in a rookie minor league. Umpires then usu­ ally need 7 to 10 years of experience in various minor leagues before being considered for major league jobs. Becoming an official for professional football also is competitive, as candi­ dates must have at least 10 years of officiating experience, with 5 of them at a collegiate varsity or minor professional level. For the National Football League (NFL), prospective trainees are interviewed by clinical psychologists to determine levels of intelligence and ability to handle extremely stressful situ­ ations. In addition, the NFL’s security department conducts thorough background checks. Potential candidates are likely to be interviewed by a panel from the NFL officiating depart­ ment and are given a comprehensive examination on the rules of the sport. Advancement. Many coaches begin their careers as assis­ tant coaches to gain the knowledge and experience needed to become a head coach. Head coaches at large schools that strive to compete at the highest levels of a sport require substantial experience as a head coach at another school or as an assistant coach. To reach the ranks of professional coaching, a person usually needs years of coaching experience and a winning re­ cord in the lower ranks.  Employment Athletes, coaches, umpires, and related workers held about 253,000 jobs in 2006. Coaches and scouts held 217,000 jobs; athletes, 18,000; and umpires, referees, and other sports offi­ cials, 19,000. Nearly 42 percent of athletes, coaches, umpires, and related workers worked part time, while 15 percent main­ tained variable schedules. Many sports officials and coaches receive such small and irregular payments for their services— occasional officiating at club games, for example—that they may not consider themselves employed in these occupations, even part time. Among those employed in wage and salary jobs, 47 percent held jobs in public and private educational services. About 13 percent worked in amusement, gambling, and recreation in­ dustries, including golf and tennis clubs, gymnasiums, health clubs, judo and karate schools, riding stables, swim clubs, and other sports and recreation facilities. Another 6 percent worked in the spectator sports industry. About 1 out of 5 workers in this occupation was self-em­ ployed, earning prize money or fees for lessons, scouting, or officiating assignments. Many other coaches and sports of­ ficials, although technically not self-employed, have such ir­ regular or tenuous working arrangements that their working conditions resemble those of self-employment.  Job Outlook Employment of athletes, coaches, umpires, and related work­ ers is expected to grow faster than the average for all occupa­ tions through 2016. Very keen competition is expected for jobs at the highest levels of sports. Employment change. Employment of athletes, coaches, umpires, and related workers is expected to increase by 15 per-  316 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Athletes, coaches, umpires, and related workers.................. ............ Athletes and sports competitors.......................................... ............ Coaches and scouts.............................................................. ............ Umpires, referees, and other sports officials...................... ............  soc Code 27-2020 27-2021 27-2022 27-2023  Employment, 2006 253,000 18,000 217,000 19,000  Projected employment, 2016 291,000 21,000 249,000 22,000  Change, 2006-2016 Number Percent 15 38,000 3,400 19 15 32,000 3,000 16  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ______________________  cent from 2006 to 2016, which is faster than the average for all occupations. Employment will grow as the general public continues to participate in organized sports for entertainment, recreation, and physical conditioning. Increasing participation in organized sports by girls and women will boost demand for coaches, umpires, and related workers. Job growth also will be driven by the increasing number of baby boomers approach­ ing retirement, during which they are expected to participate more in leisure activities such as golf and tennis which require instruction. Employment of coaches and instructors also will increase with expansion of school and college athletic programs and growing demand for private sports instruction. Sports-related job growth within education also will be driven by the deci­ sions of local school boards. Population growth dictates the construction of additional schools, particularly in the expand­ ing suburbs, but funding for athletic programs often is cut first when budgets become tight. Still, the popularity of team sports often enables shortfalls to be offset somewhat by assistance from fundraisers, booster clubs, and parents. Job prospects. Persons who are State-certified to teach aca­ demic subjects in addition to physical education are likely to have the best prospects for obtaining coaching and instructor jobs. The need to replace the many high school coaches who change occupations or leave the labor force entirely also will provide some coaching opportunities. Competition for professional athlete jobs will continue to be extremely intense. Opportunities to make a living as a profes­ sional in individual sports such as golf or tennis may grow as new tournaments are established and as prize money distrib­ uted to participants increases. Because most professional ath­ letes’ careers last only a few years due to debilitating injuries and age, annual replacement needs for these jobs is high, creat­ ing some job opportunities. However, the talented young men and women who dream of becoming sports superstars greatly outnumber the number of openings. Opportunities should be best for persons seeking part-time umpire, referee, and other sports official jobs at the high school level. Competition is expected for higher paying jobs at the college level and will be even greater for jobs in professional sports. Competition should be keen for jobs as scouts, particu­ larly for professional teams, because the number of available positions is limited.  Earnings Median annual wage and salary earnings of athletes were $41,060 in May 2006. However, the highest paid professional athletes earn much more.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Median annual wage and salary earnings of umpires and related workers were $22,880 in May 2006. The middle 50 percent earned between $17,090 and $33,840. The lowest paid 10 percent earned less than $14,120, and the highest paid 10 percent earned more than $45,430. In May 2006, median annual wage and salary earnings of coaches and scouts were $26,950. The middle 50 percent earned between $17,510 and $40,850. The lowest paid 10 per­ cent earned less than $13,990, and the highest paid 10 percent earned more than $58,890. However, the highest paid profes­ sional coaches earn much more. Median annual earnings in the industries employing the largest numbers of coaches and scouts in May 2006 are shown below: Colleges, universities, and professional schools............... $37,530 Other amusement and recreation industries........................ 27,180 Fitness and recreational sports centers.................................26,150 Other schools and instruction............................................... 23,840 Elementary and secondary schools.......................................21,960 Earnings vary by level of education, certification, and geo­ graphic region. Some instructors and coaches are paid a salary, while others may be paid by the hour, per session, or based on the number of participants.  Related Occupations Athletes and coaches use their extensive knowledge of physiol­ ogy and sports to instruct, inform, and encourage sports par­ ticipants. Other workers with similar duties include dietitians and nutritionists; physical therapists; recreation workers; fit­ ness workers; recreational therapists; and teachers—preschool, kindergarten, elementary, middle, and secondary.  Sources of Additional Information For information about sports officiating for team and individ­ ual sports, contact: 'y National Association of Sports Officials, 2017 Lathrop Ave., RaciNE., WI 53405. Internet: http://www.naso.org For more information about certification of tennis instructors and coaches, contact: y Professional Tennis Registry, P.O. Box 4739, Hilton Head Island, SC 29938. Internet: http://www.ptrtennis.org y U.S. Professional Tennis Association, 3535 Briarpark Dr., Suite ONE., Houston, TX 77042. Internet: http://www.uspta.org  Professional and Related Occupations 317  Dancers and Choreographers (0*NET 27-2031.00, 27-2032.00)  Significant Points  •  •  •  Many dancers stop performing by their late thirties, but some remain in the field as choreographers, dance teachers, or artistic directors. Most dancers begin formal training at an early age— between 5 and 15—and many have their first profes­ sional audition by age 17 or 18. Dancers and choreographers face intense competi­ tion; only the most talented find regular work.  Nature of the Work From ancient times to the present, dancers have expressed ideas, stories, and rhythm with their bodies. They use a variety of dance forms that allow free movement and self-expression, including classical ballet, modem dance, and culturally specific dance styles. Many dancers combine performance work with teaching or choreography. Dancers perform in a variety of settings, including opera, mu­ sical theater, and other musical productions, and may present folk, ethnic, tap, jazz, and other popular kinds of dance. They also perform in television, movies, music videos, and commer­ cials, in which they also may sing and act. Dancers most often perform as part of a group, although a few top artists perform solo. Dancers work with choreographers, who create original dances and develop new interpretations of existing dances. Because few dance routines are written down, choreographers instruct performers at rehearsals to achieve the desired effect. In addition, choreographers usually are involved in auditioning performers. Work environment. Dance is strenuous. Many dancers stop performing by their late thirties because of the physical de­ mands on the body. However, some continue to work in the  Bf  sp ' w  ¥ I . . . WH.; v > :  Most dancers need long-term on-the-job training to be success­ ful.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  field as choreographers, dance teachers and coaches, or artistic directors. Others move into administrative positions, such as company managers. A few celebrated dancers, however, con­ tinue performing most of their lives. Daily rehearsals require very long hours. Many dance com­ panies tour for part of the year to supplement a limited per­ formance schedule at home. Dancers who perform in musical productions and other family entertainment spend much of their time on the road; others work in nightclubs or on cruise ships. Most dance performances are in the evening, whereas rehears­ als and practice take place during the day. As a result, dancers often work very long and late hours. Generally, dancers and choreographers work in modem and temperature-controlled fa­ cilities; however, some studios may be older and less comfort­ able.  Training, Other Qualifications, and Advancement Most dancers need long-term on-the-job training to be success­ ful. Some earn a bachelor’s degree or attend dance school, al­ though neither is required. Becoming a choreographer usually requires years of dancing experience. Education and training. Training varies with the type of dance and is a continuous part of all dancers’ careers. Many dancers and dance instructors believe that dancers should start with a good foundation in classical technique before selecting a particular dance style. Ballet training for girls usually begins at 5 to 8 years of age with a private teacher or through an in­ dependent ballet school. Serious training traditionally begins between the ages of 10 and 12. Boys often begin their ballet training between the ages of 10 and 15. Students who demon­ strate potential in their early teens may seek out more intensive and advanced professional training. At about this time, students should begin to focus their training on a particular style and decide whether to pursue additional training through a dance company’s school or a college dance program. Leading dance school companies often have summer training programs from which they select candidates for admission to their regular full­ time training programs. Formal training for modem and cultur­ ally specific dancers often begins later than training in ballet; however, many folk dance forms are taught to very young chil­ dren. Many dancers have their first professional auditions by age 17 or 18. Training is an important component of professional dancers’ careers. Dancers normally spend 8 hours a day in class and rehearsal, keeping their bodies in shape and preparing for per­ formances. Their daily training period includes time to warm up and cool down before and after classes and rehearsals. Because of the strenuous and time-consuming training re­ quired, some dancers view formal education as secondary. However, a broad, general education including music, litera­ ture, history, and the visual arts is helpful in the interpretation of dramatic episodes, ideas, and feelings. Dancers sometimes conduct research to leam more about the part they are playing. Many colleges and universities award bachelor’s or master’s degrees in dance, typically through departments of dance, the­ ater, or fine arts. The National Association of Schools of Dance accredits 65 programs in dance. Many programs concentrate on modem dance, but some also offer courses in jazz, culturally  318 Occupational Outlook Handbook  specific dance, ballet, or classical techniques. Courses in dance composition, history and criticism, and movement analysis are also available. A college education is not essential for employment as a pro­ fessional dancer; however, many dancers obtain degrees in un­ related fields to prepare themselves for careers after dance. The completion of a college program in dance and education is usu­ ally essential to qualify to teach dance in college, high school, or elementary school. Colleges and conservatories sometimes re­ quire graduate degrees but may accept performance experience. A college background is not necessary, however, for teaching dance or choreography in local recreational programs. Studio schools prefer teachers to have experience as performers. Other qualifications. Because of the rigorous practice schedules of most dancers, self-discipline, patience, persever­ ance, and a devotion to dance are essential for success in the field. Dancers also must possess good problem-solving skills and an ability to work with people. Good health and physi­ cal stamina also are necessary attributes. Above all, dancers must have flexibility, agility, coordination, and grace, a sense of rhythm, a feeling for music, and a creative ability to express themselves through movement. Because dancers typically perform as members of an en­ semble made up of other dancers, musicians, and directors or choreographers, they must be able to function as part of a team. They also should be highly motivated and prepared to face the anxiety of intermittent employment and rejections when audi­ tioning for work. Advancement. For dancers, advancement takes the form of a growing reputation, more frequent work, bigger and better roles, and higher pay. Some dancers may take on added re­ sponsibilities, such as by becoming a dance captain in musical theater or ballet master/ballet mistress in concert dance compa­ nies, by leading rehearsals, or by working with less experienced dancers in the absence of the choreographer. Choreographers typically are experienced dancers with years of practice working in the theater. Through their performance as dancers, they develop reputations that often lead to opportu­ nities to choreograph productions.  theater, and opera companies; and amusement and recreation venues, such as casinos and theme parks. About 17 percent of dancers and choreographers were self-employed. Most major cities serve as home to major dance companies; however, many smaller communities across the Nation also support home-grown, full-time professional dance compa­ nies.  Employment  Earnings  Professional dancers and choreographers held about 40,000 jobs in 2006. Many others were between engagements, so that the total number of people available for work as dancers over the course of the year was greater. Dancers and choreographers worked in a variety of industries, such as private educational services, which includes dance studios and schools, as well as colleges and universities; food services and drinking estab­ lishments; performing arts companies, which include dance,  Job Outlook Employment of dancers and choreographers is expected to grow more slowly than the average for all occupations. Danc­ ers and choreographers face intense competition for jobs. Only the most talented find regular employment. Employment change. Employment of dancers and choreog­ raphers is expected to grow 6 percent during the 2006-16 de­ cade, more slowly than the average for all occupations. The public’s continued interest in dance will sustain large and mid­ size dance companies, but funding from public and private or­ ganizations is not expected to keep pace with rising production costs. For many small organizations, the result will be fewer performances and more limited employment opportunities. Job prospects. Because many people enjoy dance and would like to make their careers in dance, dancers and choreographers face intense competition for jobs. Only the most talented find regular employment. However, there are always some jobs available. Although job openings will arise each year because dancers and choreographers retire or leave the occupation for other rea­ sons, the number of applicants will continue to vastly exceed the number of job openings. National dance companies likely will continue to provide jobs in this field. Opera companies and dance groups affiliated with television and motion pictures also will offer some opportuni­ ties. Moreover, the growing popularity of dance for recreation­ al and fitness purposes has resulted in increased opportunities to teach dance, especially for older dancers who may be tran­ sitioning to another field. Finally, music video channels will provide opportunities for both dancers and choreographers.  Median hourly earnings of dancers were $9.55 in May 2006. The middle 50 percent earned between $7.31 and $17.50. The lowest 10 percent earned less than $6.62, and the highest 10 percent earned more than $25.75. Annual earnings data for dancers were not available, because of the wide variation in the number of hours worked by dancers and the short-term nature of many jobs—which may last for 1 day or 1 week—make it rare for dancers to have guaranteed employment that exceeds a  Projections data from the National Employment Matrix Occupational Title Dancers and choreographers................................... .................. Dancers................................................................. .................. Choreographers.................................................... ..................  soc  Code  27-2030 27-2031 27-2032  Employment,  2006 40,000 20,000 20,000  Projected employment,  2016 43,000 22,000 21.000  Change,  2006-2016  Number  2,400 1,900 500  Percent  6 9 2  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 319  few months. Median hourly earnings in the industries employ­ ing the largest number of dancers were as follows: Theater companies and dinner theaters.................................$15.28 Other schools and instruction.................................................. 11.71 Other amusement and recreation industries..............................8.58 Drinking places (alcoholic beverages)......................................7.76 Full-service restaurants............................................................. 7.13  Musicians, Singers, and Related Workers (0*NET 27-2041.00, 27-2041.01, 27-2041.04, 27-2042.00, 27-2042.01, 27-2042.02)  Significant Points Median annual earnings of salaried choreographers were $34,660 in May 2006. The middle 50 percent earned between $21,910 and $49,810. The lowest 10 percent earned less than $15,710, and the highest 10 percent earned more than $64,010. Median annual earnings were $34,460 in “other schools and instruction,” a North American Industry Classification System category that includes dance studios and schools. Dancers who were on tour usually received an additional al­ lowance for room and board, as well as extra compensation for overtime. Earnings from dancing are usually low because em­ ployment is irregular. Dancers often supplement their income by working as guest artists with other dance companies, teach­ ing dance, or taking jobs unrelated to the field. Earnings of dancers at many of the largest companies and in commercial settings are governed by union contracts. Danc­ ers in the major opera ballet, classical ballet, and modem dance corps belong to the American Guild of Musical Artists, Inc. of the AFL-CIO; those who appear on live or videotaped television programs belong to the American Federation of Television and Radio Artists; those who perform in films and on television be­ long to the Screen Actors Guild; and those in musical theater are members of the Actors’ Equity Association. The unions and pro­ ducers sign basic agreements specifying minimum salary rates, hours of work, benefits, and other conditions of employment. However, the contract each dancer signs with the producer of the show may be more favorable than the basic agreement. Most salaried dancers and choreographers covered by union contracts receive some paid sick leave and various health and pension benefits, including extended sick pay and family-leave benefits provided by their unions. Employers contribute toward these benefits. Dancers and choreographers not covered by union contracts usually do not enjoy such benefits.  Related Occupations People who work in other performing arts occupations include actors, producers, and directors; and musicians, singers, and related workers. Those directly involved in the production of dance programs include set and exhibit designers; fashion designers; and barbers, cosmetologists, and other personal ap­ pearance workers. Like dancers, athletes, coaches, umpires, and related workers need strength, flexibility, and agility.  Sources of Additional Information For general information about dance and a list of accredited college-level programs, contact: ^■National Association of Schools of Dance, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasd.arts-accredit.org For information about dance and dance companies, contact: > Dance/USA, 1156 15th St.NW., Suite 820, Washington, DC 20005. Internet: http://www.danceusa.org   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  •  • •  Part-time schedules—typically at night and on week­ ends—intermittent unemployment, and rejection when auditioning for work are common; many musi­ cians and singers supplement their income with earn­ ings from other sources. Aspiring musicians and singers begin studying an in­ strument or training their voices at an early age. Competition for jobs is keen; talented individuals who can play several instruments and perform a wide range of musical styles should enjoy the best job prospects.  Nature of the Work Musicians, singers, and related workers play musical instru­ ments, sing, compose or arrange music, or conduct groups in instrumental or vocal performances. They may perform solo or as part of a group. Musicians, singers, and related workers en­ tertain live audiences in nightclubs, concert halls, and theaters; others perform in recording or production studios. Regardless of the setting, musicians, singers, and related workers spend considerable time practicing, alone and with their bands, or­ chestras, or other musical ensembles. Musicians play one or more musical instruments. Many mu­ sicians learn to play several related instruments and can perform equally well in several musical styles. Instrumental musicians, for example, may play in a symphony orchestra, rock group, or jazz combo one night, appear in another ensemble the next, and work in a studio band the following day. Some play a variety of string, brass, woodwind, or percussion instruments or elec­ tronic synthesizers. Singers interpret music and text, using their knowledge of voice production, melody, and harmony. They sing character parts or perform in their own individual style. Singers are often classified according to their voice range—soprano, contralto, tenor, baritone, or bass, for example—or by the type of music they sing, such as rock, pop, folk, opera, rap, or country. Music directors and conductors conduct, direct, plan, and lead instrumental or vocal performances by musical groups, such as orchestras, choirs, and glee clubs. These leaders audition and select musicians, choose the music most appropriate for their talents and abilities, and direct rehearsals and performances. Choral directors lead choirs and glee clubs, sometimes work­ ing with a band or an orchestra conductor. Directors audition and select singers and lead them at rehearsals and performances to achieve harmony, rhythm, tempo, shading, and other desired musical effects. Composers create original music such as symphonies, op­ eras, sonatas, radio and television jingles, film scores, and pop­ ular songs. They transcribe ideas into musical notation, using  320 Occupational Outlook Handbook  Keen competition is expected for jobs as musicians and sing­ ers. harmony, rhythm, melody, and tonal structure. Although most composers and songwriters practice their craft on instruments and transcribe the notes with pen and paper, some use computer software to compose and edit their music. Arrangers transcribe and adapt musical compositions to a par­ ticular style for orchestras, bands, choral groups, or individuals. Components of music—including tempo, volume, and the mix of instruments needed—are arranged to express the composer’s message. While some arrangers write directly into a musical composition, others use computer software to make changes. Work environment. Musicians typically perform at night and on weekends. They spend much additional time practicing or in rehearsal. Full-time musicians with long-term employment contracts, such as those with symphony orchestras or television and film production companies, enjoy steady work and less travel. Nightclub, solo, or recital musicians frequently travel to perform in a variety of local settings and may tour nationally or internationally. Because many musicians find only part-time or intermittent work, experiencing unemployment between engagements, they often supplement their income with other types of jobs. The stress of constantly looking for work leads many musicians to accept permanent, full-time jobs in other oc­ cupations, while working part time as musicians. Most instrumental musicians work closely with a variety of other people, including their colleagues, agents, employers, sponsors, and audiences. Although they usually work indoors, some perform outdoors for parades, concerts, and festivals. In some nightclubs and restaurants, smoke and odors may be pres­ ent and lighting and ventilation may be poor.  Training, Other Qualifications, and Advancement Long-term on-the-job training is the most common way people learn to become musicians or singers. Aspiring musicians begin studying an instrument at an early age. They may gain valuable experience playing in a school or community band or an or­ chestra or with a group of friends. Singers usually start training when their voices mature. Participation in school musicals or choirs often provides good early training and experience. Com­ posers and music directors usually require a bachelor’s degree in a related field.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Education and training. Musicians need extensive and pro­ longed training and practice to acquire the necessary skills and knowledge to interpret music at a professional level. Like oth­ er artists, musicians and singers continually strive to improve their abilities. Formal training may be obtained through private study with an accomplished musician, in a college or univer­ sity music program, or in a music conservatory. An audition generally is necessary to qualify for university or conservatory study. The National Association of Schools of Music accredits more than 600 college-level programs in music. Courses typi­ cally include music theory, music interpretation, composition, conducting, and performance in a particular instrument or in voice. Music directors, composers, conductors, and arrangers need considerable related work experience or advanced training in these subjects. A master’s or doctoral degree usually is required to teach ad­ vanced music courses in colleges and universities; a bachelor’s degree may be sufficient to teach basic courses. A degree in music education qualifies graduates for a State certificate to teach music in public elementary or secondary schools. Musi­ cians who do not meet public school music education require­ ments may teach in private schools and recreation associations or instruct individual students in private sessions. Other qualifications. Musicians must be knowledgeable about a broad range of musical styles as well as the type of music that interests them most. Having a broader range of in­ terest, knowledge, and training can help expand employment opportunities and musical abilities. Voice training and private instrumental lessons, especially when taken at a young age, also help develop technique and enhance one’s performance. Young persons considering careers in music should have musical talent, versatility, creativity, poise, and a good stage presence. Self-discipline is vital because producing a quality performance on a consistent basis requires constant study and practice. Musicians who play in concerts or in nightclubs and those who tour must have physical stamina to endure frequent travel and an irregular performance schedule. Musicians and singers also must be prepared to face the anxiety of intermittent employment and of rejection when auditioning for work. Advancement. Advancement for musicians usually means becoming better known, finding work more easily, and per­ forming for higher earnings. Successful musicians often rely on agents or managers to find them performing engagements, negotiate contracts, and develop their careers.  Employment Musicians, singers, and related workers held about 264,000 jobs in 2006. Around 35 percent worked part time; 48 percent were self-employed. Many found jobs in cities in which enter­ tainment and recording activities are concentrated, such as New York, Los Angeles, Las Vegas, Chicago, and Nashville. Musicians, singers, and related workers are employed in a variety of settings. Of those who earn a wage or salary, 35 per­ cent were employed by religious organizations and 11 percent by performing arts companies such as professional orchestras, small chamber music groups, opera companies, musical theater companies, and ballet troupes. Musicians and singers also per­ form in nightclubs and restaurants and for weddings and other  Professional and Related Occupations 321  events. Well-known musicians and groups may perform in concerts, appear on radio and television broadcasts, and make recordings and music videos. The U.S. Armed Forces also offer careers in their bands and smaller musical groups.  Job Outlook Employment is expected to grow about as fast as the average for all occupations. Keen competition for jobs, especially full­ time jobs, is expected to continue. Talented individuals who are skilled in multiple instruments or musical styles will have the best job prospects. Employment change. Overall employment of musicians, singers, and related workers is expected to grow 11 percent during the 2006-16 decade, about as fast as the average for all occupations. Most new wage-and-salary jobs for musicians will arise in religious organizations. Five percent growth is ex­ pected for self-employed musicians, who generally perform in nightclubs, concert tours, and other venues. The Internet and other new forms of media may provide independent musicians and singers alternative methods to distribute music. Job prospects. Growth in demand for musicians will gener­ ate a number of job opportunities, and many openings also will arise from the need to replace those who leave the field each year because they are unable to make a living solely as musi­ cians or singers, or for other reasons. Competition for jobs as musicians, singers, and related work­ ers is expected to be keen, especially for full-time jobs. The vast number of people with the desire to perform will continue to greatly exceed the number of openings. New musicians or singers will have their best chance of landing a job with smaller, community-based performing arts groups or as freelance artists. Talented individuals who are skilled in multiple instruments or musical styles will have the best job prospects. However, tal­ ent alone is no guarantee of success: many people start out to become musicians or singers but leave the profession because they find the work difficult, the discipline demanding, and the long periods of intermittent unemployment a hardship.  Earnings Median hourly earnings of wage-and-salary musicians and sing­ ers were $19.73 in May 2006. The middle 50 percent earned between $10.81 and $36.55. The lowest 10 percent earned less than $7.08, and the highest 10 percent earned more than $57.37. Median hourly earnings were $23.37 in performing arts com­ panies and $13.57 in religious organizations. Annual earnings data for musicians and singers were not available because of the wide variation in the number of hours worked by musicians and singers and the short-term nature of many jobs. It is rare  for musicians and singers to have guaranteed employment that exceeds 3 to 6 months. Median annual earnings of salaried music directors and com­ posers were $39,750 in May 2006. The middle 50 percent earned between $23,660 and $60,350. The lowest 10 percent earned less than $15,210, and the highest 10 percent earned more than $110,850. For self-employed musicians and singers, earnings typically reflect the number of jobs a freelance musician or singer played or the number of hours and weeks of contract work, in addition to a performer’s professional reputation and setting. Perform­ ers who can fill large concert halls, arenas, or outdoor stadiums generally command higher pay than those who perform in local clubs. Soloists or headliners usually receive higher earnings than band members or opening acts. The most successful mu­ sicians earn performance or recording fees that far exceed the median earnings. The American Federation of Musicians negotiates minimum contracts for major orchestras during the performing season. Each orchestra works out a separate contract with its local union, but individual musicians may negotiate higher salaries. In regional orchestras, minimum salaries are often less because fewer performances are scheduled. Regional orchestra musi­ cians often are paid for their services, without any guarantee of future employment. Community orchestras often have more limited funding and offer salaries that are much lower for sea­ sons of shorter duration. Although musicians employed by some symphony orches­ tras work under master wage agreements, which guarantee a season’s work up to 52 weeks, many other musicians face relatively long periods of unemployment between jobs. Even when employed, many musicians and singers work part time in unrelated occupations. Thus, their earnings for music usually are lower than earnings in many other occupations. Moreover, because they may not work steadily for one employer, some performers cannot qualify for unemployment compensation, and few have typical benefits such as sick leave or paid vaca­ tions. For these reasons, many musicians give private lessons or take jobs unrelated to music to supplement their earnings as performers. Many musicians belong to a local of the American Federa­ tion of Musicians. Professional singers who perform live often belong to a branch of the American Guild of Musical Artists; those who record for the broadcast industries may belong to the American Federation of Television and Radio Artists.  Related Occupations Musical instrument repairers and tuners (part of the precision instrument and equipment repairers occupation) require tech-  Projections data from the National Employment Matrix Occupational Title Musicians, singers, and related workers............................................. Music directors and composers........................................................ Musicians and singers.......................................................................  SOC Code  Employment, 2006  27-2040 264,000 27-2041 68,000 27-2042196,000  Projected employment, 2016 293.000 77,000 216.000  Change, 2006-2016 Number Percent 29.000 11 8,800 13 10 20.000  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  322 Occupational Outlook Handbook  nical knowledge of musical instruments. Others whose work involves the performing arts include actors, producers, and di­ rectors; announcers; and dancers and choreographers. School teachers and self-enrichment education teachers who teach mu­ sic often use some of the same knowledge and skills as musi­ cians and singers.  Sources of Additional Information For general information about music and music teacher educa­ tion and a list of accredited college-level programs, contact: y National Association of Schools of Music, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasm.arts-accredit.org  Media and Communication-Related Occupations Announcers (0*NET 27-3011.00, 27-3012.00)  Significant Points  • • •  •  Competition for announcer jobs will continue to be keen. Jobs at small stations usually have low pay, but offer the best opportunities for inexperienced announcers. Applicants who have completed internships or have related work experience, and those with computer skills, may have an advantage in the job market. Employment is projected to decline.  Nature of the Work Radio and television announcers perform a variety of tasks on and off the air. They announce station program information, such as program schedules and station breaks for commercials, or public service information, and they introduce and close pro­ grams. Announcers read prepared scripts or make ad lib com­ mentary on the air, as they present news, sports, the weather, time, and commercials. If a written script is required, they may do the research and writing. Announcers also interview guests and moderate panels or discussions. Some provide commen­ tary for the audience during sporting events, at parades, and on other occasions. Announcers often are well known to radio and television audiences and may make promotional appearances and do remote broadcasts for their stations. Announcers at smaller stations may cover all of these areas and tend to have more off-air duties as well. They may oper­ ate the control board, monitor the transmitter, sell commercial time to advertisers, keep a log of the station’s daily program­ ming, and produce advertisements and other recorded material. Advances in technology make it possible for announcers to do some work previously performed by editors and broadcast technicians. At many music stations, the announcer is simulta­ neously responsible both for announcing and for operating the control board, which is used to broadcast programming, com­ mercials, and public-service announcements according to the station’s schedule. Much of the recorded material that used to be on records or tape is now in the form of digital files on com­ puters. (See the statement on broadcast and sound engineering technicians and radio operators elsewhere in the Handbook.)   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Public radio and television announcers are involved in station fundraising efforts. Changes in technology have led to more remote operation of stations. Several stations in different locations of the same region may be operated from one office. Some stations oper­ ate overnight without any staff, playing programming from a satellite feed or using programming that was recorded earlier, including segments from announcers. Announcers frequently participate in community activities. Sports announcers, for example, may serve as masters of cere­ monies at sports club banquets or may greet customers at open­ ings of sporting goods stores. Radio announcers who broadcast music often are called disc jockeys (DJs). Some DJs specialize in one kind of music, an­ nouncing selections as they air them. Most DJs do not select much of the music they play (although they often did so in the past); instead, they follow schedules of commercials, talk, and music provided to them by management. While on the air, DJs comment on the music, weather, and traffic. They may take requests from listeners, interview guests, and manage listener contests. Some DJs announce and play music at clubs, dances, restau­ rants, and weddings. They often have their own equipment with which to play the music. Many are self-employed and rent their services out on a job-by-job basis. Show hosts may specialize in a certain area of interest, such as politics, personal finance, sports, or health. They contribute to the preparation of the program’s content, interview guests, and discuss issues with viewers, listeners, or the studio audi­ ence.  Public address system announcers provide information to the audience at sporting, performing arts, and other events. Work environment. Announcers usually work in well-light­ ed, air-conditioned, soundproof studios. Announcers often work within tight schedules, which can be physically and men­ tally stressful. For many announcers, the intangible rewards— creative work, many personal contacts, and the satisfaction of becoming widely known—far outweigh the disadvantages of irregular and often unpredictable hours, work pressures, and disrupted personal lives. The broadcast day is long for radio and TV stations—many are on the air 24 hours a day—so announcers can expect to work unusual hours. Many present early-morning shows, when most people are getting ready for work or commuting, while others do late-night programs. The shifts, however, may not be as varied as in the past because new technology is allowing stations to eliminate some of the overnight hours.  Professional and Related Occupations 323  J  Announcers may read prepared scripts or make ad-lib commen­ tary on the air.  Training, Other Qualifications, and Advancement Entry into this occupation is highly competitive, and postsec­ ondary education or long-term on-the-job training is common. Trainees usually must have several years of experience in the industry before receiving an opportunity to work on the air. An applicant’s delivery and—in television—appearance and style is important. Education and training. Formal training in broadcasting from a college, a technical school, or a private broadcasting school is valuable. These programs prepare students to work with emerging technologies, a skill that is becoming increas­ ingly important. Many announcers have a bachelor’s degree in a subject such as communications, broadcasting, or journalism. High school and college courses in English, public speaking, drama, foreign languages, and computer science are valuable, and hobbies such as sports and music are additional assets. Individuals considering enrolling in a broadcasting school should contact personnel managers of radio and television sta­ tions, as well as broadcasting trade organizations, to determine the school’s reputation for producing suitably trained candi­ dates. Announcers are often required to complete long-term on-thejob training. This can be accomplished at campus radio or TV facilities and at commercial stations while students serve as in­ terns. Paid or unpaid internships provide students with handson training and the chance to establish contacts in the industry. Unpaid interns often receive college credit and are allowed to observe and assist station employees. Although the Fair Labor Standards Act limits the amount of work that unpaid interns may perform in a station, unpaid internships are more common than paid internships. Unpaid internships sometimes lead to paid internships, however, which are valuable because interns do work ordinarily performed by regular employees and may even go on the air.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Once hired by a television station, an employee usually starts out as a production assistant, researcher, or reporter and is given a chance to move into announcing if they show an aptitude for “on-air” work. A beginner’s chance of landing an on-air job is remote. The best chances for an on-air job for inexperienced announcers may be as a substitute for a familiar announcer at a small radio station or on the late-night shift at a larger station. In radio, newcomers usually start out taping interviews and op­ erating equipment. Other qualifications. Announcers must have a pleasant and well-controlled voice, good timing, excellent pronunciation, and correct grammar. College broadcasting programs offer courses, such as voice and diction, to help students improve their vocal qualities. Television announcers need a neat, pleas­ ing appearance as well. Knowledge of theater, sports, music, business, politics, and other subjects likely to be covered in broadcasts improves one’s chances for success. Announcers, especially those seeking radio careers, should have good infor­ mation technology skills and be capable of using computers, editing equipment, and other broadcast-related devices because new advances in technology have made these abilities increas­ ingly important. Announcers also need strong writing skills, because they normally write their own material. In addition, they should be able to ad lib all or part of a show and to work under tight deadlines. The most successful announcers attract a large audience by combining a pleasing personality and voice with an appealing style. Advancement. Announcers usually begin at a station in a small community and, if they are qualified, may move to a bet­ ter paying job in a large city. They also may advance by host­ ing a regular program as a disc jockey, sportscaster, or other specialist. Competition for employment by networks is particu­ larly intense, and employers look for college graduates with at least several years of successful announcing experience.  Employment Announcers held about 71,000 jobs in 2006. About 42 percent of all announcers worked part time. About 54 percent were employed in radio and television broadcasting. Another 30 per­ cent were self-employed freelance announcers who sold their services for individual assignments to networks and stations, to advertising agencies, other independent producers, or to spon­ sors of local events.  Job Outlook Competition for jobs as announcers will be keen because the broadcasting field attracts many more jobseekers than there are jobs. Furthermore, employment of announcers is projected to decline. In some cases, announcers leave the field because they cannot advance to better paying jobs. Changes in station own­ ership, format, and ratings frequently cause periods of unem­ ployment for many announcers. Employment change. Employment of announcers is ex­ pected to decline moderately by 7 percent from 2006 to 2016. Increasing consolidation of radio and television stations, the advent of new technology, and growth of alternative media sources, such as satellite radio, will contribute to the expected decline. Consolidation among broadcasting companies may lead to an increased use of syndicated programming and pro-  324 Occupational Outlook Handbook  Projections data from the National Employment Matrix  soc  Occupational Title  Code  Announcers.............................................................................. ........ Radio and television announcers........................................ ........ Public address system and other announcers...................  ........  27-3010 27-3011 27-3012  Projected employment,  Employment,  2006 71,000 59,000 12,000  2016 66,000 54,000 12,000  Change,  2006-2016  Number  Percent  -4,900 -4,900 0  -7 -8 0  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.  grams originating outside a station’s viewing or listening area. Digital technology is increasing the productivity of announcers, reducing the time required to edit material or perform other offair technical and production work. Job prospects. Some job openings will arise from the need to replace those who transfer to other kinds of work or leave the labor force. Nevertheless, competition for jobs as announc­ ers will be keen because the broadcasting field attracts many more jobseekers than there are jobs. Small radio stations are more inclined to hire beginners, but the pay is low. Applicants who have completed internships and those with related work experience usually receive preference for available positions. Job seekers with good computer and technical skills also will have an advantage because announcers are now doing more of the computer work that was previously carried out by techni­ cians. In radio, announcers are increasingly using computers to edit their programs. Because competition for ratings is so intense in major metropolitan areas, large stations will continue to seek announcers who have proven that they can attract and retain a sizable audience. Announcers who are knowledgeable about business, consumer, and health news also may have an advantage over others. While subject-matter specialization is more common at large stations and the networks, many small stations also encourage it. There will be some opportunities for self-employed DJ’s who provide music at clubs and special events but most of these jobs will be part time.  and translators; salespersons and those in related occupations; and public relations specialists. Many announcers also must entertain their audience, so their work is similar to other en­ tertainment-related occupations, such as actors, producers, and directors; and musicians, singers, and related workers. Some announcers write their own material, as do writers and editors. Announcers perform a variety of duties, including some tech­ nical operations similar to those performed by broadcast and sound engineering technicians and radio operators.  Sources of Additional Information General information on the broadcasting industry, where many announcers are employed, is available from: y National Association of Broadcasters, 1771 N St.NW., Washington, DC 20036. Internet: http://www.nab.org  Broadcast and Sound Engineering Technicians and Radio Operators (Q**NET 27-4011.00, 27-4012.00, 27-4013.00, 27-4014.00)  Significant Points  •  Job applicants will face keen competition for jobs in major metropolitan areas, where pay generally is higher; prospects are expected to be better in small cities and towns.  •  Technical school, community college, or college train­ ing in broadcast technology, electronics, or computer networking provides the best preparation. About 30 percent of these workers are in broadcast­ ing, mainly in radio and television stations, and 17 percent work in the motion picture, video, and sound recording industries. Evening, weekend, and holiday work is common.  Earnings Salaries in broadcasting vary widely, but generally are relatively low, except for announcers who work for large stations in major markets or for networks. Earnings are higher in television than in radio and higher in commercial broadcasting than in public broadcasting. Median hourly earnings of wage and salary radio and televi­ sion announcers in May 2006 were $11.69. The middle 50 per­ cent earned between $8.10 and $18.62. The lowest 10 percent earned less than $6.55, and the highest 10 percent earned more than $32.98. Median hourly earnings of announcers in the ra­ dio and television broadcasting industry were $11.52. Median hourly earnings of wage and salary public address and other system announcers in May 2006 were $12.02. The middle 50 percent earned between $8.41 and $19.38. The low­ est 10 percent earned less than $6.73 and the highest 10 percent earned more than $29.69.  Related Occupations The success of announcers depends upon how well they com­ municate. Others who must be skilled at oral communication in­ clude news analysts, reporters, and correspondents; interpreters  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  •  •  Nature of the Work Broadcast and sound engineering technicians and radio opera­ tors set up, operate, and maintain a wide variety of electrical and electronic equipment used in almost any radio or television broadcast, concert, play, musical recording, television show, or movie. With such a range of work, there are many specialized occupations within the field. Audio and video equipment technicians set up and operate au­ dio and video equipment, including microphones, sound speak­ ers, video screens, projectors, video monitors, and recording  Professional and Related Occupations 325  equipment. They also connect wires and cables and set up and operate sound and mixing boards and related electronic equip­ ment for concerts, sports events, meetings and conventions, pre­ sentations, and news conferences. They may set up and operate associated spotlights and other custom lighting systems. Broadcast technicians set up, operate, and maintain equip­ ment that regulates the signal strength, clarity, and the range of sounds and colors of radio or television broadcasts. These technicians also operate control panels to select the source of the material. Technicians may switch from one camera or stu­ dio to another, from film to live programming, or from network to local programming. Sound engineering technicians operate machines and equip­ ment to record, synchronize, mix, or reproduce music, voices, or sound effects in recording studios, sporting arenas, theater productions, or movie and video productions. Radio operators mainly receive and transmit communications using a variety of tools. These workers also repair equipment, using such devices as electronic testing equipment, handtools, and power tools. One of their major duties is to help to main­ tain communication systems in good condition. The transition to digital recording, editing, and broadcasting has greatly changed the work of broadcast and sound engineer­ ing technicians and radio operators. Software on desktop com­ puters has replaced specialized electronic equipment in many recording and editing functions. Most radio and television sta­ tions have replaced videotapes and audiotapes with computer hard drives and other computer data storage systems. Comput­ er networks linked to specialized equipment dominate modem broadcasting. This transition has forced technicians to learn computer networking and software skills. (See the statement on computer support specialists and systems administrators else­ where in the Handbook.) Broadcast and sound engineering technicians and radio op­ erators perform a variety of duties in small stations. In large stations and at the networks, technicians are more specialized, although job assignments may change from day to day. The terms “operator,” “engineer,” and “technician” often are used interchangeably to describe these jobs. Workers in these posi­ tions may monitor and log outgoing signals and operate trans­ mitters; set up, adjust, service, and repair electronic broad­ casting equipment; and regulate fidelity, brightness, contrast, volume, and sound quality of television broadcasts. Technicians also work in program production. Recording en­ gineers operate and maintain video and sound recording equip­ ment. They may operate equipment designed to produce special effects, such as the illusions of a bolt of lightning or a police si­ ren. Sound mixers or re-recording mixers produce soundtracks for movies or television programs. After filming or recording is complete, these workers may use a process called “dubbing” to insert sounds. Field technicians set up and operate portable transmission equipment outside the studio. Because television news coverage requires so much electronic equipment and the technology is changing so rapidly, many stations assign techni­ cians exclusively to news. Chief engineers, transmission engineers, and broadcast field supervisors oversee other technicians and maintain broadcast­ ing equipment.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Evening, weekend, and holiday work is commonfor some broad­ cast and sound engineering technicians and radio operators.  Work environment. Broadcast and sound engineering tech­ nicians and radio operators generally work indoors in pleasant surroundings. However, those who broadcast news and other programs from locations outside the studio may work outdoors in all types of weather or in other dangerous conditions. Tech­ nicians doing maintenance may climb poles or antenna towers, while those setting up equipment do heavy lifting. Technicians at large stations and the networks usually work a 40-hour week under great pressure to meet broadcast deadlines, and may occasionally work overtime. Technicians at small stations routinely work more than 40 hours a week. Evening, weekend, and holiday work is usual because most stations are on the air 18 to 24 hours a day, 7 days a week. Even though a technician may not be on duty when the station is broadcasting, some technicians may be on call during nonwork hours; these workers must handle any problems that occur when they are on call. Technicians who work on motion pictures may be on a tight schedule and may work long hours to meet contractual dead­ lines.  Training, Other Qualifications, and Advancement Both broadcast and sound engineering technicians usually re­ ceive some kind of formal training prior to beginning work. Audio and video technicians usually learn the skills they need through a year or more of on-the-job training, but some have formal education after high school. Radio operators usually train for several months on the job Education and training. The best way to prepare for a broad­ cast and sound engineering technician job is to obtain techni­ cal school, community college, or college training in broadcast technology, electronics, or computer networking. For broad­ cast technicians, an associate degree is recommended. Sound engineering technicians usually complete vocational programs, which usually takes about a year, although there are shorter pro­  326 Occupational Outlook Handbook  grams. Prospective technicians should take high school courses in math, physics, and electronics. When starting out, broadcast and sound engineering techni­ cians learn skills on the job from experienced technicians and supervisors. These beginners often start their careers in small stations and, once experienced, transfer to larger ones. Large stations usually hire only technicians with experience. Many employers pay tuition and expenses for courses or seminars to help technicians keep abreast of developments in the field. Audio and video equipment technicians generally need a high school diploma. Many recent entrants have a community col­ lege degree or other forms of postsecondary degrees, although they are not always required. These technicians may substitute on-the-job training for formal education requirements. Many audio and video technicians learn through long-term on-the-job training, lasting from 1 to several years, depending on the spe­ cifics of their job. Working in a studio as an assistant is a good way of gaining experience and knowledge. Radio operators usually are not required to complete any formal training. This is an entry-level position that generally requires on-the-job training. In the motion picture industry, people are hired as appren­ tice editorial assistants and work their way up to more skilled jobs. Employers in the motion picture industry usually hire ex­ perienced freelance technicians on a picture-by-picture basis. Reputation and determination are important in getting jobs. Continuing education to become familiar with emerging technologies is recommended for all broadcast and sound engi­ neering technicians and radio operators. Other qualifications. Building electronic equipment from hobby kits and operating a “ham,” or amateur, radio are good ways to prepare for these careers, as is working in college radio and television stations. Information technology skills also are valuable because digital recording, editing, and broadcasting are now the norm. Broadcast and sound engineering techni­ cians and radio operators must have manual dexterity and an aptitude for working with electrical, electronic, and mechanical systems and equipment. Certification and advancement. Licensing is not required for broadcast technicians. However, certification by the Society of Broadcast Engineers is a mark of competence and experi­ ence. The certificate is issued to experienced technicians who pass an examination. Experienced technicians can become supervisory technicians or chief engineers. A college degree in engineering is needed to become chief engineer at a large television station.  Employment Broadcast and sound engineering technicians and radio opera­ tors held about 105,000 jobs in 2006. Their employment was distributed among the following detailed occupations: Audio and video equipment technicians...............................50,000 Broadcast technicians............................................................ 38,000 Sound engineering technicians............................................. 16,000 Radio operators........................................................................1,500 About 30 percent worked in broadcasting (except Internet) and 17 percent worked in the motion picture, video, and sound recording industries. About 13 percent were self-employed. Television stations employ, on average, many more technicians than radio stations. Some technicians are employed in other industries, producing employee communications, sales, and training programs. Technician jobs in television and radio are located in virtually all cities; jobs in radio also are found in many small towns. The highest paying and most specialized jobs are concentrated in New York City, Los Angeles, Chicago, and Washington, DC—the originating centers for most network or news programs. Motion picture production jobs are concen­ trated in Los Angeles and New York City.  Job Outlook Employment is expected to grow faster than average through 2016. But people seeking entry-level jobs as technicians in broadcasting are expected to face keen competition in major metropolitan areas. Prospects are expected to be better in small cities and towns. Employment change. Overall employment of broadcast and sound engineering technicians and radio operators is expected to grow 17 percent over the 2006-16 decade, which is faster than the average for all occupations. Job growth in radio and televi­ sion broadcasting will be limited by consolidation of ownership of radio and television stations and by labor-saving technical advances, such as computer-controlled programming and re­ motely controlled transmitters. Stations often are consolidated and operated from a single location, reducing employment be­ cause one or a few technicians can provide support to multiple stations. Offsetting these trends, however, is a move toward digital broadcasting that will increase employment opportuni­ ties. As of February 2009, television stations will only be al­ lowed to broadcast digital signals and, by law, will be forced to turn off their analog signals. Technicians who can install and operate digital transmitters will be in demand as stations attempt to meet this deadline. Radio stations are beginning to  Projections data from the National Employment Matrix Occupational Title Broadcast and sound engineering technicians and radio operators .. Audio and video equipment technicians......................................... Broadcast technicians.................................................................. Radio operators.................................................................................. Sound engineering technicians........................................................  soc Code 27-4010 27-4011 27-4012 27-4013 27-4014  Employment, 2006 105,000 50,000 38,000 1,500 16,000  Projected employment, 2016 123,000 62,000 42,000 1,300 18,000  Change, 2006-2016 Number Percent 18,000 17 12,000 24 4,600 12 -300 -16 1,500 9  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 327  broadcast digital signals as well, but there is no law that will require them to do so. Projected job growth varies among detailed occupations in this field. Employment of audio and video equipment techni­ cians is expected to grow 24 percent through 2016, which is much faster than the average for all occupations. Not only will these workers have to set up audio and video equipment, but they will have to maintain and repair it as well. Employment of broadcast technicians and sound engineering technicians is expected to grow 12 percent and 9 percent respectively, through 2016, about as fast as the average for all occupations. Advance­ ments in technology will enhance the capabilities of technicians to produce higher quality radio and television programming. Employment of radio operators, on the other hand, is projected to decline rapidly by 16 percent through 2016 as more stations control programming and operate transmitters remotely. Employment of broadcast and sound engineering technicians in the cable and pay television portion of the broadcasting in­ dustry is expected to grow as the range of products and services expands, including cable Internet access and video-on-demand. Employment of these workers in the motion picture industry is expected to grow rapidly. However, this job market is ex­ pected to remain competitive because of the large number of people who are attracted by the glamour of working in motion pictures. Job prospects. People seeking entry-level jobs as technicians in broadcasting are expected to face keen competition in ma­ jor metropolitan areas, where pay generally is higher and the number of qualified jobseekers typically exceeds the number of openings. Prospects for entry-level positions are expected to be better in small cities and towns for beginners with appropriate training. In addition to employment growth, job openings will result from the need to replace experienced technicians who leave this field. Some of these workers leave for other jobs that require knowledge of electronics, such as computer repairer or indus­ trial machinery repairer.  Median annual earnings of sound engineering technicians in May 2006 were $43,010. The middle 50 percent earned be­ tween $29,270 and $65,590. The lowest 10 percent earned less than $21,050, and the highest 10 percent earned more than $90,770. Median annual earnings of radio operators in May 2006 were $37,890. The middle 50 percent earned between $28,860 and $48,280. The lowest 10 percent earned less than $20,790, and the highest 10 percent earned more than $57,920.  Earnings  (Q*NET 27-3091.00)  Television stations usually pay higher salaries than radio sta­ tions; commercial broadcasting usually pays more than public broadcasting; and stations in large markets pay more than those in small markets. Median annual earnings of audio and video equipment tech­ nicians in May 2006 were $34,840. The middle 50 percent earned between $26,090 and $46,320. The lowest 10 percent earned less than $19,980, and the highest 10 percent earned more than $62,550. Median annual earnings in motion picture and video industries, which employed the largest number of au­ dio and video equipment technicians, were $34,530. Median annual earnings of broadcast technicians in May 2006 were $30,690. The middle 50 percent earned between $20,880 and $45,310. The lowest 10 percent earned less than $15,680, and the highest 10 percent earned more than $64,860. Median annual earnings in radio and television broadcasting, which employed the largest number of broadcast technicians, were $27,380.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Related Occupations Broadcast and sound engineering technicians and radio opera­ tors need the electronics training necessary to operate technical equipment, and they generally complete specialized postsecond­ ary programs. Occupations with similar characteristics include engineering technicians, science technicians, and electrical and electronics installers and repairers. Broadcast and sound en­ gineering technicians also may operate computer networks, as do computer support specialists and systems administrators. Broadcast technicians on some live radio and television pro­ grams screen incoming calls; these workers have responsibili­ ties similar to those of communications equipment operators.  Sources of Additional Information For career information and links to employment resources, con­ tact: y National Association of Broadcasters, 1771 N St.NW., Washington, DC 20036. Internet: http://www.nab.org For information on certification, contact: y Society ofBroadcast Engineers, 9182 North Meridian St., Suite 150, Indianapolis, IN 46260. Internet: http://www.sbe.org For information on audio and video equipment technicians, contact: y InfoComm International, 11242 Waples Mill Rd., Suite 200, Fairfax, VA 22030. Internet: http://www.infocomm.org  Interpreters and Translators  Significant Points  • • •  •  About 22 percent of interpreters and translators are self-employed. Work is often sporadic, and many of these workers are part time. In addition to needing fluency in at least two languag­ es, many interpreters and translators need a bachelor’s degree. Many also complete job-specific training pro­ grams. Job outlook varies by specialty.  Nature of the Work Interpreters and translators enable the cross-cultural communi­ cation necessary in today’s society by converting one language into another. However, these language specialists do more than  328 Occupational Outlook Handbook  simply translate words—they relay concepts and ideas between languages. They must thoroughly understand the subject matter in which they work in order to accurately convert information from one language, known as the source language, into another, the target language. In addition, they must be sensitive to the cultures associated with their languages of expertise. Interpreters and translators are often discussed together be­ cause they share some common traits. For example, both must be fluent in at least two languages—a native, or active, language and a secondary, or passive, language; a small number of inter­ preters and translators are fluent in two or more passive lan­ guages. Their active language is the one that they know best and into which they interpret or translate, and their passive lan­ guage is one for which they have nearly perfect knowledge. Although some people do both, interpretation and translation are different professions. Interpreters deal with spoken words, translators with written words. Each task requires a distinct set of skills and aptitudes, and most people are better suited for one or the other. While interpreters often work into and from both languages, translators generally work only into their active language. Interpreters convert one spoken language into another—or, in the case of sign-language interpreters, between spoken com­ munication and sign language. This requires interpreters to pay attention carefully, understand what is communicated in both languages, and express thoughts and ideas clearly. Strong re­ search and analytical skills, mental dexterity, and an exceptional memory also are important. The first part of an interpreter’s work begins before arriving at the jobsite. The interpreter must become familiar with the subject matter that the speakers will discuss, a task that may involve research to create a list of common words and phrases associated with the topic. Next, the interpreter usually travels to the location where his or her services are needed. Physical presence may not be required for some work, such as telephone interpretation. But it is usually important that the interpreter see the communicators in order to hear and observe the person speaking and to relay the message to the other party. There are two types of interpretation: simultaneous and con­ secutive. Simultaneous interpretation requires interpreters to listen and speak (or sign) at the same time. In simultaneous interpretation, the interpreter begins to convey a sentence being spoken while the speaker is still talking. Ideally, simultaneous interpreters should be so familiar with a subject that they are able to anticipate the end of the speaker’s sentence. Because they need a high degree of concentration, simultaneous inter­ preters work in pairs, with each interpreting for 20- to 30-min­ ute periods. This type of interpretation is required at interna­ tional conferences and is sometimes used in the courts. In contrast to simultaneous interpretation’s immediacy, con­ secutive interpretation begins only after the speaker has verbal­ ized a group of words or sentences. Consecutive interpreters often take notes while listening to the speakers, so they must develop some type of note-taking or shorthand system. This form of interpretation is used most often for person-to-person communication, during which the interpreter is positioned near both parties.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Translators convert written materials from one language into another. They must have excellent writing and analytical abil­ ity. And because the documents that they translate must be as flawless as possible, they also need good editing skills. Assignments may vary in length, writing style, and subject matter. When translators first receive text to convert into an­ other language, they usually read it in its entirety to get an idea of the subject. Next, they identify and look up any unfamiliar words. Multiple additional readings are usually needed before translators begin to actually write and finalize the translation. Translators also might do additional research on the subject matter if they are unclear about anything in the text. They con­ sult with the text’s originator or issuing agency to clarify un­ clear or unfamiliar ideas, words, or acronyms. Translating involves more than replacing a word with its equivalent in another language; sentences and ideas must be manipulated to flow with the same coherence as those in the source document so that the translation reads as though it origi­ nated in the target language. Translators also must bear in mind any cultural references that may need to be explained to the intended audience, such as colloquialisms, slang, and other ex­ pressions that do not translate literally. Some subjects may be more difficult than others to translate because words or passag­ es may have multiple meanings that make several translations possible. Not surprisingly, translated work often goes through multiple revisions before final text is submitted. The way in which translators do their jobs has changed with advances in technology. Today, nearly all translation work is done on a computer, and most assignments are received and submitted electronically. This enables translators to work from almost anywhere, and a large percentage of them work from home. The Internet provides advanced research capabilities and valuable language resources, such as specialized diction­ aries and glossaries. In some cases, use of machine-assisted translation—including memory tools that provide comparisons of previous translations with current work—helps save time and reduce repetition. The services of interpreters and translators are needed in a number of subject areas. While these workers may not com­ pletely specialize in a particular field or industry, many do focus on one area of expertise. Some of the most common areas are described below; however, interpreters and translators also may work in a variety of other areas, including business, social ser­ vices, or entertainment. Conference interpreters work at conferences that have nonEnglish-speaking attendees. This work includes international business and diplomacy, although conference interpreters in­ terpret for any organization that works with foreign language speakers. Employers prefer high-level interpreters who have the ability to translate from at least two passive languages into one active (native) language—for example, the ability to inter­ pret from Spanish and French into English. For some posi­ tions, such as those with the United Nations, this qualification is mandatory. Much of the interpreting performed at conferences is simul­ taneous; however, at some meetings with a small number of attendees, consecutive interpreting also may be used. Usually, interpreters sit in soundproof booths, listening to the speakers  Professional and Related Occupations 329  through headphones and interpreting into a microphone what is said. The interpreted speech is then relayed to the listener through headsets. When interpreting is needed for only one or two people, the interpreter generally sits behind or next to the attendee and whispers a translation of the proceedings. Guide or escort interpreters accompany either U.S. visitors abroad or foreign visitors in the United States to ensure that they are able to communicate during their stay. These special­ ists interpret on a variety of subjects, both on an informal basis and on a professional level. Most of their interpretation is con­ secutive, and work is generally shared by two interpreters when the assignment requires more than an 8-hour day. Frequent travel, often for days or weeks at a time, is common, an aspect of the job that some find particularly appealing. Judiciary interpreters and translators help people appearing in court who are unable or unwilling to communicate in Eng­ lish. These workers must remain detached from the content of their work and not alter or modify the meaning or tone of what is said. Legal translators must be thoroughly familiar with the language and functions of the U.S. judicial system, as well as other countries’ legal systems. Court interpreters work in a va­ riety of legal settings, such as attorney-client meetings, prelimi­ nary hearings, depositions, trials, and arraignments. Success as a court interpreter requires an understanding of both legal ter­ minology and colloquial language. In addition to interpreting what is said, court interpreters also may be required to translate written documents and read them aloud, also known as sight translation. Literary translators adapt written literature from one lan­ guage into another. They may translate any number of docu­ ments, including journal articles, books, poetry, and short sto­ ries. Literary translation is related to creative writing; literary translators must create a new text in the target language that reproduces the content and style of the original. Whenever pos­ sible, literary translators work closely with authors to best cap­ ture their intended meanings and literary characteristics. This type of work often is done as a sideline by university professors; however, opportunities exist for well-established literary translators. As with writers, finding a publisher and maintaining a network of contacts in the publishing industry is a critical part of the job. Most aspiring literary translators begin by submitting a short sample of their work, in the hope that it will be printed and give them recognition. For example, after receiving permission from the author, they might submit to a publishing house a previously unpublished short work, such as a poem or essay. Localization translators constitute a relatively recent and rapidly expanding specialty. Localization involves the com­ plete adaptation of a product for use in a different language and culture. At its earlier stages, this work dealt primarily with soft­ ware localization, but the specialty has expanded to include the adaptation of Internet sites and products in manufacturing and other business sectors. The goal of these specialists is to make the product to appear as if it were originally manufactured in the country where it will be sold and supported. Medical interpreters and translators provide language ser­ vices to health care patients with limited English proficiency. Medical interpreters help patients to communicate with doc­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  tors, nurses, and other medical staff. Translators working in this specialty primarily convert patient materials and informa­ tional brochures issued by hospitals and medical facilities into the desired language. Medical interpreters need a strong grasp of medical and colloquial terminology in both languages, along with cultural sensitivity regarding how the patient receives the information. They must remain detached but aware of the pa­ tient’s feelings and pain. Sign language interpreters facilitate communication between people who are deaf or hard of hearing and people who can hear. Sign language interpreters must be fluent in English and in American Sign Language (ASL), which combines signing, finger spelling, and specific body language. ASL has its own grammatical rules, sentence structure, idioms, historical con­ texts, and cultural nuances. Sign language interpreting, like for­ eign language interpreting, involves more than simply replacing a word of spoken English with a sign representing that word. Most sign language interpreters either interpret, aiding com­ munication between English and ASL, or transliterate, facili­ tating communication between English and contact signing—a form of signing that uses a more English language-based word order. Some interpreters specialize in oral interpreting for deaf or hard of hearing people who lip-read instead of sign. Other specialties include tactile signing, which is interpreting for peo­ ple who are blind as well as deaf by making manual signs into a person’s hands; cued speech; and signing exact English. Self-employed and freelance interpreters and translators need general business skills to successfully manage their finances and careers. They must set prices for their work, bill custom­ ers, keep financial records, and market their services to attract new business and build their client base. Work environment. Interpreters work in a variety of settings, such as hospitals, courtrooms, and conference centers. They are required to travel to the site—whether it is in a neighboring town or on the other side of the world—where their services are needed. Interpreters who work over the telephone gener­ ally work in call centers in urban areas, and keep to a standard 5-day, 40-hour workweek. Interpreters for deaf students in schools usually work in a school setting for 9 months out of the year. Translators usually work alone, and they must frequently perform under pressure of deadlines and tight schedules. Many translators choose to work at home; however, technology al­ lows translators to work from almost anywhere. Because many interpreters and translators freelance, their schedules are often erratic, with extensive periods of no work interspersed with periods requiring long, irregular hours. For those who freelance, a significant amount of time must be dedi­ cated to looking for jobs. In addition, freelancers must manage their own finances, and payment for their services may not al­ ways be prompt. Freelancing, however, offers variety and flex­ ibility, and allows many workers to choose which jobs to accept or decline. The work can be stressful and exhausting, and translation can be lonesome. However, interpreters and translators may use their irregular schedules to pursue other interests, such as traveling, dabbling in a hobby, or working a second job. Many interpreters and translators enjoy what they do and value the ability to control their schedules and workloads.  330 Occupational Outlook Handbook  Hr.  Interpreters and translators need fluency in at least two lan­ guages and, in many cases, a bachelor’s degree.  Training, Other Qualifications, and Advancement Interpreters and translators must be fluent in at least two lan­ guages. Their educational backgrounds may vary widely, but most have a bachelor’s degree. Many also complete job-spe­ cific training programs. Education and training. The educational backgrounds of in­ terpreters and translators vary. Knowing at least two languages is essential. Although it is not necessary to have been raised bilingual to succeed, many interpreters and translators grew up speaking two languages. In high school, students can prepare for these careers by tak­ ing a broad range of courses that include English writing and comprehension, foreign languages, and basic computer profi­ ciency. Other helpful pursuits include spending time abroad, engaging in direct contact with foreign cultures, and reading extensively on a variety of subjects in English and at least one other language. Beyond high school, there are many educational options. Al­ though a bachelor’s degree is often required, interpreters and translators note that it is acceptable to major in something other than a language. An educational background in a particular field of study provides a natural area of subject matter expertise. However, specialized training in how to do the work is gener­ ally required. Formal programs in interpreting and translation are available at colleges nationwide and through nonuniversity training programs, conferences, and courses. Many people who work as conference interpreters or in more technical areas—such as localization, engineering, or finance—have mas­ ter’s degrees, while those working in the community as court or medical interpreters or translators are more likely to complete job-specific training programs. Other qualifications. Experience is an essential part of a successful career in either interpreting or translation. In fact, many agencies or companies use only the services of people who have worked in the field for 3 to 5 years or who have a degree in translation studies or both. A good way for translators to leam firsthand about the profes­ sion is to start out working in-house for a translation company; however, such jobs are not very numerous. People seeking to enter interpreter or translator jobs should begin by getting expe­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  rience whatever way they can—even if it means doing informal or unpaid work. Volunteer opportunities are available through community or­ ganizations, hospitals, and sporting events, such as marathons, that involve international competitors. The American Transla­ tors Association works with the Red Cross to provide volunteer interpreters in crisis situations. All translation can be used as examples for potential clients, even translation done as prac­ tice. Paid or unpaid internships and apprenticeships are other ways for interpreters and translators to get started. Escort interpreting may offer an opportunity for inexperienced candidates to work alongside a more seasoned interpreter. Interpreters might also find it easier to break into areas with particularly high demand for language services, such as court or medical interpretation. Whatever path of entry they pursue, new interpreters and translators should establish mentoring relationships to build their skills, confidence, and a professional network. Mentoring may be formal, such as through a professional association, or informal with a coworker or an acquaintance who has experi­ ence as an interpreter or translator. Both the American Transla­ tors Association and the Registry of Interpreters for the Deaf offer formal mentoring programs. Translators working in localization need a solid grasp of the languages to be translated, a thorough understanding of techni­ cal concepts and vocabulary, and a high degree of knowledge about the intended target audience or users of the product. Be­ cause software often is involved, it is not uncommon for people who work in this area of translation to have a strong background in computer science or to have computer-related work experi­ ence.  Certification and advancement. There is currently no uni­ versal form of certification required of interpreters and transla­ tors in the United States, but there are a variety of different tests that workers can take to demonstrate proficiency. The American Translators Association provides certification in more than 24 language combinations for its members; other options include a certification program offered by The Translators and Interpret­ ers Guild. Many interpreters are not certified. Federal courts have certification for Spanish, Navajo, and Haitian Creole interpreters, and many State and municipal courts offer their own forms of certification. The National As­ sociation of Judiciary Interpreters and Translators also offers certification for court interpreting. The U.S. Department of State has a three-test series for in­ terpreters, including simple consecutive interpreting (for escort work), simultaneous interpreting (for court or seminar work), and conference-level interpreting (for international confer­ ences). These tests are not referred to directly as certification, but successful completion often indicates that a person has an adequate level of skill to work in the field. The National Association of the Deaf and the Registry of In­ terpreters for the Deaf (RID) jointly offer certification for gen­ eral sign interpreters. In addition, the registry offers specialty tests in legal interpreting, speech reading, and deaf-to-deaf in­ terpreting—which includes interpreting between deaf speakers with different native languages and from ASL to tactile sign­ ing.  Professional and Related Occupations 331  Once interpreters and translators have gained sufficient expe­ rience, they may then move up to more difficult or prestigious assignments, may seek certification, may be given editorial responsibility, or may eventually manage or start a translation agency. Many self-employed interpreters and translators start busi­ nesses by submitting resumes and samples to many different employment agencies and then wait to be contacted when an agency matches their skills with a job. After establishing a few regular clients, interpreters and translators may receive enough work from a few clients to stay busy, and they often hear of subsequent jobs by word of mouth or through referrals from existing clients.  Employment Interpreters and translators held about 41,000 jobs in 2006. However, the actual number of interpreters and translators is probably significantly higher because many work in the occu­ pation only sporadically. Interpreters and translators are em­ ployed in a variety of industries, reflecting the diversity of em­ ployment options in the field. About 33 worked in public and private educational institutions, such as schools, colleges, and universities. About 12 worked in health care and social assis­ tance, many of whom worked for hospitals. Another 10 worked in other areas of government, such as Federal, State and local courts. Other employers of interpreters and translators include publishing companies, telephone companies, airlines, and inter­ preting and translating agencies. About 22 percent of interpreters and translators are self-em­ ployed. Many who freelance in the occupation work only part time, relying on other sources of income to supplement earn­ ings from interpreting or translation. Job Outlook Interpreters and translators can expect much faster than average employment growth over the next decade. Job prospects vary by specialty. Employment change. Employment of interpreters and trans­ lators is projected to increase 24 percent over the 2006-16 de­ cade, much faster than the average for all occupations. This growth will be driven partly by strong demand in health care settings and work related to homeland security. Additionally, higher demand for interpreters and translators results directly from the broadening of international ties and the increase in the number of foreign language speakers in the United States. Both of these trends are expected to continue, contributing to relatively rapid growth in the number of jobs for interpreters and translators. Current events and changing political environments, often difficult to foresee, will increase the need for people who can work with other languages. For example, homeland security  needs are expected to drive increasing demand for interpreters and translators of Middle Eastern and North African languages, primarily in Federal Government agencies. Demand will remain strong for translators of the languages referred to as “PFIGS”—Portuguese, French, Italian, German, and Spanish; Arabic and other Middle Eastern languages; and the principal Asian languages—Chinese, Japanese, and Korean. Demand for American Sign Language interpreters will grow rapidly, driven by the increasing use of video relay services, which allow individuals to conduct video calls using a sign lan­ guage interpreter over an Internet connection. Technology has made the work of interpreters and translators easier. However, technology is not likely to have a negative impact on employment of interpreters and translators because such innovations are incapable of producing work comparable with work produced by these professionals. Job prospects. Urban areas, especially Washington D.C., New York, and cities in California, provide the largest numbers of employment possibilities, especially for interpreters; how­ ever, as the immigrant population spreads into more rural areas, jobs in smaller communities will become more widely avail­ able. Job prospects for interpreters and translators vary by spe­ cialty. There should be demand for specialists in localization, driven by imports and exports and the expansion of the Internet; however, demand may be dampened somewhat by outsourcing of localization work to other countries. Demand is expected to be strong in other technical areas, such as medicine and law. Given the shortage of interpreters and translators meeting the desired skill level of employers, interpreters for the deaf will continue to have favorable employment prospects. On the other hand, job opportunities are expected to be limited for both con­ ference interpreters and literary translators.  Earnings Salaried interpreters and translators had median hourly earnings of $17.10 in May 2006. The middle 50 percent earned between $12.94 and $22.60. The lowest 10 percent earned less than $9.88, and the highest 10 percent earned more than $30.91. Earnings depend on language, subject matter, skill, experi­ ence, education, certification, and type of employer, and salaries of interpreters and translators can vary widely. Interpreters and translators who know languages for which there is a greater de­ mand, or which relatively few people can translate, often have higher earnings as do those with specialized expertise, such as those working in software localization. Individuals classified as language specialists for the Federal Government earned an average of $76,287 annually in 2007. Limited information sug­ gests that some highly skilled interpreters and translators—for example, high-level conference interpreters—working full time can earn more than $100,000 annually.  Projections data from the National Employment Matrix Projected Change, employment, 2006-2016 Code 2016 Number Percent Interpreters and translators...................................... ............................. 27-3091 41,000 51,000 9,700 24 NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2006  332 Occupational Outlook Handbook  For those who are not salaried, earnings may fluctuate, de­ pending on the availability of work. Freelance interpreters usu­ ally earn an hourly rate, whereas translators who freelance typi­ cally earn a rate per word or per hour.  Related Occupations Interpreters and translators use their multilingual skills, as do teachers of languages. These include preschool, kindergarten, elementary, middle, and secondary school teachers; postsecond­ ary school teachers; special education teachers; adult literacy and remedial education teachers; and self-enrichment education teachers. The work of interpreters, particularly guide or escort interpreters, is similar to that of tour guides and escorts, in that they accompany individuals or groups on tours or to places of interest. The work of translators is similar to that of writers and edi­ tors, in that they communicate information and ideas in writing and prepare texts for publication or dissemination. Further­ more, interpreters or translators working in a legal or health care environment are required to have a knowledge of terms and concepts that is similar to that of professionals working in these fields, such as court reporters or medical transcriptionists.  Sources of Additional Information Organizations dedicated to these professions can provide valu­ able advice and guidance to people interested in learning more about interpretation and translation. The language services di­ vision of local hospitals or courthouses also may have informa­ tion about available opportunities. For general career information, contact the organizations listed below; y American Translators Association, 225 Reinekers Ln., Suite 590, Alexandria, VA 22314. Internet: http://www.atanet.org For more detailed information by specialty, contact the as­ sociation affiliated with that subject area: y American Literary Translators Association, The University of Texas at Dallas, Box 830688 Mail Station J051, Richardson, TX 75083-0688. Internet: http://www.literarytranslators.org y Localization Industry Standards Association, Domaine en Prael, CH-1323 Romainmotier, Switzerland. Internet: http://www.lisa.org y National Association of Judiciary Interpreters and Translators, 603 Stewart St., Suite 610, Seattle, WA 98101. Internet: http://www.najit.org y National Council on Interpreting in Health Care, 270 West Lawrence St., Albany, NY 12208. Internet: http://www.ncihc.org y Registry of Interpreters for the Deaf, 333 Commerce St., Alexandria, VA 22314. Internet: http://www.rid.org For information about testing to become a contract interpreter or translator with the U.S. State Department, contact: y U.S. Department of State, Office of Language Services, 2401 E St.NW., SA-1, Room H1400, Washington, DC 20520-2204. Information on obtaining positions as interpreters and trans­ lators with the Federal Government is available from the Of­ fice of Personnel Management through USAJOBS, the Federal Government’s official employment information system. This resource for locating and applying for job opportunities can be accessed through the Internet at http://www.usajobs.opm.gov   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  or through an interactive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not toll free, and charges may result. For advice on how to find and apply for Federal jobs, see the Occupational Outlook Quarterly article “How to get a job in the Federal Government,” online at: http://www.bls.gov/opub/ooq/2004/summer/art01.pdf.  News Analysts, Reporters, and Correspondents (0*NET 27-3021.00, 27-3022.00)  Significant Points  •  Competition will be keen for jobs at large metropoli­ tan and national newspapers, broadcast stations, and magazines; small publications and broadcast stations and online newspapers and magazines should provide the best opportunities. • Most employers prefer individuals with a bachelor’s degree in journalism or mass communications and ex­ perience gained at school newspapers or broadcasting stations or through internships with news organiza­ tions. •  Jobs often involve long, irregular hours and pressure to meet deadlines.  Nature of the Work News analysts, reporters, and correspondents gather informa­ tion, prepare stories, and make broadcasts that inform us about local, State, national, and international events; present points of view on current issues; and report on the actions of public officials, corporate executives, interest groups, and others who exercise power. News analysts—also called newscasters or news anchors— examine, interpret, and broadcast news received from various sources. News anchors present news stories and introduce vid­ eotaped news or live transmissions from on-the-scene reporters. News correspondents report on news occurring in the large U.S. and foreign cities where they are stationed. In covering a story, reporters investigate leads and news tips, look at documents, observe events at the scene, and interview people. Reporters take notes and also may take photographs or shoot videos. At their office, they organize the material, deter­ mine the focus or emphasis, write their stories, and edit accom­ panying video material. Many reporters enter information or write stories using laptop computers and electronically submit the material to their offices from remote locations. In some cases, newswriters write a story from information collected and submitted by reporters. Radio and television reporters often compose stories and report “live” from the scene. At times, they later tape an introduction to or commentary on their story in the studio. Some journalists also interpret the news or offer  Professional and Related Occupations 333  opinions to readers, viewers, or listeners. In this role, they are called commentators or columnists. Newscasters at large stations and networks usually specialize in a particular type of news, such as sports or weather. Weathercasters, also called weather reporters, report current and forecasted weather conditions. They gather information from national satellite weather services, wire services, and local and regional weather bureaus. Some weathercasters are trained me­ teorologists and can develop their own weather forecasts. (See the statement on atmospheric scientists elsewhere in the Hand­ book.) Sportscasters select, write, and deliver sports news. This may include interviews with sports personalities and coverage of games and other sporting events. General-assignment reporters write about newsworthy occur­ rences—such as accidents, political rallies, visits of celebrities, or business closings—as assigned. Large newspapers and radio and television stations assign reporters to gather news about specific topics, such as crime or education. Some reporters spe­ cialize in fields such as health, politics, foreign affairs, sports, theater, consumer affairs, social events, science, business, or re­ ligion. Investigative reporters cover stories that may take many days or weeks of information gathering. Some publications use teams of reporters instead of assign­ ing each reporter one specific topic, allowing reporters to cover a greater variety of stories. News teams may include reporters, editors, graphic artists, and photographers working together to complete a story. Reporters on small publications cover all aspects of the news. They take photographs, write headlines, lay out pages, edit wireservice stories, and write editorials. Some also solicit advertise­ ments, sell subscriptions, and perform general office work. Work environment. The work of news analysts, reporters, and correspondents is usually hectic. They are under great pres­ sure to meet deadlines. Broadcasts sometimes are aired with  'ni»sr BiigpSi  Large newspapers and radio and television stations assign re­ porters to cover specific topics.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  little or no time for preparation. Some news analysts, report­ ers, and correspondents work in comfortable, private offices; others work in large rooms filled with the sound of keyboards and computer printers, as well as the voices of other report­ ers. Curious onlookers, police, or other emergency workers can distract those reporting from the scene for radio and television. Covering wars, political uprisings, fires, floods, and similar events is often dangerous. Working hours vary. Reporters on morning papers often work from late afternoon until midnight. Radio and television reporters usually are assigned to a day or evening shift. Maga­ zine reporters usually work during the day. Reporters sometimes have to change their work hours to meet a deadline or to follow late-breaking developments. Their work demands long hours, irregular schedules, and some travel. Be­ cause many stations and networks are on the air 24 hours a day, newscasters can expect to work unusual hours.  Training, Other Qualifications, and Advancement Most employers prefer individuals with a bachelor’s degree in journalism or mass communications, but some hire graduates with other majors. They look for experience at school newspa­ pers or broadcasting stations, and internships with news orga­ nizations. Large-city newspapers and stations also may prefer candidates with a degree in a subject-matter specialty such as economics, political science, or business. Some large newspa­ pers and broadcasters may hire only experienced reporters. Education and training. More than 1,500 institutions offer programs in communications, journalism, and related programs. In 2007, 109 of these were accredited by the Accrediting Coun­ cil on Education in Journalism and Mass Communications. Most of the courses in a typical curriculum are in liberal arts; the remaining courses are in journalism. Examples of journal­ ism courses are introductory mass media, basic reporting and copy editing, history of journalism, and press law and ethics. Students planning a career in broadcasting take courses in radio and television news and production. Those planning newspaper or magazine careers usually specialize in news-editorial jour­ nalism. To create stories for online media, they need to learn to use computer software to combine online story text with audio and video elements and graphics. Some schools also offer a master’s or Ph.D. degree in jour­ nalism. Some graduate programs are intended primarily as preparation for news careers, while others prepare journalism teachers, researchers and theorists, and advertising and public relations workers. A graduate degree may help those looking to advance more quickly. High school courses in English, journalism, and social stud­ ies provide a good foundation for college programs. Useful college liberal arts courses include English with an emphasis on writing, sociology, political science, economics, history, and psychology. Courses in computer science, business, and speech are useful as well. Fluency in a foreign language is necessary in some jobs. Employers report that practical experience is the most impor­ tant part of education and training. Upon graduation many stu­ dents already have gained much practical experience through part-time or summer jobs or through internships with news or-  334 Occupational Outlook Handbook  ganizations. Most newspapers, magazines, and broadcast news organizations offer reporting and editing internships. Work on high school and college newspapers, at broadcasting stations, or on community papers or U.S. Armed Forces publications also provides practical training. In addition, journalism scholar­ ships, fellowships, and assistantships awarded to college jour­ nalism students by universities, newspapers, foundations, and professional organizations are helpful. Experience as a stringer or freelancer—a part-time reporter who is paid only for stories printed—is advantageous. Other qualifications. Reporters typically need more than good word-processing skills. Computer graphics and desktop­ publishing skills also are useful. Computer-assisted reporting involves the use of computers to analyze data in search of a sto­ ry. This technique and the interpretation of the results require computer skills and familiarity with databases. Knowledge of news photography also is valuable for entry-level positions, which sometimes combine the responsibilities of a reporter with those of a camera operator or photographer. Reporters should be dedicated to providing accurate and im­ partial news. Accuracy is important, both to serve the public and because untrue or libelous statements can lead to lawsuits. A nose for news, persistence, initiative, poise, resourcefulness, a good memory, and physical stamina are important, as is the emotional stability to deal with pressing deadlines, irregular hours, and dangerous assignments. Broadcast reporters and news analysts must be comfortable on camera. All reporters must be at ease in unfamiliar places and with a variety of peo­ ple. Positions involving on-air work require a pleasant voice and appearance. Advancement. Most reporters start at small publications or broadcast stations as general assignment reporters or copy editors. They are usually assigned to cover court proceedings and civic and club meetings, summarize speeches, and write obituaries. With experience, they report more difficult assign­ ments or specialize in a particular field. Large publications and stations hire few recent graduates; as a rule, they require new reporters to have several years of experience. Some news analysts and reporters can advance by moving to larger newspapers or stations. A few experienced report­ ers become columnists, correspondents, writers, announcers, or public relations specialists. Others become editors in print journalism or program managers in broadcast journalism, who supervise reporters. Some eventually become broadcasting or publishing industry managers. Employment News analysts, reporters, and correspondents held about 67,000 jobs in 2006. About 59 percent worked for newspaper, periodi-  cal, book, and directory publishers. Another 23 percent worked in radio and television broadcasting. About 11 percent of news analysts, reporters, and correspondents were self-employed (free lancers or stringers).  Job Outlook There is expected to be little or no change in employment through 2016. Competition will continue to be keen for jobs on large metropolitan and national newspapers, broadcast sta­ tions and networks, and magazines. Small broadcast stations and publications and online newspapers and magazines should provide the best opportunities. Talented writers who can handle highly specialized scientific or technical subjects will have an advantage. Employment change. Employment of news analysts, report­ ers, and correspondents is expected to grow 2 percent between 2006 and 2016, which is considered to be little or no change in employment. Many factors will contribute to the limited job growth in this occupation. Consolidation and convergence should continue in the publishing and broadcasting industries. As a result, companies will be better able to allocate their news analysts, reporters, and correspondents to cover news stories. Constantly improving technology also is allowing workers to do their jobs more efficiently, another factor that will limit the number of workers needed to cover a story or certain type of news. However, the continued demand for news will create some job opportunities. Job openings also will result from the need to replace workers who leave their occupations perma­ nently; some news analysts, reporters, and correspondents find the work too stressful and hectic or do not like the lifestyle, and transfer to other occupations. Job prospects. Competition will continue to be keen for jobs on large metropolitan and national newspapers, broadcast sta­ tions and networks, and magazines. Job opportunities will be best for applicants in the expanding world of new media, such as online newspapers or magazines. Small, local papers and news stations also will provide greater job prospects for poten­ tial reporters and news analysts. For beginning newspaper re­ porters, freelancing will supply more opportunities for employ­ ment as well. Students with a background in journalism as well as another specific subject matter, such as politics, economics, or biology, will have an advantage over those without additional background knowledge. Journalism graduates have the background for work in close­ ly related fields such as advertising and public relations, and many take jobs in these fields. Other graduates accept sales, managerial, or other nonmedia positions. The number of job openings in the newspaper and broadcast­ ing industries—in which news analysts, reporters, and corre-  Projections data from the National Employment Matrix Occupational Title News analysts, reporters and correspondents..................... .......... Broadcast news analysts.................................................... .......... Reporters and correspondents.......................................... ..........  soc  Code  27-3020 27-3021 27-3022  Employment,  2006 67,000 7,700 59,000  Projected employment,  2016 68,000 8,200 60,000  Change,  2006-2016  Number  1,200 500 700  Percent  2 6 1  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 335  spondents are employed—is sensitive to economic upswings and downturns because these industries depend on advertising revenue.  Photographers (Q*NET 27-4021.00)  Earnings Salaries for news analysts, reporters, and correspondents vary widely. Median annual earnings of reporters and correspon­ dents were $33,470 in May 2006. The middle 50 percent earned between $24,370 and $51,700. The lowest 10 percent earned less than $19,180, and the highest 10 percent earned more than $73,880. Median annual earnings of reporters and correspondents were $31,690 in newspaper, periodical, book, and directory publishing, and $38,050 in radio and television broadcasting. Median annual earnings of broadcast news analysts were $46,710 in May 2006. The middle 50 percent earned be­ tween $30,080 and $83,370. The lowest 10 percent earned less than $22,430, and the highest 10 percent earned more than $ 145,600. Median annual earnings of broadcast news analysts were $48,790 in radio and television broadcasting.  Related Occupations News analysts, reporters, and correspondents must write clearly and effectively to succeed in their profession. Others for whom good writing ability is essential include writers and editors and public relations specialists. Many news analysts, reporters, and correspondents also must communicate information orally. Others for whom oral communication skills are important are announcers, interpreters and translators, those in sales and re­ lated occupations, and teachers.  Sources of Additional Information For information on broadcasting education and scholarship re­ sources, contact: y National Association of Broadcasters, 1771 N St.NW., Washington, DC 20036. Internet: http://www.nab.org Information on careers in journalism, colleges and universi­ ties offering degree programs in journalism or communications, and journalism scholarships and internships may be obtained from: y Dow Jones Newspaper Fund, Inc., P.O. Box 300, Princeton, NJ 08543-0300. Information on union wage rates for newspaper and maga­ zine reporters is available from: y Newspaper Guild, Research and Information Department, 501 Third St.NW., Suite 250, Washington, DC 20001. For a list of schools with accredited programs in journalism and mass communications, send a stamped, self-addressed en­ velope to: y Accrediting Council on Education in Journalism and Mass Communications, University of Kansas School of Journalism and Mass Communications, Stauffer-Flint Hall, 1435 Jayhawk Blvd., Lawrence, KS 66045. Internet: http://www.ku.edu/acejmc/STUDENT/STUDENT.SHTML Names and locations of newspapers and a list of schools and departments of journalism are published in the Editor and Pub­ lisher International Year Book, available in most public libraries and newspaper offices.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Significant Points  •  Competition for jobs is expected to be keen because the work is attractive to many people.  •  Technical expertise, a “good eye,” imagination, and creativity are essential. More than half of all photographers are self-employed, a much higher proportion than for most occupations.  •  Nature of the Work Photographers produce and preserve images that paint a picture, tell a story, or record an event. To create commercial-quality photographs, photographers need technical expertise, creativity, and the appropriate professional equipment. Producing a suc­ cessful picture requires choosing and presenting a subject to achieve a particular effect, and selecting the right cameras and other photographic enhancing tools. For example, photographers may enhance the subject’s appearance with natural or artificial light, shoot the subject from an interesting angle, draw attention to a particular aspect of the subject by blurring the background, or use various lenses to produce desired levels of detail at vari­ ous distances from the subject. Today, most photographers use digital cameras instead of tra­ ditional silver-halide film cameras, although some photographers use both types, depending on their own preference and the nature of the assignment. Regardless of the camera they use, photog­ raphers also employ an array of other equipment—from lenses, filters, and tripods to flash attachments and specially constructed lighting equipment—to improve the quality of their work. Digital cameras capture images electronically, allowing them to be edited on a computer. Images can be stored on portable memory devices such as compact disks or on smaller storage devices such as memory cards used in digital cameras and flash drives. Once the raw image has been transferred to a computer, photographers can use processing software to crop or modify the image and enhance it through color correction and other special­ ized effects. As soon as a photographer has finished editing the image, it can be sent anywhere in the world over the Internet. Photographers also can create electronic portfolios of their work and display them on their own webpage, allowing them to reach prospective customers directly. Digital technology also allows the production of larger, more colorful, and more accu­ rate prints or images for use in advertising, photographic art, and scientific research. Photographers who process their own digital images need to be proficient in the use of computers, high-qual­ ity printers, and editing software. Photographers who use cameras with silver-halide film often send their film to laboratories for processing. Color film re­ quires expensive equipment and exacting conditions for correct processing and printing. (See the statement on photographic process workers and processing machine operators elsewhere in the Handbook.) Other photographers develop and print their  336 Occupational Outlook Handbook  own photographs using their own fully equipped darkrooms, especially if they use black and white film or seek to achieve special effects. Photographers who do their own film developing must invest in additional developing and printing equipment and acquire the technical skills to operate it. Some photographers specialize in areas such as portrait, com­ mercial and industrial, scientific, news, or fine arts photography. Portrait photographers take pictures of individuals or groups of people and often work in their own studios. Some specialize in weddings, religious ceremonies, or school photographs and may work on location. Portrait photographers who own and op­ erate their own business have many responsibilities in addition to taking pictures. They must arrange for advertising, schedule appointments, set and adjust equipment, purchase supplies, keep records, bill customers, pay bills, and—if they have employ­ ees—hire, train, and direct their workers. Many also process their own images, design albums, and mount and frame the fin­ ished photographs. Commercial and industrial photographers take pictures of various subjects, such as buildings, models, merchandise, arti­ facts, and landscapes. These photographs are used in a variety of media, including books, reports, advertisements, and catalogs. Industrial photographers often take pictures of equipment, ma­ chinery, products, workers, and company officials. The pictures are used for various purposes—for example, analysis of engi­ neering projects, publicity, or records of equipment development or deployment, such as placement of an offshore oil rig. This photography frequently is done on location. Scientific photographers take images of a variety of subjects to illustrate or record scientific or medical data or phenomena, using knowledge of scientific procedures. They typically pos­ sess additional knowledge in areas such as engineering, medi­ cine, biology, or chemistry. News photographers, also called photojoumalists, photograph newsworthy people, places, and sporting, political, and commu­ nity events for newspapers, journals, magazines, or television. Fine arts photographers sell their photographs as fine artwork. In addition to technical proficiency, fine arts photographers need artistic talent and creativity. Self-employed, or freelance, photographers usually specialize in one of the above fields. In addition to carrying out assign­ ments under direct contract with clients, they may license the use of their photographs through stock-photo agencies or mar­ ket their work directly to the public. Stock-photo agencies sell magazines and other customers the right to use photographs, and pay the photographer a commission. These agencies require an application from the photographer and a sizable portfolio of pictures. Once accepted, photographers usually are required to submit a large number of new photographs each year. Self-em­ ployed photographers must also have a thorough understanding of copyright laws in order to protect their work. Most photographers spend only a small portion of their work schedule actually taking photographs. Their most common ac­ tivities are editing images on a computer—if they use a digital camera—and looking for new business—if they are self-em­ ployed. Work environment. Working conditions for photographers vary considerably. Photographers employed in government and   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Technical expertise, imagination and creativity, and a “good eye" are important for photographers. advertising studios usually work a 5-day, 40-hour week. On the other hand, news photographers often work long, irregular hours and must be available to work on short notice. Many photogra­ phers work part time or on variable schedules. Portrait photographers usually work in their own studios but also may travel to take photographs at the client’s location, such as a school, a company office, or a private home. News and commercial photographers frequently travel locally, stay over­ night on assignments, or travel to distant places for long peri­ ods. Some photographers work in uncomfortable or even danger­ ous surroundings, especially news photographers covering acci­ dents, natural disasters, civil unrest, or military conflicts. Many photographers must wait long hours in all kinds of weather for an event to take place and stand or walk for long periods while carrying heavy equipment. News photographers often work un­ der strict deadlines. Self-employment allows for greater autonomy, freedom of expression, and flexible scheduling. However, income can be uncertain and the continuous, time consuming search for new clients can be stressful. Some self-employed photographers hire assistants who help seek out new business.  Training, Other Qualifications, and Advancement Employers usually seek applicants with a “good eye,” imagina­ tion, and creativity, as well as a good technical understanding of photography. Photojoumalists or industrial or scientific photog­ raphers generally need a college degree. Freelance and portrait photographers need technical proficiency, gained through a de­ gree, training program, or experience. Education and training. Entry-level positions in photo­ journalism or in industrial or scientific photography generally require a college degree in photography or in a field related to the industry in which the photographer seeks employment. En­ try-level freelance or portrait photographers need technical pro­ ficiency. Some complete a college degree or vocational training programs. Photography courses are offered by many universities, com­ munity and junior colleges, vocational-technical institutes, and private trade and technical schools. Basic courses in photog­ raphy cover equipment, processes, and techniques. Learning  Professional and Related Occupations 337  good business skills is important and some bachelor’s degree programs offer courses focusing on them. Art schools offer use­ ful training in photographic design and composition. Photographers may start out as assistants to experienced pho­ tographers. Assistants acquire the technical knowledge needed to be a successful photographer and also learn other skills neces­ sary to run a portrait or commercial photography business. Some photographers enter the field by submitting unsolicited a portfolio of photographs to magazines and to art directors at advertising agencies; for freelance photographers, a good port­ folio is essential. Individuals interested in a career in photography should try to develop contacts in the field by subscribing to photographic newsletters and magazines, joining camera clubs, and seeking summer or part-time employment in camera stores, newspapers, or photo studios. Other qualifications. Photographers need good eyesight, ar­ tistic ability, and good hand-eye coordination. They should be patient, accurate, and detail-oriented and should be able to work well with others, as they frequently deal with clients, graphic designers, and advertising and publishing specialists. Photog­ raphers need to know how to use computer software programs and applications that allow them to prepare and edit images, and those who market directly to clients should know how to use the Internet to display their work. Portrait photographers need the ability to help people relax in front of the camera. Commercial and fine arts photographers must be imaginative and original. News photographers must not only be good with a camera, but also understand the story behind an event so that their pictures match the story. They must be decisive in recognizing a potentially good photograph and act quickly to capture it. Photographers who operate their own business, or freelance, need business skills as well as talent. These individuals must know how to prepare a business plan; submit bids; write con­ tracts; keep financial records; market their work; hire models, if needed; get permission to shoot on locations that normally are not open to the public; obtain releases to use photographs of people; license and price photographs; and secure copyright protection for their work. To protect their rights and their work, self-employed photographers require basic knowledge of licens­ ing and copyright laws, as well as knowledge of contracts and negotiation procedures. Freelance photographers also should develop an individual style of photography to differentiate themselves from the com­ petition. Advancement. After several years of experience, magazine and news photographers may advance to photography or picture editor positions. Some photographers teach at technical schools, film schools, or universities.  Employment Photographers held about 122,000 jobs in 2006. More than half were self-employed, a much higher proportion than for most oc­ cupations. Some self-employed photographers have contracts with advertising agencies, magazine publishers, or other busi­ nesses to do individual projects for a set fee, while others operate portrait studios or provide photographs to stock-photo agencies. Most salaried photographers work in portrait or commercial photography studios; most of the others work for newspapers, magazines, and advertising agencies. Photographers work in all areas of the country, but most are employed in metropolitan ar­ eas.  Job Outlook Employment of photographers is expected to grow about as fast as the average for all occupations through 2016. Photographers can expect keen competition for job openings because the work is attractive to many people. Employment change. Demand for portrait photographers should increase as the population grows. Moreover, growth of Internet versions of magazines, journals, and newspapers will require increasing numbers of commercial photographers to provide digital images. The Internet and improved data man­ agement programs also should make it easier for freelancers to market directly to their customers, increasing opportunities for self-employment and decreasing reliance on stock photo agen­ cies. As a result, employment of photographers is expected to grow 10 percent over the 2006-16 projection period, about as fast as the average for all occupations. Job growth, however, will be constrained somewhat by the widespread use of digital photography and the falling price of digital equipment. Improvements in digital technology reduce barriers of entry into this profession and allow more individual consumers and businesses to produce, store, and access photo­ graphic images on their own. Photojoumalists may be adversely affected by the increase in “citizen journalism”—when newspa­ pers buy images taken by non-professionals who happen to be at the scene of an event. Declines in the newspaper industry also will reduce demand for photographers to provide still images for print. Job prospects. Photographers can expect keen competition for job openings because the work is attractive to many people. The number of individuals interested in positions as commercial and news photographers usually is much greater than the num­ ber of openings. Salaried jobs in particular may be difficult to find as more companies contract with freelancers rather than hire their own photographers. Those who succeed in landing a sala­ ried job or attracting enough work to earn a living by freelancing are likely to be adept at operating a business and to be among the most creative. They will be able to find and exploit the new op­ portunities available from rapidly changing technologies. Relat-  Projections data from the National Employment Matrix Occupational Title Photographers........................................................................................  SOC Code 27-4021  Employment, 2006  122,000  Projected employment, 2016 135,000  Change, 2006-2016 Number Percent 13,000 10  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  338 Occupational Outlook Handbook  ed work experience, job-related training, or some unique skill or talent—such as a background in computers or electronics—also improve a photographer’s job prospects.  Earnings Median annual earnings of salaried photographers were $26,170 in May 2006. The middle 50 percent earned between $18,680 and $38,730. The lowest 10 percent earned less than $15,540, and the highest 10 percent earned more than $56,640. Median annual earnings in the industry employing the largest numbers of salaried photographers were $22,860 in the photographic ser­ vices industry. Salaried photographers—more of whom work full time—tend to earn more than those who are self-employed. Because most freelance and portrait photographers purchase their own equip­ ment, they incur considerable expense acquiring and maintain­ ing cameras and accessories. Unlike news and commercial pho­ tographers, few fine arts photographers are successful enough to support themselves solely through their art.  Related Occupations Other occupations requiring artistic talent and creativity include architects, except landscape and naval; artists and related work­ ers; commercial and industrial designers, fashion designers, and graphic designers; and television, video, and motion picture cam­ era operators and editors. Photojoumalists are often required to cover news stories much the same as news analysts, reporters, and correspondents. The processing work that photographers do on computers is similar to the work of prepress technicians and workers and desktop publishers.  Sources of Additional Information Career information on photography is available from: y Professional Photographers of America, Inc., 229 Peachtree St.NE., Suite 2200, Atlanta, GA 30303. Internet: http://www.ppa.com y National Press Photographers Association, Inc., 3200 Croasdaile Dr., Suite 306, Durham, NC 27705. Internet: http://www.nppa.org y American Society of Media Photographers, Inc., 150 North Second St., Philadelphia, PA 19106. Internet: http://www.asmp.org  Public Relations Specialists (0*NET 27-3031.00) Significant Points  •  Although employment is projected to grow faster than average, keen competition is expected for entry-level jobs. • Opportunities should be best for college graduates who combine a degree in public relations, journalism, or another communications-related field with a public relations internship or other related work experience. • The ability to communicate effectively is essential.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work An organization’s reputation, profitability, and even its contin­ ued existence can depend on the degree to which its targeted “publics” support its goals and policies. Public relations spe­ cialists—also referred to as communications specialists and media specialists, among other titles—serve as advocates for businesses, nonprofit associations, universities, hospitals, and other organizations, and build and maintain positive relation­ ships with the public. As managers recognize the importance of good public relations to the success of their organizations, they increasingly rely on public relations specialists for advice on the strategy and policy of such programs. Public relations specialists handle organizational functions such as media, community, consumer, industry, and govern­ mental relations; political campaigns; interest-group represen­ tation; conflict mediation; and employee and investor relations. They do more than “tell the organization’s story.” They must understand the attitudes and concerns of community, consumer, employee, and public interest groups and establish and main­ tain cooperative relationships with them and with representa­ tives from print and broadcast journalism. Public relations specialists draft press releases and contact people in the media who might print or broadcast their material. Many radio or television special reports, newspaper stories, and magazine articles start at the desks of public relations special­ ists. Sometimes the subject is an organization and its policies toward its employees or its role in the community. Often the subject is a public issue, such as health, energy, or the environ­ ment, and what an organization does to advance that issue. Public relations specialists also arrange and conduct pro­ grams to keep up contact between organization representatives and the public. For example, they set up speaking engagements and often prepare speeches for company officials. These media specialists represent employers at community projects; make film, slide, or other visual presentations at meetings and school assemblies; and plan conventions. In addition, they are respon­ sible for preparing annual reports and writing proposals for various projects. In government, public relations specialists—who may be called press secretaries, information officers, public affairs specialists, or communication specialists—keep the public informed about the activities of agencies and officials. For example, public affairs specialists in the U.S. Department of State keep the public informed of travel advisories and of U.S. positions on foreign issues. A press secretary for a member of Congress keeps constituents aware of the representative’s ac­ complishments. In large organizations, the key public relations executive, who often is a vice president, may develop overall plans and policies with other executives. In addition, public relations departments employ public relations specialists to write, research, prepare materials, maintain contacts, and respond to inquiries. People who handle publicity for an individual or who direct public relations for a small organization may deal with all as­ pects of the job. They contact people, plan and research, and prepare materials for distribution. They also may handle adver­ tising or sales promotion work to support marketing efforts.  Professional and Related Occupations 339  Public relations specialists draft press releases and contact people in the media who print or broadcast their material.  Work environment. Public relations specialists work in busy offices. The pressures of deadlines and tight work schedules can be stressful. Some public relations specialists work a standard 35- to 40hour week, but unpaid overtime is common and work schedules can be irregular and frequently interrupted. Occasionally, they must be at the job or on call around the clock, especially if there is an emergency or crisis. Schedules often have to be re­ arranged so that workers can meet deadlines, deliver speeches, attend meetings and community activities, and travel.  Training, Other Qualifications, and Advancement There are no defined standards for entry into a public relations career. A college degree in a communications-related field combined with public relations experience is excellent prepara­ tion for public relations work. Education and training. Many entry-level public relations specialists have a college degree in public relations, journalism, advertising, or communication. Some firms seek college gradu­ ates who have worked in electronic or print journalism. Other employers seek applicants with demonstrated communication skills and training or experience in a field related to the firm’s business—information technology, health care, science, engi­ neering, sales, or finance, for example. Many colleges and universities offer bachelor’s and postsec­ ondary degrees in public relations, usually in a journalism or communications department. In addition, many other colleges offer at least one course in this field. A common public rela­ tions sequence includes courses in public relations principles and techniques; public relations management and administra­ tion, including organizational development; writing, emphasiz­ ing news releases, proposals, annual reports, scripts, speeches, and related items; visual communications, including desktop publishing and computer graphics; and research, emphasizing social science research and survey design and implementation.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Courses in advertising, journalism, business administration, finance, political science, psychology, sociology, and creative writing also are helpful. Specialties are offered in public rela­ tions for business, government, and nonprofit organizations. Many colleges help students gain part-time internships in public relations that provide valuable experience and training. Membership in local chapters of the Public Relations Student Society of America (affiliated with the Public Relations Soci­ ety of America) or in student chapters of the International As­ sociation of Business Communicators provides an opportunity for students to exchange views with public relations specialists and to make professional contacts that may help them find a job in the field. A portfolio of published articles, television or radio programs, slide presentations, and other work is an asset in finding a job. Writing for a school publication or television or radio station provides valuable experience and material for one’s portfolio. Some organizations, particularly those with large public rela­ tions staffs, have formal training programs for new employees. In smaller organizations, new employees work under the guid­ ance of experienced staff members. Beginners often maintain files of material about company activities, scan newspapers and magazines for appropriate articles to clip, and assemble infor­ mation for speeches and pamphlets. They also may answer calls from the press and the public, work on invitation lists and details for press conferences, or escort visitors and clients. Af­ ter gaining experience, they write news releases, speeches, and articles for publication or plan and carry out public relations programs. Public relations specialists in smaller firms usually get all-around experience, whereas those in larger firms tend to be more specialized. Other qualifications. Public relations specialists must show creativity, initiative, and good judgment and have the ability to communicate thoughts clearly and simply. Decision-making, problem-solving, and research skills also are important. People who choose public relations as a career need an outgoing per­ sonality, self-confidence, an understanding of human psychol­ ogy, and an enthusiasm for motivating people. They should be competitive, yet able to function as part of a team and be open to new ideas. Certification and advancement. The Universal Accredita­ tion Board accredits public relations specialists who are mem­ bers of the Public Relations Society of America and who partic­ ipate in the Examination for Accreditation in Public Relations process. This process includes both a readiness review and an examination, which are designed for candidates who have at least 5 years of full-time work or teaching experience in public relations and who have earned a bachelor’s degree in a commu­ nications-related field. The readiness review includes a written submission by each candidate, a portfolio review, and dialogue between the candidate and a three-member panel. Candidates who successfully advance through readiness review and pass the computer-based examination earn the Accredited in Public Relations (APR) designation. The International Association of Business Communicators (IABC) also has an accreditation program for professionals in the communications field, including public relations specialists. Those who meet all the requirements of the program earn the  340 Occupational Outlook Handbook  Accredited Business Communicator (ABC) designation. Can­ didates must have at least 5 years of experience and a bachelor’s degree in a communications field and must pass written and oral examinations. They also must submit a portfolio of work samples demonstrating involvement in a range of communica­ tions projects and a thorough understanding of communications planning. Employers may consider professional recognition through accreditation as a sign of competence in this field, which could be especially helpful in a competitive job market. Promotion to supervisory jobs may come to public relations specialists who show that they can handle more demanding as­ signments. In public relations firms, a beginner might be hired as a research assistant or account coordinator and be promoted to account executive, senior account executive, account man­ ager, and eventually vice president. A similar career path is followed in corporate public relations, although the titles may differ. Some experienced public relations specialists start their own consulting firms. (For more information on public relations managers, see the Handbook statement on advertising, market­ ing, promotions, public relations, and sales managers.)  Employment Public relations specialists held about 243,000 jobs in 2006. They are concentrated in service-providing industries such as advertising and related services; health care and social assis­ tance; educational services; and government. Others work for communications firms, financial institutions, and government agencies. Public relations specialists are concentrated in large cities, where press services and other communications facilities are readily available and many businesses and trade associations have their headquarters. Many public relations consulting firms, for example, are in New York, Los Angeles, San Francis­ co, Chicago, and Washington, DC. There is a trend, however, for public relations jobs to be dispersed throughout the Nation, closer to clients.  Job Outlook Employment is projected to grow faster than average; however, keen competition is expected for entry-level jobs. Employment change. Employment of public relations spe­ cialists is expected to grow by 18 percent from 2006 to 2016, faster than average for all occupations. The need for good pub­ lic relations in an increasingly competitive business environ­ ment should spur demand for these workers in organizations of all types and sizes. Those with additional language capabilities also are in great demand.  Employment in public relations firms should grow as firms hire contractors to provide public relations services rather than support full-time staff. Among detailed industries, the largest job growth will con­ tinue to be in advertising and related services. Job prospects. Keen competition likely will continue for entry-level public relations jobs, as the number of qualified applicants is expected to exceed the number of job openings. Many people are attracted to this profession because of the high profile nature of the work. Opportunities should be best for col­ lege graduates who combine a degree in journalism, public rela­ tions, advertising, or another communications-related field with a public relations internship or other related work experience. Applicants without the appropriate educational background or work experience will face the toughest obstacles. Additional job opportunities should result from the need to replace public relations specialists who retire or leave the oc­ cupation for other reasons.  Earnings Median annual earnings for salaried public relations specialists were $47,350 in May 2006. The middle 50 percent earned be­ tween $35,600 and $65,310; the lowest 10 percent earned less than $28,080, and the top 10 percent earned more than $89,220. Median annual earnings in the industries employing the largest numbers of public relations specialists in May 2006 were: Management of companies and enterprises........................$52,940 Business, professional, labor, political, and similar organizations........................................................................51,400 Advertising and related services...........................................49,980 Local government................................................................. 47,550 Colleges, universities, and professional schools...................43,330  Related Occupations Public relations specialists create favorable attitudes among various organizations, interest groups, and the public through effective communication. Other workers with similar jobs in­ clude advertising, marketing, promotions, public relations, and sales managers; demonstrators, product promoters, and models; news analysts, reporters, and correspondents; lawyers; market and survey researchers; sales representatives, wholesale and manufacturing; and police and detectives involved in commu­ nity relations.  Sources of Additional Information A comprehensive directory of schools offering degree programs, a sequence of study in public relations, a brochure on careers in public relations, and an online brochure entitled Where Shall  Projections data from the National Employment Matrix Occupational Title Public relations specialists....................................................................  SOC Code 27-3031  Employment, 2006 243,000  Projected employment, 2016 286,000  Change, 2006-2016 Number Percent 43,000 18  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 341  I Go to Study Advertising and Public Relations?, are available from: y Public Relations Society of America, Inc., 33 Maiden LaNE., New York, NY 10038-5150. Internet: http://www.prsa.org For information on accreditation for public relations profes­ sionals and the IABC Student Web site, contact: y International Association of Business Communicators, One Hallidie Plaza, Suite 600, San Francisco, CA 94102.  Television, Video, and Motion Picture Camera Operators and Editors (0*NET 27-4031.00, 27-4032.00) Significant Points •  Workers acquire their skills through on-the-job or for­ mal postsecondary training.  •  Keen competition for jobs is expected due to the large number of people who wish to enter the broadcasting and motion picture industries, where many camera operators and editors are employed.  •  Those with the most experience and the most advanced computer skills will have the best job opportunities.  Nature of the Work Television, video, and motion picture camera operators pro­ duce images that tell a story, inform or entertain an audience, or record an event. Film and video editors edit soundtracks, film, and video for the motion picture, cable, and broadcast televi­ sion industries. Some camera operators do their own editing. Camera operators use television, video, or motion picture cameras to shoot a wide range of material, including televi­ sion series, studio programs, news and sporting events, music videos, motion pictures, documentaries, and training sessions. This material is constructed from many different shots by film and video editors. With the increase in digital technology, much of the editing work is now done on a computer. Many camera operators and editors are employed by independent television stations; local affiliate stations of television networks; large cable and television networks; or smaller, independent produc­ tion companies. Making commercial-quality movies and video programs re­ quires technical expertise and creativity. Producing successful images requires choosing and presenting interesting material, selecting appropriate equipment, and applying a good eye and a steady hand to ensure smooth, natural movement of the cam­ era. Some camera operators film or videotape private ceremonies and special events, such as weddings and conference program sessions. Those who record these images on videotape are of­ ten called videographers. Studio camera operators work in a broadcast studio and usually videotape their subjects from a fixed position. News camera operators, also called electronic news gathering (ENG) operators, work as part of a reporting team, following newsworthy events as they unfold. To capture   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  live events, they must anticipate the action and act quickly. ENG operators sometimes edit raw footage on the spot for relay to a television affiliate for broadcast. Camera operators employed in the entertainment field use motion picture cameras to film movies, television programs, and commercials. Those who film motion pictures also are known as cinematographers. Some specialize in filming car­ toons or special effects. Cinematographers may be an integral part of the action, using cameras in any of several different mounts. For example, the camera can be stationary and shoot whatever passes in front of the lens, or it can be mounted on a track, with the camera operator responsible for shooting the scene from different angles or directions. Wider use of digital cameras has enhanced the number of angles and the clarity that a camera operator can provide. Other camera operators sit on cranes and follow the action while crane operators move them into position. Steadicam operators mount a harness and carry the camera on their shoulders to provide a clear picture while they move about the action. Camera operators who work in the entertainment field often meet with directors, actors, editors, and camera assistants to discuss ways of filming, editing, and improving scenes. Work environment. ENG operators and those who cover ma­ jor events, such as conventions or sporting events, frequently travel locally and stay overnight or travel to distant places for longer periods. Camera operators filming television programs or motion pictures may travel to film on location. Some camera operators—especially ENG operators covering accidents, natural disasters, civil unrest, or military conflicts— work in uncomfortable or even dangerous surroundings. Many camera operators must wait long hours in all kinds of weather for an event to take place and must stand or walk for long pe­ riods while carrying heavy equipment. ENG operators often work under strict deadlines. Hours of work and working schedules for camera operators and editors vary considerably. Those employed by television and cable networks and advertising agencies usually work a 5day, 40-hour week; however, they may work longer hours to meet production schedules. ENG operators often work long, irregular hours and must be available to work on short notice.  FL v '  >5  Film and video editors use computers to create a finished prod­ uct.  342 Occupational Outlook Handbook  Camera operators and editors working in motion picture pro­ duction also may work long, irregular hours.  Training, Other Qualifications, and Advancement Television, video, and motion picture camera operators and edi­ tors usually acquire their skills through formal postsecondary training at vocational schools, colleges, universities, or pho­ tographic institutes. A bachelor’s degree may be required for some positions, particularly those for film and video editors. Employers usually seek applicants with a good eye, imagina­ tion, and creativity, as well as a good technical understanding of how the camera operates. Education and training. Many universities, community and junior colleges, vocational-technical institutes, and private trade and technical schools offer courses in camera operation and videography. Basic courses cover equipment, processes, and techniques. It is increasingly important for camera operators to have a good understanding of computer technology. Bachelor’s degree programs, especially those including business courses, provide a well-rounded education. Film schools also may pro­ vide training on the artistic or aesthetic aspects of filmmaking. Individuals interested in camera operations should subscribe to videographic newsletters and magazines, join audio-video clubs, and seek summer or part-time employment in cable and television networks, motion picture studios, or camera and vid­ eo stores. To enter the occupation, many camera operators first become production assistants to learn how film and video production works. In entry-level jobs they learn to set up lights, cameras, and other equipment. They also may receive routine assign­ ments requiring adjustments to their cameras or decisions on what subject matter to capture. Camera operators in the film and television industries usually are hired for a project on the basis of recommendations from individuals such as producers, directors of photography, and camera assistants from previous projects or through interviews with the producer. ENG and stu­ dio camera operators who work for television affiliates usually start in small markets to gain experience. Other qualifications. Camera operators need good eyesight, artistic ability, and hand-eye coordination. They should be patient, accurate, and detail oriented. Camera operators also should have good communication skills and, if needed, the abil­ ity to hold a camera by hand for extended periods. Camera operators, who run their own businesses or do free­ lance work, need business skills as well as talent. These in­ dividuals must know how to submit bids, write contracts, get permission to shoot on locations that normally are not open to the public, obtain releases to use film or tape of people, price  their services, secure copyright protection for their work, and keep financial records. Advancement. With experience, operators may advance to more demanding assignments or to positions with larger or net­ work television stations. Advancement for ENG operators may mean moving to larger media markets. Other camera operators and editors may become directors of photography for movie studios, advertising agencies, or television programs. Some teach at technical schools, film schools, or universities.  Employment Television, video, and motion picture camera operators and edi­ tors held about 47,000 jobs in 2006. About 27,000 were camera operators and film and video editors held about 21,000 jobs. Many are employed by independent television stations, lo­ cal affiliate stations of television networks or broadcast groups, large cable and television networks, or smaller independent pro­ duction companies. About 17 percent of camera operators and film editors were self-employed. Some self-employed camera operators contracted with television networks, documentary or independent filmmakers, advertising agencies, or trade show or convention sponsors to work on individual projects for a set fee, often at a daily rate. Most of the salaried camera operators and editors were em­ ployed by television broadcasting stations or motion picture studios. More than half of the salaried film and video editors worked for motion picture studios. Most camera operators and editors worked in large metropolitan areas.  Job Outlook Keen competition for jobs is expected due to the large num­ ber of people who wish to enter the broadcasting and motion picture industries, where many camera operators and editors are employed. Those with the most experience and the most advanced computer skills will have the best job opportunities. Employment is expected to grow about as fast as the average. Employment change. Employment of camera operators and editors is expected to grow 12 percent over the 2006-16 decade, which is about as fast as the average for all occupations through 2016. Rapid expansion of the entertainment market, especially motion picture production and distribution, will spur growth of camera operators. In addition, computer and Internet services will provide new outlets for interactive productions. Camera operators will be needed to film made-for-Internet broadcasts, such as live music videos, digital movies, sports features, and general information or entertainment programming. These im­ ages can be delivered directly into the home either on compact discs or as streaming video over the Internet. Growth will be tempered, however, by the increased offshore production of  Projections data from the National Employment Matrix Occupational Title Television, video, and motion picture camera operators and editors Camera operators, television, video, and motion picture.............. Film and video editors......................................................................  soc Code 27-4030 27-4031 27-4032  Employment, 2006 47,000 27,000 21,000  Projected employment, 2016 53,000 30,000 23,000  Change, 2006-2016 Number Percent 5,700 12 3,100 12 2,600 13  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 343  motion pictures. Job growth in television broadcasting will be tempered by the use of automated cameras under the control of a single person working either on the studio floor or in a director’s booth. Job prospects. Television, video, and motion picture camera operators and editors can expect keen competition for job open­ ings because of the large number of people who wish to enter the broadcasting and motion picture industries, where many of these workers are employed. The number of individuals inter­ ested in positions as videographers and movie camera operators usually is much greater than the number of openings. Those who succeed in landing a salaried job or attracting enough work to earn a living by freelancing are likely to be the most creative and highly motivated people, able to adapt to rapidly changing technologies and adept at operating a business. The change to digital cameras has increased the importance of strong com­ puter skills. Those with the most experience and the most ad­ vanced computer skills will have the best job opportunities.  Earnings Median annual earnings for television, video, and motion pic­ ture camera operators were $40,060 in May 2006. The middle 50 percent earned between $26,930 and $59,440. The lowest 10 percent earned less than $18,810, and the highest 10 per­ cent earned more than $84,500. Median annual earnings were $44,010 in the motion picture and video industries and $32,200 in radio and television broadcasting. Median annual earnings for film and video editors were $46,670 in May 2006. The middle 50 percent earned between $30,610 and $74,650. The lowest 10 percent earned less than $22,710, and the highest 10 percent earned more than $110,720. Median annual earnings were $53,580 in the motion picture and video industries, which employed the largest numbers of film and video editors. Many camera operators who work in film or video are free­ lancers, whose earnings tend to fluctuate each year. Because most freelance camera operators purchase their own equip­ ment, they incur considerable expense acquiring and maintain­ ing cameras and accessories. Some camera operators belong to unions, including the International Alliance of Theatrical Stage Employees, and the National Association of Broadcast Employ­ ees and Technicians.  Related Occupations Related arts and media occupations include artists and related workers, broadcast and sound engineering technicians and ra­ dio operators, graphic designers, and photographers.  Sources of Additional Information For information about careers as a camera operator, contact: y International Cinematographer’s Guild, 80 Eighth Ave., 14th Floor, New York, NY 10011. y National Association of Broadcast Employees and Technicians, 501 Third St.NW., 6th floor, Washington, DC 20001. Internet: http://www.nabetcwa.org Information about career and employment opportunities for camera operators and film and video editors also is available from local offices of State employment service agencies, local offices of the relevant trade unions, and local television and film production companies that employ these workers.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Writers and Editors (0*NET 23-2091.00, 27-3041.00, 27-3042.00, 27-3043.00, 27-3043.04, 27-3043.05)  Significant Points  •  Most jobs in this occupation require a college degree preferably in communications, journalism, or English, but a degree in a technical subject may be useful for technical writing positions. • The outlook for most writing and editing jobs is ex­ pected to be competitive because many people are at­ tracted to the occupation. • Online publications and services are growing in num­ ber and sophistication, spurring the demand for writ­ ers and editors with Web or multimedia experience. Nature of the Work Writers and editors produce a wide variety of written materi­ als delivered to an audience in an increasing number of ways. They develop content using any number of multimedia formats for readers, listeners, or viewers. Although many people write as part of their primary job, or on on-line chats or blogs, only writers and editors who are paid for their work are included in this occupation. (News analysts, reporters and correspondents, who gather information and prepare stories about newsworthy events, are described elsewhere in the Handbook.) Writers fall into two main categories—writers and authors and technical writers. Writers and authors develop original written materials for books, magazines, trade journals, online publica­ tions, company newsletters, radio and television broadcasts, motion pictures, and advertisements. Their works are classified broadly as either fiction or nonfiction and writers often are iden­ tified by the type of writing they do—for example, novelists, playwrights, biographers, screenwriters, and textbook writers. Some freelance writers may be commissioned by a sponsor to write a script; others may be contracted to write a book on the basis of a proposal in the form of a draft or an outline. Writers may produce materials for publication or performance, such as songwriters or scriptwriters. Writers work with editors and publishers throughout the writing process to review edits, topics, and production sched­ ules. Editors and publishers may assign topics to staff writers or review proposals from freelance writers. All writers con­ duct research on their topics, which they gather through per­ sonal observation, library and Internet research, and interviews. Writers, especially of nonfiction, are expected to establish their credibility with editors and readers through strong research and the use of appropriate sources and citations. Writers and au­ thors then select the material they want to use, organize it, and use the written word to express story lines, ideas, or to convey information. With help from editors, they may revise or rewrite sections, searching for the best organization or the right phras­ ing. Copy writers are a very specialized type of writer. They pre­ pare advertising copy for use in publications or for broadcasting  344 Occupational Outlook Handbook  and they write other materials to promote the sale of a good or service. They often must work with the client to produce adver­ tising themes or slogans and may be involved in the marketing of the product or service. Technical writers put technical information into easily un­ derstandable language. They prepare product documentation, such as operating and maintenance manuals, catalogs, assembly instructions, and project proposals. Technical writers primarily are found in the information technology industry, writing oper­ ating instructions for online Help and documentation for com­ puter programs. Many technical writers work with engineers on technical subject matters to prepare written interpretations of engineering and design specifications and other information for a general readership. Technical writers also may serve as part of a team conducting usability studies to help improve the design of a product that still is in the prototype stage. They plan and edit technical materials and oversee the preparation of illustrations, photographs, diagrams, and charts. Most writers and editors have at least a basic familiarity with technology, regularly using personal computers, desktop or electronic publishing systems, scanners, and other electronic communications equipment. Many writers prepare material directly for the Internet. For example, they may write for elec­ tronic editions of newspapers or magazines, create short fiction or poetry, or produce technical documentation that is available only online. These writers also may prepare text for Web sites. As a result, they should be knowledgeable about graphic de­ sign, page layout, and multimedia software. In addition, they should be familiar with interactive technologies of the Web so that they can blend text, graphics, and sound together. Bloggers who are paid to write may be considered writers. Many writers are considered freelance writers. They are selfemployed and sell their work to publishers, publication enter­ prises, manufacturing firms, public relations departments, or advertising agencies. Sometimes, they contract with publish­ ers first to write a book or an article. Others may be hired to complete specific short-term or recurring assignments, such as writing about a new product or contributing to an organization’s quarterly newsletter. Editors review, rewrite, and edit the work of writers. They also may do original writing. An editor’s responsibilities vary with the employer and type and level of editorial position held. Editorial duties may include planning the content of books, technical journals, trade magazines, and other general-interest publications. Editors also review story ideas proposed by staff and freelance writers then decide what material will appeal to readers. They review and edit drafts of books and articles, offer comments to improve the work, and suggest possible titles. In addition, they may oversee the production of publications. In the book-publishing industry, an editor’s primary responsibility is to review proposals for books and decide whether to buy the publication rights from the author. Major newspapers and newsmagazines usually employ sev­ eral types of editors. The executive editor oversees assistant editors, and generally has the final say about what stories are published and how they are covered. Assistant editors have re­ sponsibility for particular subjects, such as local news, inter­ national news, feature stories, or sports. The managing editor  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  usually is responsible for the daily operation of the news depart­ ment. Assignment editors determine which reporters will cover a given story. Copy editors mostly review and edit a reporter’s copy for accuracy, content, grammar, and style. In smaller organizations—such as small daily or weekly newspapers—a single editor may do everything or share respon­ sibility with only a few other people. Executive and managing editors typically hire writers, reporters, and other employees. They also plan budgets and negotiate contracts with freelance writers, sometimes called “stringers” in the news industry. Editors often have assistants, many of whom hold entry-level jobs. These assistants, frequently called copy editors, review copy for errors in grammar, punctuation, and spelling and check the copy for readability, style, and agreement with edi­ torial policy. They suggest revisions, such as changing words and rearranging sentences and paragraphs, to improve clarity or accuracy. They also carry out research for writers and ver­ ify facts, dates, and statistics. In addition, they may arrange page layouts of articles, photographs, and advertising; compose headlines; and prepare copy for printing. Publication assistants who work for publishing houses may read and evaluate manu­ scripts submitted by freelance writers, proofread printers’ gal­ leys, and answer letters about published material. Assistants on small newspapers or in radio stations compile articles available from wire services or the Internet, answer phones, and make photocopies. Work environment. While some writers and editors work in comfortable, private offices, others work in noisy rooms filled with the sounds of keyboards and the voices of other writers tracking down information or interviewing sources. The search for information sometimes requires that writers travel to diverse workplaces, such as factories, offices, or laboratories, but many find their material through telephone interviews, the library, and the Internet. Advances in electronic communications have changed the work environment for many writers. Laptop computers and wireless communications technologies allow growing numbers of writers to work from home and on the road. The ability to e-mail, transmit and download stories, research, or review ma­ terials using the Internet allows writers and editors greater flex­ ibility in where and how they complete assignments. Some writers keep regular office hours, either to maintain contact with sources and editors or to establish a writing rou­ tine, but most writers set their own hours. Many writers—es­ pecially freelance writers—are paid per assignment; therefore, they work any number of hours necessary to meet a deadline. As a result, writers must be willing to work evenings, nights, or weekends to produce a piece acceptable to an editor or client by the publication deadline. Those who prepare morning or weekend publications and broadcasts also may regularly work nights, early mornings, and weekends. While many freelance writers enjoy running their own busi­ nesses and the advantages of working flexible hours, most routinely face the pressures of juggling multiple projects with competing demands and the continual need to find new work. Deadline pressures and long, erratic work hours—often part of the daily routine in these jobs—may cause stress, fatigue, or burnout. In addition, the use of computers for extended periods  Professional and Related Occupations 345  :«5i,  Writers and editors use reference books and other resources to research or verify information. may cause some individuals to experience back pain, eyestrain, or fatigue.  Training, Other Qualifications, and Advancement A college degree generally is required for a position as a writer or editor. Good facility with computers and communications equipment is necessary in order to stay in touch with sourc­ es, editors, and other writers while working on assignments, whether from home, an office, or while traveling. Education and training. Some employers look for a broad liberal arts background, while others prefer to hire people with degrees in communications, journalism, or English. For those who specialize in a particular area, such as fashion, business, or law, additional background in the chosen field is expected. Increasingly, technical writing requires a degree in, or some knowledge about, a specialized field—for example, engineer­ ing, business, or one of the sciences. Knowledge of a second language is helpful for some positions. A background in web design, computer graphics, or other technology field is increas­ ingly practical, because of the growing use of graphics and rep­ resentational design in developing technical documentation. In many cases, people with good writing skills may transfer from jobs as technicians, scientists, or engineers into jobs as writers or editors. Others begin as research assistants or as trainees in a technical information department, develop technical commu­ nication skills, and then assume writing duties. Other qualifications. Writers and editors must be able to express ideas clearly and logically and should enjoy writing. Creativity, curiosity, a broad range of knowledge, self-motiva­ tion, and perseverance also are valuable. Writers and editors must demonstrate good judgment and a strong sense of ethics in deciding what material to publish. In addition, the ability to concentrate amid confusion and to work under pressure often is essential. Editors also need tact and the ability to guide and encourage  others in their work. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Familiarity with electronic publishing, graphics, and video production increasingly is needed. Use of electronic and wire­ less communications equipment to send e-mail, transmit work, and review copy often is necessary. Online newspapers and magazines require knowledge of computer software used to combine online text with graphics, audio, video, and anima­ tion. High school and college newspapers, literary magazines, community newspapers, and radio and television stations all provide valuable—but sometimes unpaid—practical writing experience. Many magazines, newspapers, and broadcast sta­ tions have internships for students. Interns write short pieces, conduct research and interviews, and learn about the publishing or broadcasting business. Advancement. In small firms, beginning writers and edi­ tors hired as assistants may actually begin writing or editing material right away. Opportunities for advancement and also full-time work can be limited, however. Many small or not-forprofit organizations either do not have enough regular work or cannot afford to employ writers on a full-time basis. However, they routinely contract out work to freelance writers. In larger businesses, jobs usually are more formally struc­ tured. Beginners generally do research, fact check articles, or copy edit drafts. Advancement to full-scale writing or editing assignments may occur more slowly for newer writers and edi­ tors in larger organizations than for employees of smaller com­ panies. Advancement often is more predictable, though, com­ ing with the assignment of more important articles. Advancement for writers, especially freelancers, often means working on larger, more complex projects for better known publications or for more money. Building a reputation and es­ tablishing a track record for meeting deadlines also makes it easier to get future assignments. Experience, credibility, and reliability often lead to long-term freelance relationships with the same publications and to contacts with editors who will seek you out for particular assignments. The growing popularity of blogging could allow some writers to get their work read. For example, a few well-written blogs may gamer some recognition for the author and may lead to a few paid pieces in other print or electronic publications. Some established staff writers contribute to blogs on the on-line ver­ sions of publications in conjunction with their routine work. However, most bloggers do not earn a considerable amount of money writing their blogs.  Employment Writers and editors held about 306,000 jobs in 2006. More than one-third were self-employed Writers and authors held about 135,000 jobs; editors, about 122,000 jobs; and technical writers, about 49,000 jobs. About one-third of the salaried jobs for writers and editors were in the information sector, which includes newspaper, periodical, book, and directory publishers; radio and television broadcasting; software publishers; motion picture and sound-recording industries; Internet service provid­ ers, Web search portals and data-processing services; and In­ ternet publishing and broadcasting. Substantial numbers also worked in professional, scientific, and technical services. Other salaried writers and editors work in computer systems design  346 Occupational Outlook Handbook  and related services, public and private educational services, and religious organizations. Jobs with major book publishers, magazines, broadcasting companies, advertising agencies, and public relations firms are concentrated in New York, Chicago, Los Angeles, Boston, Philadelphia, and San Francisco. However, many writers work outside these cities and travel regularly to meet with personnel at the headquarters. Jobs with newspapers, business and pro­ fessional journals, and technical and trade magazines are more widely dispersed throughout the country. Technology permits writers and editors to work from distant and remote locations and still communicate with editors and publishers. As a re­ sult, geographic concentration is less of a requirement for many writing or editing positions than it once was. Thousands of other individuals work primarily as freelance writers, earning income from their articles, books, and less commonly, television and movie scripts. Many support them­ selves with income derived from other sources.  Job Outlook Employment of writers and editors is expected to grow about as fast as the average for all occupations. Competition is expected for writing and editing jobs because many people with the ap­ propriate training and talent are attracted to the occupation. Employment change. Employment of writers and editors is expected to grow 10 percent, or about as fast as the average for all occupations, from 2006 to 2016. Employment of salaried writers and editors is expected to increase as demand grows for web-based publications. Technical writing, blogging, and other writing for interactive media that provide readers with nearly real-time information will provide opportunities for writers. Print magazines and other periodicals increasingly are develop­ ing market niches, appealing to readers with special interests, and making Internet-only content available on their websites. Businesses and organizations are developing newsletters and websites, and more companies are publishing materials directly for the Internet. Online publications and services are growing in number and sophistication, spurring the demand for writers and editors, especially those with Web experience. Profession­ al, scientific, and technical services firms, including advertising and public relations agencies, also are growing and should be another source of new jobs. Job prospects. Opportunities should be best for technical writers and those with training in a specialized field. Demand for technical writers and writers with expertise in areas such as law, medicine, or economics is expected to increase because of the continuing expansion of scientific and technical information and the need to communicate it to others. Legal, scientific, and  technological developments and discoveries generate demand for people to interpret technical information for a more general audience. Rapid growth and change in the high-technology and electronics industries result in a greater need for people to write users’ guides, instruction manuals, and training materials. This work requires people who not only are technically skilled as writers, but also are familiar with the subject area. In addition to job openings created by employment growth, some openings will arise as experienced workers retire, trans­ fer to other occupations, or leave the labor force. Replacement needs are relatively high in this occupation because many free­ lancers leave because they cannot earn enough money.  Earnings Median annual earnings for salaried writers and authors were $48,640 in May 2006. The middle 50 percent earned between $34,850 and $67,820. The lowest 10 percent earned less than $25,430, and the highest 10 percent earned more than $97,700. Median annual earnings were $50,650 in advertising and re­ lated services and $40,880 in newspaper, periodical, book, and directory publishers.  Median annual earnings for salaried editors were $46,990 in May 2006. The middle 50 percent earned between $35,250 and $64,140. The lowest 10 percent earned less than $27,340, and the highest 10 percent earned more than $87,400. Median an­ nual earnings of those working for newspaper, periodical, book, and directory publishers were $45,970. Median annual earnings for salaried technical writers were $58,050 in May 2006. The middle 50 percent earned between $45,130 and $73,750. The lowest 10 percent earned less than $35,520, and the highest 10 percent earned more than $91,720. Median annual earnings in computer systems design and related services were $59,830. According to the Society for Technical Communication, the median annual salary for entry level technical writers was $40,400 in 2005. The median annual salary for midlevel nonsupervisory technical writers was $52,140, and for senior nonsupervisory technical writers, $69,000.  Related Occupations Writers and editors communicate ideas and information. Other communications occupations include announcers; interpreters and translators; news analysts, reporters, and correspondents; and public relations specialists.  Sources of Additional Information For information on careers in technical writing, contact: y Society for Technical Communication, Inc., 901N. Stuart St., Suite 904, Arlington, VA 22203. Internet: http://www.stc.org  Projections data from the National Employment Matrix Occupational Title Writers and editors.................................................. ............................. Editors.................................................................. ............................. Technical writers................................................. ............................. Writers and authors............................................. .............................  soc Code 27-3040 27-3041 27-3042 27-3043  Employment, 2006 306,000 122,000 49,000 135,000  Projected employment, 2016 336,000 124,000 59,000 153,000  Change, 2006-2016 Number Percent 10 30,000 2,800 2 9,600 20 17,000 13  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 347  Health Diagnosing and Treating Practitioners Audiologists (0*NET 29-1121.00)  Significant Points •  More than half worked in health care facilities; many others were employed by educational services.  •  A master’s degree in audiology (hearing) is the stan­ dard level of education required; however, a doctoral degree is becoming more common for new entrants.  •  Few openings are expected because of the small size of the occupation.  •  Job prospects will be favorable for those possessing the doctoral (Au.D.) degree.  Nature of the Work Audiologists work with people who have hearing, balance, and related ear problems. They examine individuals of all ages and identify those with the symptoms of hearing loss and other au­ ditory, balance, and related sensory and neural problems. They then assess the nature and extent of the problems and help the individuals manage them. Using audiometers, computers, and other testing devices, they measure the loudness at which a per­ son begins to hear sounds, the ability to distinguish between sounds, and the impact of hearing loss on an individual’s daily life. In addition, audiologists use computer equipment to evalu­ ate and diagnose balance disorders. Audiologists interpret these results and may coordinate them with medical, educational, and psychological information to make a diagnosis and determine a course of treatment. Hearing disorders can result from a variety of causes includ­ ing trauma at birth, viral infections, genetic disorders, expo­ sure to loud noise, certain medications, or aging. Treatment may include examining and cleaning the ear canal, fitting and  Audiologists usually work at a desk or table in clean, comfort­ able surroundings.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  dispensing hearing aids, and fitting and programming cochlear implants. Audiologic treatment also includes counseling on adjusting to hearing loss, training on the use of hearing instru­ ments, and teaching communication strategies for use in a va­ riety of environments. For example, they may provide instruc­ tion in listening strategies. Audiologists also may recommend, fit, and dispense personal or large area amplification systems and alerting devices. In audiology clinics, audiologists may independently develop and carry out treatment programs. They keep records on the initial evaluation, progress, and discharge of patients. In other settings, audiologists may work with other health and education providers as part of a team in planning and implementing ser­ vices for children and adults. Audiologists who diagnose and treat balance disorders often work in collaboration with physi­ cians, and physical and occupational therapists. Some audiologists specialize in work with the elderly, chil­ dren, or hearing-impaired individuals who need special treat­ ment programs. Others develop and implement ways to protect workers’ hearing from on-the-job injuries. They measure noise levels in workplaces and conduct hearing protection programs in factories and in schools and communities. Audiologists who work in private practice also manage the business aspects of running an office, such as developing a patient base, hiring employees, keeping records, and ordering equipment and supplies. A few audiologists conduct research on types of, and treat­ ment for, hearing, balance, and related disorders. Others design and develop equipment or techniques for diagnosing and treat­ ing these disorders. Work environment. Audiologists usually work at a desk or table in clean, comfortable surroundings. The job is not physi­ cally demanding but does require attention to detail and intense concentration. The emotional needs of patients and their fami­ lies may be demanding. Most full-time audiologists work about 40 hours per week, which may include weekends and evenings to meet the needs of patients. Some work part time. Those who work on a contract basis may spend a substantial amount of time traveling between facilities.  Training, Other Qualifications, and Advancement All States require audiologists to be licensed or registered. Li­ censure or registration requires at least a master’s degree in audiology; however, a first professional, or doctoral, degree is becoming increasingly necessary. Education and training. Individuals must have at least a master’s degree in audiology to qualify for a job. However, a first professional or doctoral degree is becoming more com­ mon. As of early 2007, eight States required a doctoral degree or its equivalent. The professional doctorate in audiology (Au. D.) requires approximately 8 years of university training and supervised professional experience. In early 2007, the Accreditation Commission of Audiology Education accredited more than 50 Au.D. programs and the  348 Occupational Outlook Handbook  Council on Academic Accreditation in Audiology and SpeechLanguage Pathology (CAA) accredited over 70 graduate pro­ grams in audiology. Graduation from an accredited program may be required to obtain a license in some States. Require­ ments for admission to programs in audiology include courses in English, mathematics, physics, chemistry, biology, psychol­ ogy, and communication. Graduate coursework in audiology includes anatomy; physiology; physics; genetics; normal and abnormal communication development; auditory, balance, and neural systems assessment and treatment; diagnosis and treat­ ment; pharmacology; and ethics. Licensure and certification. Audiologists are regulated by licensure or registration in all 50 States. Forty-one States have continuing education requirements for licensure renewal, the number of hours required varies by State. Twenty States and the District of Columbia also require audiologists to have a Hearing Aid Dispenser license to dispense hearing aids; for the remaining 30 States, an audiologist license is all that is needed to dispense hearing aids. Third-party payers generally require practitioners to be licensed to qualify for reimbursement. States set requirements for education, mandating a master’s or doc­ toral degree, as well as other requirements. For information on the specific requirements of your State, contact that State’s licensing board. In some States, specific certifications from professional asso­ ciations satisfy some or all of the requirements for State licen­ sure. Certification can be obtained from two certifying bodies. Audiologists can earn the Certificate of Clinical Competence in Audiology (CCC-A) offered by the American Speech-Lan­ guage-Hearing Association; they may also be certified through the American Board of Audiology. Other qualifications. Audiologists should be able to ef­ fectively communicate diagnostic test results, diagnoses, and proposed treatments in a manner easily understood by their patients. They must be able to approach problems objectively and provide support to patients and their families. Because a patient’s progress may be slow, patience, compassion, and good listening skills are necessary. It is important for audiologists to be aware of new diagnostic and treatment technologies. Most audiologists participate in continuing education courses to learn new methods and tech­ nologies. Advancement. With experience, audiologists can advance to open their own private practice. Audiologist working in hos­ pitals and clinics can advance to management or supervisory positions.  outpatient care centers. About 13 percent of jobs were in edu­ cational services, including elementary and secondary schools. Other jobs for audiologists were in health and personal care stores, including hearing aid stores; scientific research and de­ velopment services; and State and local governments. A small number of audiologists were self-employed in pri­ vate practice. They provided hearing health care services in their own offices or worked under contract for schools, health care facilities, or other establishments.  Job Outlook Average employment growth is projected. However, because of the small size of the occupation, few job openings are expected. Job prospects will be favorable for those possessing the Au.D. degree. Employment change. Employment of audiologists is expect­ ed to grow 10 percent from 2006 to 2016, about as fast as the average for all occupations. Hearing loss is strongly associated with aging, so rapid growth in older population groups will cause the number of people with hearing and balance impairments to increase markedly. Medical advances also are improving the survival rate of premature infants and trauma victims, who then need assessment and sometimes treatment. Greater awareness of the importance of early identification and diagnosis of hear­ ing disorders in infants also will increase employment. A num­ ber of States require that newborns be screened for hearing loss and receive appropriate early intervention services. Employment in educational services will increase along with growth in elementary and secondary school enrollments, in­ cluding enrollment of special education students. Growth in employment of audiologists will be moderated by limitations on reimbursements made by third-party payers for the tests and services they provide. Job prospects. Job prospects will be favorable for those pos­ sessing the Au.D. degree. Only a few job openings for au­ diologists will arise from the need to replace those who leave the occupation, because the occupation is relatively small and workers tend to stay in this occupation until they retire.  Earnings Median annual earnings of wage-and-salary audiologists were $57,120 in May 2006. The middle 50 percent earned between $47,220 and $70,940. The lowest 10 percent earned less than $38,370, and the highest 10 percent earned more than $89,160. Some employers may pay for continuing education courses.  Employment  Related Occupations  Audiologists held about 12,000 jobs in 2006. More than half of all jobs were in health care facilities—offices of physicians or other health practitioners, including audiologists; hospitals; and  Audiologists specialize in the prevention, diagnosis, and treat­ ment of hearing problems. Workers in related occupations in­ clude occupational therapists, optometrists, physical therapists,  Projections data from the National Employment Matrix Occupational Title Audiologists............................................................. ...................  soc  Code  29-1121  Employment,  2006 12,000  Projected employment,  2016 13,000  Change,  2006-2016  Number  1,200  Percent  10  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 349  psychologists, recreational therapists, rehabilitation counselors, and speech-language pathologists.  Sources of Additional Information State licensing boards can provide information on licensure requirements. State departments of education can supply in­ formation on certification requirements for those who wish to work in public schools. For information on the specific requirements of your State, contact that State’s licensing board. Career information, a de­ scription of the CCC-A credential, and information on State li­ censure is available from: y American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, MD 20852. Internet: http://www.asha.org Information on American Board of Audiology certification is available from: >• American Board of Audiology, 11730 Plaza America Dr., Suite 300, Reston, VA 20190. Internet: http://www.americanboardofaudiology.org For information on the Au.D. degree, contact: > Audiology Foundation of America, 8 N. 3rd St., Suite 406, Lafayette, IN 47901. Internet: http://www.audfound.org  health, including exercise, diet, rest, environment, and heredity. Chiropractors recommend changes in lifestyle that affect those factors. In some situations, chiropractors refer patients to or consult with other health practitioners. Like other health practitioners, chiropractors follow a stan­ dard routine to get information needed to diagnose and treat patients. They take the patient’s medical history; conduct physical, neurological, and orthopedic examinations; and may order laboratory tests. X-rays and other diagnostic images are important tools because of the chiropractor’s emphasis on the spine and its proper function. Chiropractors also analyze the patient’s posture and spine using a specialized technique. For patients whose health problems can be traced to the musculosk­ eletal system, chiropractors manually adjust the spinal column. Some chiropractors use other alternative medicines in their practices, including therapies using water, light, massage, ul­ trasound, electric, acupuncture, and heat. They also may apply supports such as straps, tapes, and braces to manually adjust the spine. Chiropractors counsel patients about health concepts such as nutrition, exercise, changes in lifestyle, and stress man­ agement, but chiropractors do not prescribe drugs or perform surgery.  Chiropractors (C)**NET 29-1011.00)  Significant Points •  Job prospects should be good; employment is expect­ ed to grow faster than average because of increasing consumer demand for alternative health care.  •  Chiropractors must be licensed, requiring 2 to 4 years of undergraduate education, the completion of a 4year chiropractic college course, and passing scores on national and State examinations.  •  About 52 percent of chiropractors were self em­ ployed.  •  Earnings are relatively low in the beginning but in­ crease as the practice grows.  Nature of the Work Chiropractors, also known as doctors of chiropractic or chiro­ practic physicians, diagnose and treat patients with health prob­ lems of the musculoskeletal system and treat the effects of those problems on the nervous system and on general health. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine. Chiropractic medicine is based on the principle that spinal joint misalignments interfere with the nervous system and can result in lower resistance to disease and many different conditions of diminished health. The chiropractic approach to health care stresses the patient’s overall health. Chiropractors provide natural, drugless, nonsurgical health treatments, relying on the body’s inherent recu­ perative abilities. They also recognize that many factors affect  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Chiropractors provide natural, drugless, nonsurgical health treatments to patients, including spinal adjustments.  350 Occupational Outlook Handbook  In addition to general chiropractic practice, some chiroprac­ tors specialize in sports injuries, neurology, orthopedics, pedi­ atrics, nutrition, internal disorders, or diagnostic imaging. Many chiropractors are solo or group practitioners who also have the administrative responsibilities of running a practice. In larger offices, chiropractors delegate these tasks to office managers and chiropractic assistants. Chiropractors in private practice are responsible for developing a patient base, hiring employees, and keeping records. Work environment. Chiropractors work in clean, comfort­ able offices. Like other health practitioners, chiropractors are sometimes on their feet for long periods. Chiropractors who take x-rays must employ appropriate precautions against the dangers of repeated exposure to radiation. Chiropractors work, on average, about 40 hours per week, although longer hours are not uncommon. Solo practitioners set their own hours but may work evenings or weekends to ac­ commodate patients. Like other health care practitioners, chi­ ropractors in a group practice will sometimes be on call or treat patients of other chiropractors in the group.  Training, Other Qualifications, and Advancement Chiropractors must be licensed, which requires 2 to 4 years of undergraduate education, the completion of a 4-year chiro­ practic college course, and passing scores on national and State examinations. Education and training. In 2007, 16 chiropractic programs and 2 chiropractic institutions in the United States were ac­ credited by the Council on Chiropractic Education. Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor’s degree, including courses in Eng­ lish, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor’s degree, which may eventually become the minimum entry requirement. Several chiropractic colleges of­ fer prechiropractic study, as well as a bachelor’s degree pro­ gram. Recognition of prechiropractic education offered by chiropractic colleges varies among the States. Chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. Dur­ ing the first 2 years, most chiropractic programs emphasize classroom and laboratory work in sciences such as anatomy, physiology, public health, microbiology, pathology, and bio­ chemistry. The last 2 years focus on courses in manipulation and spinal adjustment and provide clinical experience in physi­ cal and laboratory diagnosis, neurology, orthopedics, geriat­ rics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic. Chiropractic colleges also offer postdoctoral training in or­ thopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences. Once such training is com­ plete, chiropractors may take specialty exams leading to “diplomate” status in a given specialty. Exams are administered by specialty chiropractic associations. Licensure. All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet the educational and examination requirements estab­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  lished by the State. Chiropractors can practice only in States where they are licensed. Some States have agreements per­ mitting chiropractors licensed in one State to obtain a license in another without further examination, provided that their educational, examination, and practice credentials meet State specifications. Most State licensing boards require at least 2 years of under­ graduate education, but an increasing number are requiring a 4-year bachelor’s degree. All boards require the completion of a 4-year program at an accredited chiropractic college leading to the Doctor of Chiropractic degree. For licensure, most State boards recognize either all or part of the four-part test administered by the National Board of Chi­ ropractic Examiners. State examinations may supplement the National Board tests, depending on State requirements. All States except New Jersey require the completion of a specified number of hours of continuing education each year in order to maintain licensure. Chiropractic associations and accredited chiropractic programs and institutions offer continuing educa­ tion programs. Other qualifications. Chiropractic requires keen observa­ tion to detect physical abnormalities. It also takes considerable manual dexterity, but not unusual strength or endurance, to per­ form adjustments. Chiropractors should be able to work inde­ pendently and handle responsibility. As in other health-related occupations, empathy, understanding, and the desire to help others are good qualities for dealing effectively with patients. Advancement. Newly licensed chiropractors can set up a new practice, purchase an established one, or enter into part­ nership with an established practitioner. They also may take a salaried position with an established chiropractor, a group practice, or a health care facility  Employment Chiropractors held about 53,000 jobs in 2006. Most chiroprac­ tors work in a solo practice, although some are in group prac­ tice or work for other chiropractors. A small number teach, conduct research at chiropractic institutions, or work in hos­ pitals and clinics. Approximately 52 percent of chiropractors were self employed. Many chiropractors are located in small communities. How­ ever, the distribution of chiropractors is not geographically uniform. This occurs primarily because new chiropractors fre­ quently establish their practices in close proximity to one of the few chiropractic educational institutions.  Job Outlook Employment is expected to grow faster than average because of increasing consumer demand for alternative health care. Job prospects should be good. Employment change. Employment of chiropractors is ex­ pected to increase 14 percent between 2006 and 2016, faster than the average for all occupations. Projected job growth stems from increasing consumer demand for alternative health care. Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform sur­ gery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremi­ ties, and joints has become more accepted as a result of re-  Professional and Related Occupations 351  Projections data from the National Employment Matrix Occupational Title Chiropractors............................................... ................................  SOC Code 29-1011  Projected employment, 2016 60,000  Employment, 2006 53,000  Change, 2006-2016 Number Percent 7,600 14  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  search and changing attitudes about alternative, noninvasive health care practices. The rapidly expanding older population, with its increased likelihood of mechanical and structural prob­ lems, also will increase demand for chiropractors. Demand for chiropractic treatment, however, is related to the ability of patients to pay, either directly or through health in­ surance. Although more insurance plans now cover chiroprac­ tic services, the extent of such coverage varies among plans. Chiropractors must educate communities about the benefits of chiropractic care in order to establish a successful practice. Job prospects. Job prospects for new chiropractors are ex­ pected to be good. In this occupation, replacement needs arise almost entirely from retirements. Chiropractors usually remain in the occupation until they retire; few transfer to other occupa­ tions. Establishing a new practice will be easiest in areas with a low concentration of chiropractors.  Earnings Median annual earnings of salaried chiropractors were $65,220 in 2006. The middle 50 percent earned between $45,710 and $96,500 a year. In 2005, the mean salary for chiropractors was $104,363 according to a survey conducted by Chiropractic Economics magazine. In chiropractic, as in other types of independent practice, earnings are relatively low in the beginning and increase as the practice grows. Geographic location and the characteristics and qualifications of the practitioner also may influence earn­ ings. Salaried chiropractors typically receive heath insurance and retirement benefits from their employers, whereas self-em­ ployed chiropractors must provide for their own health insur­ ance and retirement.  For a list of chiropractic programs and institutions, as well as general information on chiropractic education, contact: y Council on Chiropractic Education, 8049 North 85th Way, Scottsdale, AZ 85258-4321. Internet: http://www.cce-usa.org For information on State education and licensure require­ ments, contact: y Federation of Chiropractic Licensing Boards, 5401 W. 10th St., Suite 101, Greeley, CO 80634-4400. Internet: http://www.fclb.org For more information on the national chiropractic licensing exam, contact: y National Board of Chiropractic Examiners, 901 54th Ave., Greeley, CO 80634-4400. Internet: http://www.nbce.org For information on admission requirements to a specific chi­ ropractic college, as well as scholarship and loan information, contact the college’s admissions office.  Dentists (0**NET 29-1021.00, 29-1022.00, 29-1023.00, 29-1024.00, 29-1029.99)  Significant Points •  Most dentists are solo practitioners.  •  Dentists usually complete at least 8 years of education beyond high school.  •  openings, but most openings will result from the need to replace the large number of dentists expected to re­ tire.  Related Occupations Chiropractors treat patients and work to prevent bodily disor­ ders and injuries. So do athletic trainers, massage therapists, occupational therapists, physical therapists, physicians and sur­ geons, podiatrists, and veterinarians.  Sources of Additional Information General information on a career as a chiropractor is available from the following organizations: y American Chiropractic Association, 1701 Clarendon Blvd., Arlington, VA 22209. Internet: http://www.acatoday.org y International Chiropractors Association, 1110 North Glebe Rd., Suite 650, Arlington, VA 22201. Internet: http://www.chiropractic.org y World Chiropractic Alliance, 2950 N. Dobson Rd., Suite 3, Chandler, AZ 85224.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Average employment growth will generate some job  •  Job prospects should be good.  Nature of the Work Dentists diagnose and treat problems with teeth and tissues in the mouth, along with giving advice and administering care to help prevent future problems. They provide instruction on diet, brushing, flossing, the use of fluorides, and other aspects of dental care. They remove tooth decay, fill cavities, exam­ ine x-rays, place protective plastic sealants on children’s teeth, straighten teeth, and repair fractured teeth. They also perform corrective surgery on gums and supporting bones to treat gum diseases. Dentists extract teeth and make models and measure­ ments for dentures to replace missing teeth. They also adminis­ ter anesthetics and write prescriptions for antibiotics and other medications.  352 Occupational Outlook Handbook  Dentists use a variety of equipment, including x-ray ma­ chines, drills, mouth mirrors, probes, forceps, brushes, and scalpels. They wear masks, gloves, and safety glasses to protect themselves and their patients from infectious diseases. Dentists in private practice oversee a variety of administrative tasks, including bookkeeping and the buying of equipment and supplies. They may employ and supervise dental hygienists, dental assistants, dental laboratory technicians, and reception­ ists. (These occupations are described elsewhere in the Hand­ book.) Most dentists are general practitioners, handling a variety of dental needs. Other dentists practice in any of nine specialty areas. Orthodontists, the largest group of specialists, straighten teeth by applying pressure to the teeth with braces or retainers. The next largest group, oral and maxillofacial surgeons, oper­ ates on the mouth and jaws. The remainder may specialize as pediatric dentists (focusing on dentistry for children); perio­ dontists (treating gums and bone supporting the teeth); prosth­ odontists (replacing missing teeth with permanent fixtures, such as crowns and bridges, or with removable fixtures such as dentures); endodontists (performing root canal therapy); pub­ lic health dentists (promoting good dental health and prevent­ ing dental diseases within the community); oral pathologists (studying oral diseases); or oral and maxillofacial radiologists  f  is  w  Dentists use various equipment to diagnose and treat problems with teeth and tissues in the mouth.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  (diagnosing diseases in the head and neck through the use of imaging technologies). Work environment. Most dentists are solo practitioners, meaning that they own their own businesses and work alone or with a small staff. Some dentists have partners, and a few work for other dentists as associate dentists. Most dentists work 4 or 5 days a week. Some work eve­ nings and weekends to meet their patients’ needs. The number of hours worked varies greatly among dentists. Most full-time dentists work between 35 and 40 hours a week. However, oth­ ers, especially those who are trying to establish a new practice, work more. Also, experienced dentists often work fewer hours. It is common for dentists to continue in part-time practice well beyond the usual retirement age.  Training, Other Qualifications, and Advancement All 50 States and the District of Columbia require dentists to be licensed. To qualify for a license in most States, candidates must graduate from an accredited dental school and pass writ­ ten and practical examinations. Education and training. In 2006, there were 56 den­ tal schools accredited by the American Dental Association’s (ADA’s) Commission on Dental Accreditation. Dental schools require a minimum of 2 years of college-level predental educa­ tion prior to admittance. Most dental students have at least a bachelor’s degree before entering dental school, although a few applicants are accepted to dental school after 2 or 3 years of college and complete their bachelor’s degree while attending dental school. High school and college students who want to become den­ tists should take courses in biology, chemistry, physics, health, and mathematics. College undergraduates planning on apply­ ing to dental school are required to take many science courses. Because of this, some choose a major in a science, such as biol­ ogy or chemistry, while others take the required science coursework while pursuing a major in another subject. All dental schools require applicants to take the Dental Ad­ missions Test (DAT). When selecting students, schools consid­ er scores earned on the DAT, applicants’ grade point averages, and information gathered through recommendations and inter­ views. Competition for admission to dental school is keen. Dental school usually lasts 4 academic years. Studies begin with classroom instruction and laboratory work in science, in­ cluding anatomy, microbiology, biochemistry, and physiology. Beginning courses in clinical sciences, including laboratory techniques, are also completed. During the last 2 years, stu­ dents treat patients, usually in dental clinics, under the supervi­ sion of licensed dentists. Most dental schools award the degree of Doctor of Dental Surgery (DDS). Others award an equiva­ lent degree, Doctor of Dental Medicine (DMD). Some dental school graduates work for established dentists as associates for 1 to 2 years to gain experience and save money to equip an office of their own. Most dental school graduates, however, purchase an established practice or open a new one immediately after graduation. Licensure. Licensing is required to practice as a dentist. In most States, licensure requires passing written and practical examinations in addition to having a degree from an accred­  Professional and Related Occupations 353  ited dental school. Candidates may fulfill the written part of the State licensing requirements by passing the National Board Dental Examinations. Individual States or regional testing agencies administer the written or practical examinations. In 2006, 17 States licensed or certified dentists who intended to practice in a specialty area. Requirements include 2 to 4 years of postgraduate education and, in some cases, the comple­ tion of a special State examination. Most State licenses permit dentists to engage in both general and specialized practice. Other qualifications. Dentistry requires diagnostic ability and manual skills. Dentists should have good visual memory, excellent judgment regarding space, shape, and color, a high degree of manual dexterity, and scientific ability. Good busi­ ness sense, self-discipline, and good communication skills are helpful for success in private practice. Advancement. Dentists who want to teach or conduct re­ search usually spend an additional 2 to 5 years in advanced den­ tal training, in programs operated by dental schools or hospitals. A recent survey by the American Dental Education Association showed that 11 percent of new graduates enrolled in postgradu­ ate training programs to prepare for a dental specialty. Employment Dentists held about 161,000 jobs in 2006. Employment was distributed among general practitioners and specialists as fol­ lows: Dentists, general...................................................................136,000 Orthodontists............................................................................9,200 Oral and maxillofacial surgeons............................................. 7,700 Prosthodontists.........................................................................1,000 Dentists, all other specialists................................................... 6,900 About one third of dentists were self-employed and not in­ corporated. Almost all dentists work in private practice. Ac­ cording to the ADA, about 3 out of 4 dentists in private practice are sole proprietors, and 1 in 7 belongs to a partnership. A few salaried dentists work in hospitals and offices of physicians.  Job Outlook Average employment growth will generate some job openings, but most openings will result from the need to replace the large number of dentists expected to retire. Job prospects should be good as new dentists take over established practices or start their own.  Employment change. Employment of dentists is projected to grow nine percent through 2016, about as fast as the average for all occupations. The demand for dental services is expected to continue to increase. The overall population is growing, par­ ticularly the number of older people, which will increase the demand for dental care. As members of the baby-boom genera­ tion advance into middle age, a large number will need compli­ cated dental work, such as bridges. In addition, elderly people are more likely to retain their teeth than were their predeces­ sors, so they will require much more care than in the past. The younger generation will continue to need preventive checkups despite an overall increase in the dental health of the public over the last few decades. Recently, some private insurance provid­ ers have increased their dental coverage. If this trend contin­ ues, those with new or expanded dental insurance will be more likely to visit a dentist than in the past. Also, while they are currently a small proportion of dental expenditures, cosmetic dental services, such as fitting braces for adults as well as chil­ dren and providing teeth-whitening treatments, have become increasingly popular. However, employment of dentists is not expected to keep pace with the increased demand for dental services. Produc­ tivity increases from new technology, as well as having dental hygienists and assistants perform some tasks, will allow den­ tists to perform more work than they have in the past. As their practices expand, dentists are likely to hire more hygienists and dental assistants to handle routine services. Dentists will increasingly provide care and instruction aimed at preventing the loss of teeth, rather than simply providing treatments such as fillings. Improvements in dental technology also will allow dentists to offer more effective and less painful treatment to their patients. Job prospects. As an increasing number of dentists from the baby-boom generation reach retirement age, many of them will retire or work fewer hours. However, the number of applicants to, and graduates from, dental schools has increased in recent years. Therefore, younger dentists will be able to take over the work from older dentists who retire or cut back on hours, as well as provide dental services to accommodate the growing demand. Demand for dental services tends to follow the business cy­ cle, primarily because these services usually are paid for either by the patient or by private insurance companies. As a result, during slow times in the economy, demand for dental services can decrease; dentists may have difficulty finding employment,  Projections data from the National Employment Matrix Occupational Title Dentists.......................................................................... ........................ Dentists, general........................................................ ........................ Oral and maxillofacial surgeons............................. ........................ Orthodontists............................................................. ........................ Prosthodontists.......................................................... ........................ Dentists, all other specialists................................... ........................  soc Code 29-1020 29-1021 29-1022 29-1023 29-1024 29-1029  Employment, 2006 161,000 136,000 7,700 9,200 1,000 6,900  Projected employment, 2016 176,000 149,000 8,400 10,000 1,100 7,400  Change, 2006-2016 Number Percent 15,000 9 13,000 9 700 9 800 9 100 11 500 7  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  354 Occupational Outlook Handbook  or if already in an established practice, they may work fewer hours because of reduced demand.  Earnings Median annual earnings of salaried dentists were $136,960 in May 2006. Earnings vary according to number of years in practice, location, hours worked, and specialty. Self-employed dentists in private practice tend to earn more than do salaried dentists. Dentists who are salaried often receive benefits paid by their employer, with health insurance and malpractice insurance be­ ing among the most common. However, like other business owners, self-employed dentists must provide their own health insurance, life insurance, retirement plans, and other benefits.  Related Occupations Dentists examine, diagnose, prevent, and treat diseases and abnor­ malities. Chiropractors, optometrists, physicians and surgeons, podiatrists, psychologists, and veterinarians do similar work.  Sources of Additional Information For information on dentistry as a career, a list of accredited dental schools, and a list of State boards of dental examiners, contact: y American Dental Association, Commission on Dental Accreditation, 211 E. Chicago Ave., Chicago, IL 60611. Internet: http://www.ada.org For information on admission to dental schools, contact: y AmericanDentalEducationAssociation, 1400KSt.NW.,Suite 1100, Washington, DC 20005. Internet: http://www.adea.org Persons interested in practicing dentistry should obtain the requirements for licensure from the board of dental examiners of the State in which they plan to work. To obtain information on scholarships, grants, and loans, in­ cluding Federal financial aid, prospective dental students should contact the office of student financial aid at the schools to which they apply.  Dietitians and Nutritionists (0**NET 29-1031.00)  Significant Points  •  •  •  •  Most jobs are in hospitals, nursing care facilities, out­ patient care centers, and offices of physicians or other health practitioners. Dietitians and nutritionists need at least a bachelor’s degree in dietetics, foods and nutrition, food service systems management, or a related area; licensure, cer­ tification, or registration requirements vary by State. Employment is projected to grow about as fast as the average for all occupations; however, growth may be constrained if employers substitute other workers for dietitians and if limitations are placed on insurance reimbursement for dietetic services. Good job opportunities are expected.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Dietitians and nutritionists plan food and nutrition programs, supervise meal preparation, and oversee the serving of meals. They prevent and treat illnesses by promoting healthy eating habits and recommending dietary modifications. For example, dietitians might teach a patient with high blood pressure how to use less salt when preparing meals, or create a diet reduced in fat and sugar for an overweight patient. Dietitians manage food service systems for institutions such as hospitals and schools, promote sound eating habits through education, and conduct research. Many dietitians specialize, becoming a clinical dietitian, community dietitian, manage­ ment dietitian, or consultant. Clinical dietitians provide nutritional services to patients in hospitals, nursing care facilities, and other institutions. They assess patients’ nutritional needs, develop and implement nu­ trition programs, and evaluate and report the results. They also confer with doctors and other health care professionals to coordinate medical and nutritional needs. Some clinical dietitians specialize in managing the weight of overweight pa­ tients or in the care of renal (kidney), diabetic, or critically ill patients. In addition, clinical dietitians in nursing care facili­ ties, small hospitals, or correctional facilities may manage the food service department. Community dietitians counsel individuals and groups on nutritional practices designed to prevent disease and promote health. Working in places such as public health clinics, home health agencies, and health maintenance organizations, com­ munity dietitians evaluate individual needs, develop nutri­ tional care plans, and instruct individuals and their families. Dietitians working in home health agencies provide instruc­ tion on grocery shopping and food preparation to the elderly, children, and individuals with special needs. Increased public interest in nutrition has led to job oppor­ tunities in food manufacturing, advertising, and marketing. In these areas, dietitians analyze foods, prepare literature for distribution, or report on issues such as dietary fiber, vitamin supplements, or the nutritional content of recipes. Management dietitians oversee large-scale meal planning and preparation in health care facilities, company cafeterias, prisons, and schools. They hire, train, and direct other dieti­ tians and food service workers; budget for and purchase food, equipment, and supplies; enforce sanitary and safety regula­ tions; and prepare records and reports. Consultant dietitians work under contract with health care facilities or in their own private practice. They perform nutri­ tion screenings for their clients and offer advice on diet-re­ lated concerns such as weight loss and cholesterol reduction. Some work for wellness programs, sports teams, supermar­ kets, and other nutrition-related businesses. They may consult with food service managers, providing expertise in sanitation, safety procedures, menu development, budgeting, and plan­ ning. Work environment. Dietitians and nutritionists usually work in clean, well-lighted, and well-ventilated areas. How­ ever, some work in hot, congested kitchens. Many dietitians and nutritionists are on their feet for much of the workday.  Professional and Related Occupations 355  PM  *tiS§'  \  ’ Dietitians and nutritionists plan food and nutrition programs to reach the client’s health goals. Most full-time dietitians and nutritionists work a regular 40-hour week, although some work weekends. About 1 in 3 worked part time in 2006.  Training, Other Qualifications, and Advancement Dietitians and nutritionists need at least a bachelor’s degree. Licensure, certification, or registration requirements vary by State. Education and training. Becoming a dietitian or nutritionist usually requires at least a bachelor’s degree in dietetics, foods and nutrition, food service systems management, or a related area. Graduate degrees also are available. College students in these majors take courses in foods, nutrition, institution man­ agement, chemistry, biochemistry, biology, microbiology, and physiology. Other suggested courses include business, math­ ematics, statistics, computer science, psychology, sociology, and economics. High school students interested in becom­ ing a dietitian or nutritionist should take courses in biology, chemistry, mathematics, health, and communications. As of 2007, there were 281 bachelor’s degree programs and 22 master’s degree programs approved by the American Di­ etetic Association’s Commission on Accreditation for Dietet­ ics Education. Licensure. Of the 48 States and jurisdictions with laws governing dietetics, 35 require licensure, 12 require statutory certification, and 1 requires registration. Requirements vary by State. As a result, interested candidates should determine the requirements of the State in which they want to work be­ fore sitting for any exam. In States that require licensure, only people who are li­ censed can work as dietitians and nutritionists. States that re­ quire statutory certification limit the use of occupational titles to people who meet certain requirements; individuals without certification can still practice as a dietitian or nutritionist but   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  without using certain titles. Registration is the least restrictive form of State regulation of dietitians and nutritionists. Un­ registered people are permitted to practice as a dietitian or nutritionist. Certification and other qualifications. Although not re­ quired, the Commission on Dietetic Registration of the Amer­ ican Dietetic Association awards the Registered Dietitian cre­ dential to those who pass an exam after completing academic coursework and a supervised internship. This certification is different from the statutory certification regulated by some States and discussed in the previous section. To maintain a Registered Dietitian status, workers must complete at least 75 credit hours in approved continuing education classes every 5 years. A supervised internship, required for certification, can be completed in one of two ways. The first requires the comple­ tion of a program accredited by the Commission on Dietetic Registration. As of 2007, there were 53 accredited programs that combined academic and supervised practice experience and generally lasted 4 to 5 years. The second option requires the completion of 900 hours of supervised practice experience in any of the 265 accredited internships. These internships may be full-time programs lasting 6 to 12 months or part-time programs lasting 2 years. Advancement. Experienced dietitians may advance to man­ agement positions, such as assistant director, associate direc­ tor, or director of a dietetic department, or may become selfemployed. Some dietitians specialize in areas such as renal, diabetic, cardiovascular, or pediatric dietetics. Others leave the occupation to become sales representatives for equipment, pharmaceutical, or food manufacturers. A master’s degree can help some workers to advance their careers, particularly in career paths related to research, advanced clinical positions, or public health.  Employment Dietitians and nutritionists held about 57,000 jobs in 2006. More than half of all jobs were in hospitals, nursing care facil­ ities, outpatient care centers, or offices of physicians and other health practitioners. State and local government agencies pro­ vided additional jobs—mostly in correctional facilities, health departments, and other public-health-related areas. Some di­ etitians and nutritionists were employed in special food ser­ vices, an industry made up of firms providing food services on contract to facilities such as colleges and universities, airlines, correctional facilities, and company cafeterias. Other jobs were in public and private educational services, community care facilities for the elderly (which includes assisted-living facilities), individual and family services, home health care services, and the Federal Government—mostly in the U.S. Department of Veterans Affairs. Some dietitians were self-employed, working as consultants to facilities such as hospitals and nursing care facilities or providing dietary counseling to individuals.  Job Outlook Average employment growth is projected. Good job opportu­ nities are expected, especially for dietitians with specialized  356 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Dietitians and nutritionists..................................... ..............................  soc Code  Employment, 2006  29-1031  57,000  Projected employment, 2016 62,000  Change, 2006-2016 Number Percent 4,900 9  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  training, an advanced degree, or certifications beyond the par­ ticular State’s minimum requirement. Employment change. Employment of dietitians and nutri­ tionists is expected to increase 9 percent during the 2006-16 projection decade, about as fast as the average for all occupa­ tions. Job growth will result from an increasing emphasis on disease prevention through improved dietary habits. A grow­ ing and aging population will boost demand for nutritional counseling and treatment in hospitals, residential care facili­ ties, schools, prisons, community health programs, and home health care agencies. Public interest in nutrition and increased emphasis on health education and prudent lifestyles also will spur demand, especially in food service management. Employment growth, however, may be constrained if some employers substitute other workers, such as health educators, food service managers, and dietetic technicians, to do work related to nutrition. Also, demand for nutritional therapy ser­ vices is related to the ability of patients to pay, either out-of­ pocket or through health insurance, and although more insur­ ance plans now cover nutritional therapy services, the extent of such coverage varies among plans. Growth may be curbed by limitations on insurance reimbursement for dietetic ser­ vices. Hospitals will continue to employ a large number of dieti­ tians and nutritionists to provide medical nutritional therapy and plan meals. But hospitals also will continue to contract with outside agencies for food service and move medical nutri­ tional therapy to outpatient care facilities, slowing job growth in hospitals relative to food service, outpatient facilities, and other employers. The number of dietitian positions in nursing care facilities is expected to decline, as these establishments continue to contract with outside agencies for food services. However, employment is expected to grow rapidly in contract providers of food services, in outpatient care centers, and in offices of physicians and other health practitioners. Finally, with increased public awareness of obesity and dia­ betes, Medicare coverage may be expanded to include medi­ cal nutrition therapy for renal and diabetic patients, creating job growth for dietitians and nutritionists specializing in those diseases. Job prospects. In addition to employment growth, job open­ ings will result from the need to replace experienced workers who retire or leave the occupation for other reasons. Overall, job opportunities will be good for dietitians and nutritionists, particularly for licensed and registered dietitians. Job oppor­ tunities should be particularly good in outpatient care facili­ ties, offices of physicians, and food service management. Di­ etitians and nutritionists without a bachelor’s degree will face keen competition for jobs.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Dietitians with specialized training, an advanced degree, or certifications beyond the particular State’s minimum require­ ment will experience the best job opportunities. Those spe­ cializing in renal and diabetic nutrition or gerontological nu­ trition will benefit from the growing number of diabetics and the aging of the population.  Earnings Median annual earnings of dietitians and nutritionists were $46,980 in May 2006. The middle 50 percent earned between $38,430 and $57,090. The lowest 10 percent earned less than $29,860, and the highest 10 percent earned more than $68,330. Median annual earnings in the industries employ­ ing the largest numbers of dietitians and nutritionists in May 2006 were: Outpatient care centers.......................................................$49,950 General medical and surgical hospitals............................... 47,320 State government.................................................................. 46,690 Nursing care facilities...........................................................46,660 Local government................................................................. 43,250 According to the American Dietetic Association, median annualized wages for registered dietitians in 2005 varied by practice area as follows: $53,800 in consultation and business; $60,000 in food and nutrition management; $60,200 in edu­ cation and research; $48,800 in clinical nutrition/ambulatory care; $50,000 in clinical nutrition/long-term care; $44,800 in community nutrition; and $45,000 in clinical nutrition/acute care. Salaries also vary by years in practice, education level, and geographic region.  Related Occupations Workers in other occupations who may apply the principles of dietetics include food service managers, health educators, dietetic technicians, and registered nurses.  Sources of Additional Information For a list of academic programs, scholarships, and other infor­ mation about dietetics, contact: y The American Dietetic Association, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Internet: http ://www.eatright.org For information on the Registered Dietitian exam and other specialty credentials, contact: y The Commission on Dietetic Registration, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Internet: http://www.cdrnet.org  Professional and Related Occupations 357  Occupational Therapists (0*NET 29-1122.00)  Significant Points  •  Employment is expected to grow much faster than average and job opportunities should be good, espe­ cially for therapists treating the elderly. • Occupational therapists must be licensed, requiring a master’s degree in occupational therapy, 6 months of supervised fieldwork, and passing scores on national and State examinations. • Occupational therapists are increasingly taking on supervisory roles, allowing assistants and aides to work more closely with clients under the guidance of a therapist. • More than a quarter of occupational therapists work part time. Nature of the Work Occupational therapists help patients improve their ability to perform tasks in living and working environments. They work with individuals who suffer from a mentally, physically, devel­ opmentally, or emotionally disabling condition. Occupational therapists use treatments to develop, recover, or maintain the daily living and work skills of their patients. The therapist helps clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. The goal is to help clients have independent, productive, and satisfying lives. Occupational therapists help clients to perform all types of activities, from using a computer to caring for daily needs such as dressing, cooking, and eating. Physical exercises may be used to increase strength and dexterity, while other activities may be chosen to improve visual acuity or the ability to discern patterns. For example, a client with short-term memory loss might be encouraged to make lists to aid recall, and a person with coordination problems might be assigned exercises to im­ prove hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision-making, abstract-reasoning, problem-solving, and perceptual skills, as well as memory, sequencing, and coordination—all of which are important for independent living. Patients with permanent disabilities, such as spinal cord inju­ ries, cerebral palsy, or muscular dystrophy, often need special instruction to master certain daily tasks. For these individuals, therapists demonstrate the use of adaptive equipment, includ­ ing wheelchairs, orthoses, eating aids, and dressing aids. They also design or build special equipment needed at home or at work, including computer-aided adaptive equipment. They teach clients how to use the equipment to improve communica­ tion and control various situations in their environment. Some occupational therapists treat individuals whose ability to function in a work environment has been impaired. These practitioners might arrange employment, evaluate the work   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  space, plan work activities, and assess the client’s progress. Therapists also may collaborate with the client and the em­ ployer to modify the work environment so that the client can successfully complete the work. Assessing and recording a client’s activities and progress is an important part of an occupational therapist’s job. Accurate records are essential for evaluating clients, for billing, and for reporting to physicians and other health care providers. Occupational therapists may work exclusively with individu­ als in a particular age group or with a particular disability. In schools, for example, they evaluate children’s capabilities, rec­ ommend and provide therapy, modify classroom equipment, and help children participate in school activities. A therapist may work with children individually, lead small groups in the classroom, consult with a teacher, or serve on an administrative committee. Some therapists provide early intervention therapy to infants and toddlers who have, or are at risk of having, devel­ opmental delays. Therapies may include facilitating the use of the hands and promoting skills for listening, following direc­ tions, social play, dressing, or grooming. Other occupational therapists work with elderly patients. These therapists help the elderly lead more productive, active, and independent lives through a variety of methods. Thera­ pists with specialized training in driver rehabilitation assess an individual’s ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommen­ dations for adaptive equipment, training to prolong driving independence, and alternative transportation options. Occu­ pational therapists also work with clients to assess their homes for hazards and to identify environmental factors that contrib­ ute to falls. Occupational therapists in mental health settings treat in­ dividuals who are mentally ill, developmentally challenged, or emotionally disturbed. To treat these problems, therapists  Occupational therapists help people improve their ability to perform tasks in their daily living and working environments.  358 Occupational Outlook Handbook  choose activities that help people learn to engage in and cope with daily life. Activities might include time management skills, budgeting, shopping, homemaking, and the use of public transportation. Occupational therapists also work with individ­ uals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress-related disorders. Work environment. In large rehabilitation centers, thera­ pists may work in spacious rooms equipped with machines, tools, and other devices generating noise. The work can be tiring because therapists are on their feet much of the time. Those providing home health care services may spend time driving from appointment to appointment. Therapists also face hazards such as back strain from lifting and moving clients and equipment. Occupational therapists in hospitals and other health care and community settings usually work a 40-hour week. Those in schools may participate in meetings and other activities dur­ ing and after the school day. In 2006, more than a quarter of occupational therapists worked part time. Training, Other Qualifications, and Advancement Occupational therapists must be licensed, requiring a master’s degree in occupational therapy, 6 months of supervised field­ work, and passing scores on national and State examinations. Education and training. A master’s degree or higher in oc­ cupational therapy is the minimum requirement for entry into the field. In 2007, 124 master’s degree programs offered entrylevel education, 66 programs offered a combined bachelor’s and master’s degree, and 5 offered an entry-level doctoral de­ gree. Most schools have full-time programs, although a grow­ ing number are offering weekend or part-time programs as well. Coursework in occupational therapy programs include the physical, biological, and behavioral sciences as well as the application of occupational therapy theory and skills. Pro­ grams also require the completion of 6 months of supervised fieldwork. People considering this profession should take high school courses in biology, chemistry, physics, health, art, and the so­ cial sciences. College admissions offices also look favorably on paid or volunteer experience in the health care field. Rel­ evant undergraduate majors include biology, psychology, soci­ ology, anthropology, liberal arts, and anatomy. Licensure. All States, Puerto Rico, Guam, and the District of Columbia regulate the practice of occupational therapy. To obtain a license, applicants must graduate from an accredited educational program and pass a national certification exami­ nation. Those who pass the exam are awarded the title “Oc­ cupational Therapist Registered (OTR).” Some States have additional requirements for therapists who work in schools or early intervention programs. These requirements may include  education-related classes, an education practice certificate, or early intervention certification. Other qualifications. Occupational therapists need patience and strong interpersonal skills to inspire trust and respect in their clients. Patience is necessary because many clients may not show rapid improvement. Ingenuity and imagination in adapting activities to individual needs are assets. Those work­ ing in home health care services also must be able to adapt to a variety of settings. Advancement. Occupational therapists are expected to con­ tinue their professional development by participating in con­ tinuing education courses and workshops. In fact, a number of States require continuing education as a condition of maintain­ ing licensure. Therapists are increasingly taking on supervisory roles. Be­ cause of rising health care costs, third-party payers are begin­ ning to encourage occupational therapist assistants and aides to take more hands-on responsibility for clients. Occupational therapists can choose to advance their careers by taking on ad­ ministrative duties and supervising assistants and aides. Occupational therapists also can advance by specializing in a clinical area and gaining expertise in treating a certain type of patient or ailment. Therapists have specialized in gerontology, mental health, pediatrics, and physical rehabilitation. In addi­ tion, some occupational therapists choose to teach classes in accredited occupational therapy educational programs. Employment Occupational therapists held about 99,000 jobs in 2006. About 1 in 10 occupational therapists held more than one job. The largest number of jobs was in hospitals. Other major employ­ ers were offices of other health practitioners (including offices of occupational therapists), public and private educational ser­ vices, and nursing care facilities. Some occupational therapists were employed by home health care services, outpatient care centers, offices of physicians, individual and family services, community care facilities for the elderly, and government agencies. A small number of occupational therapists were self-em­ ployed in private practice. These practitioners treated clients referred by other health professionals. They also provided con­ tract or consulting services to nursing care facilities, schools, adult day care programs, and home health care agencies. Job Outlook Employment of occupational therapists is expected to grow much faster than the average for all occupations. Job oppor­ tunities should be good, especially for occupational therapists treating the elderly. Employment change. Employment of occupational therapists is expected to increase 23 percent between 2006 and  Projections data from the National Employment Matrix Occupational Title Occupational therapists.................................................................  SOC Code 29-1122  Employment, 2006 99,000  Projected employment, 2016 122,000  Change, 2006-2016 Number Percent 23,000 23  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 359  2016, much faster than the average for all occupations. The increasing elderly population will drive growth in the demand for occupational therapy services. In the short run, the impact of proposed Federal legislation imposing limits on reimburse­ ment for therapy services may adversely affect the job market for occupational therapists. However, over the long run, the demand for occupational therapists should continue to rise as a result of the increasing number of individuals with disabilities or limited function who require therapy services. The babyboom generation’s movement into middle age, a period when the incidence of heart attack and stroke increases, will spur demand for therapeutic services. Growth in the population 75 years and older—an age group that suffers from high inci­ dences of disabling conditions—also will increase demand for therapeutic services. In addition, medical advances now en­ able more patients with critical problems to survive—patients who ultimately may need extensive therapy. Hospitals will continue to employ a large number of occupa­ tional therapists to provide therapy services to acutely ill inpa­ tients. Hospitals also will need occupational therapists to staff their outpatient rehabilitation programs. Employment growth in schools will result from the expan­ sion of the school-age population, the extension of services for disabled students, and an increasing prevalence of sensory dis­ orders in children. Therapists will be needed to help children with disabilities prepare to enter special education programs. Job prospects. Job opportunities should be good for licensed occupational therapists in all settings, particularly in acute hos­ pital, rehabilitation, and orthopedic settings because the elderly receive most of their treatment in these settings. Occupational therapists with specialized knowledge in a treatment area also will have increased job prospects. Driver rehabilitation and fall-prevention training for the elderly are emerging practice areas for occupational therapy.  Earnings Median annual earnings of occupational therapists were $60,470 in May 2006. The middle 50 percent earned between $50,450 and $73,710. The lowest 10 percent earned less than $40,840, and the highest 10 percent earned more than $89,450. Median annual earnings in the industries employing the largest numbers of occupational therapists in May 2006 were: Home health care services.................................................. $67,600 Nursing care facilities...........................................................64,750 Offices of physical, occupational and speech therapists, and audiologists................................................................... 62,290 General medical and surgical hospitals................................61,610 Elementary and secondary schools......................................54,260  Related Occupations Occupational therapists use specialized knowledge to help in­ dividuals perform daily living skills and achieve maximum in­ dependence. Other workers performing similar duties include athletic trainers, audiologists, chiropractors, physical thera­ pists, recreational therapists, rehabilitation counselors, respira­ tory therapists, and speech-language pathologists.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Sources of Additional Information For more information on occupational therapy as a career, con­ tact: y American Occupational Therapy Association, 4720 Montgomery LaNE., Bethesda, MD 20824-1220. Internet: http://www.aota.org For information regarding the requirements to practice as an occupational therapist in schools, contact the appropriate occu­ pational therapy regulatory agency for your State.  Optometrists (0*NET 29-1041.00)  Significant Points •  Admission to optometry school is competitive.  •  To be licensed, optometrists must earn a Doctor of Op­ tometry degree from an accredited optometry school and pass the appropriate exams administered by the National Board of Examiners in Optometry.  •  Employment is expected to grow as fast as average in response to the vision care needs of a growing and aging population.  Nature of the Work Optometrists, also known as doctors of optometry, or ODs, are the main providers of vision care. They examine people’s eyes to diagnose vision problems, such as nearsightedness and far­ sightedness, and they test patients’ depth and color perception and ability to focus and coordinate the eyes. Optometrists may prescribe eyeglasses or contact lenses, or they may prescribe or provide other treatments, such as vision therapy or low-vision rehabilitation. Optometrists also test for glaucoma and other eye diseases and diagnose conditions caused by systemic diseases such as diabetes and high blood pressure, referring patients to other health practitioners as needed. They administer drugs to pa­ tients to aid in the diagnosis of vision problems and to treat eye diseases. Optometrists often provide preoperative and postop­ erative care to cataract patients, as well as to patients who have had laser vision correction or other eye surgery. Most optometrists are in general practice. Some specialize in work with the elderly, children, or partially sighted persons who need specialized visual devices. Others develop and implement ways to protect workers’ eyes from on-the-job strain or injury. Some specialize in contact lenses, sports vision, or vision thera­ py. A few teach optometry, perform research, or consult. Most optometrists are private practitioners who also handle the business aspects of running an office, such as developing a patient base, hiring employees, keeping paper and electronic re­ cords, and ordering equipment and supplies. Optometrists who operate franchise optical stores also may have some of these duties. Optometrists should not be confused with ophthalmologists or dispensing opticians. Ophthalmologists are physicians who  360 Occupational Outlook Handbook  » ' 1-  Optometrists use specialized equipment to test vision and detect diseases of the eye. perform eye surgery, as well as diagnose and treat eye diseases and injuries. Like optometrists, they also examine eyes and prescribe eyeglasses and contact lenses. Dispensing opticians fit and adjust eyeglasses and, in some States, may fit contact lenses according to prescriptions written by ophthalmologists or optometrists. (See the sections on physicians and surgeons; and opticians, dispensing, elsewhere in the Handbook.) Work environment. Optometrists work in places—usually their own offices—that are clean, well lighted, and comfort­ able. Most full-time optometrists work about 40 hours a week. Many work weekends and evenings to suit the needs of patients. Emergency calls, once uncommon, have increased with the pas­ sage of therapeutic-drug laws expanding optometrists’ ability to prescribe medications. Optometrists who work in solo practice or with a partner tend to work longer hours because they must tend to admin­ istrative duties in addition to their medical ones. According to the American Optometric Association surveys, optometrists worked about 49 hours per week, on average, in 2004, and were available to see patients about 38 hours per week.  Training, Other Qualifications, and Advancement The Doctor of Optometry degree requires the completion of a 4-year program at an accredited optometry school, preceded by at least 3 years of preoptometric study at an accredited college or university. All States require optometrists to be licensed. Education and training. Optometrists need a Doctor of Op­ tometry degree, which requires the completion of a 4-year pro­ gram at an accredited optometry school. In 2006, there were 16 colleges of optometry in the U.S. and 1 in Puerto Rico that offered programs accredited by the Accreditation Council on Optometric Education of the American Optometric Associa­ tion. Requirements for admission to optometry schools include college courses in English, mathematics, physics, chemistry, and biology. Because a strong background in science is impor­ tant, many applicants to optometry school major in a science, such as biology or chemistry as undergraduates. Others major in another subject and take many science courses offering labo­ ratory experience. Admission to optometry school is competitive. Applicants must take the Optometry Admissions Test, which measures aca­ demic ability and scientific comprehension. As a result, most  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  applicants take the test after their sophomore or junior year in college, allowing them an opportunity to take the test again and raise their score. A few applicants are accepted to optometry school after 3 years of college and complete their bachelor’s degree while attending optometry school. However, most stu­ dents accepted by a school or college of optometry have com­ pleted an undergraduate degree. Each institution has its own undergraduate prerequisites, so applicants should contact the school or college of their choice for specific requirements. Optometry programs include classroom and laboratory study of health and visual sciences and clinical training in the diagno­ sis and treatment of eye disorders. Courses in pharmacology, optics, vision science, biochemistry, and systemic diseases are included. One-year postgraduate clinical residency programs are avail­ able for optometrists who wish to obtain advanced clinical com­ petence. Specialty areas for residency programs include family practice optometry, pediatric optometry, geriatric optometry, vision therapy and rehabilitation, low-vision rehabilitation, cor­ nea and contact lenses, refractive and ocular surgery, primary eye care optometry, and ocular disease. Licensure. All States and the District of Columbia require that optometrists be licensed. Applicants for a license must have a Doctor of Optometry degree from an accredited optom­ etry school and must pass both a written National Board exami­ nation and a National, regional, or State clinical examination. The written and clinical examinations of the National Board of Examiners in Optometry usually are taken during the student’s academic career. Many States also require applicants to pass an examination on relevant State laws. Licenses must be renewed every 1 to 3 years and, in all States, continuing education cred­ its are needed for renewal. Other qualifications. Business ability, self-discipline, and the ability to deal tactfully with patients are important for suc­ cess. The work of optometrists also requires attention to detail and manual dexterity. Advancement. Optometrists wishing to teach or conduct research may study for a master’s degree or Ph.D. in visual science, physiological optics, neurophysiology, public health, health administration, health information and communication, or health education.  Employment Optometrists held about 33,000 jobs in 2006. Salaried jobs for optometrists were primarily in offices of optometrists; offices of physicians, including ophthalmologists; and health and per­ sonal care stores, including optical goods stores. A few salaried jobs for optometrists were in hospitals, the Federal Government, or outpatient care centers including health maintenance organi­ zations. Nearly 25 percent of optometrists are self-employed. According to a 2005 survey by the American Optometric As­ sociation most self-employed optometrists worked in private practice or in partnership with other health care professionals. A small number worked for optical chains or franchises or as independent contractors.  Job Outlook Employment of optometrists is expected to grow as fast as aver­ age for all occupations through 2016, in response to the vision  Professional and Related Occupations 361  Projections data from the National Employment Matrix Occupational Title Optometrists...........................................................................................  SOC Code 29-1041  Projected employment, 2016 36,000  Employment, 2006 33,000  Change, 2006-2016 Number Percent 3,700 11  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  care needs of a growing and aging population. Greater recog­ nition of the importance of vision care, along with growth in employee vision care plans, will also spur job growth. Employment change. Employment of optometrists is pro­ jected to grow 11 percent between 2006 and 2016. A growing population that recognizes the importance of good eye care will increase demand for optometrists. Also, an increasing number of health insurance plans that include vision care, should gener­ ate more job growth. As the population ages, there will likely be more visits to optometrists and ophthalmologists because of the onset of vi­ sion problems that occur at older ages, such as cataracts and glaucoma. In addition, increased incidences of diabetes and hypertension in the general population as well as in the elderly will generate greater demand for optometric services as these diseases often affect eyesight. Employment of optometrists would grow more rapidly if not for productivity gains expected to allow each optometrist to see more patients. These expected gains stem from greater use of optometric assistants and other support personnel, who can re­ duce the amount of time optometrists need with each patient. The increasing popularity of laser surgery to correct some vi­ sion problems may reduce some of the demand for optometrists as patients often do not require eyeglasses afterward. But op­ tometrists still will be needed to provide preoperative and post­ operative care for laser surgery patients. Job prospects. Job opportunities for optometrists should be very good over the next decade. Demand is expected to be much higher, and because there are only 16 schools of optome­ try, the number of students who can get a degree in optometry is limited. In addition to growth, the need to replace optometrists who retire or leave the occupation for other reasons will create more employment opportunities.  Related Occupations Other workers who apply scientific knowledge to prevent, di­ agnose, and treat disorders and injuries are chiropractors, den­ tists, physicians and surgeons, psychologists, podiatrists, and veterinarians.  Sources of Additional Information For information on optometry as a career and a list of accredited optometric institutions of education, contact: y Association of Schools and Colleges of Optometry, 6110 Executive Blvd., Suite 510, Rockville, MD 20852. Internet: http://www.opted.org Additional career information is available from: y American Optometric Association, Educational Services, 243 North Lindbergh Blvd., St.Louis, MO 63141. Internet: http://www.aoa.org The board of optometry in each State can supply information on licensing requirements. For information on specific admission requirements and sources of financial aid, contact the admissions officers of indi­ vidual optometry schools.  (0*NET 29-1051.00)  Significant Points •  Excellent job opportunities are expected.  •  Earnings are high, but some pharmacists are required to work nights, weekends, and holidays.  •  Pharmacists are becoming more involved in counsel­ ing patients and planning drug therapy programs.  •  A license is required; the prospective pharmacist must graduate from an accredited college of pharmacy and pass a series of examinations.  Earnings Median annual earnings of salaried optometrists were $91,040 in May 2006. The middle 50 percent earned between $66,530 and $118,490. Median annual earnings of salaried optometrists in offices of optometrists were $86,760. Salaried optometrists tend to earn more initially than do optometrists who set up their own practices. In the long run, however, those in private prac­ tice usually earn more. According to the American Optometric Association, median net annual income for all optometrists, including the self-em­ ployed, was $105,000 in 2006. The middle 50 percent earned between $84,000 and $150,000. Self-employed optometrists, including those working in part­ nerships, must provide their own benefits. Optometrists em­ ployed by others typically enjoy paid vacation, sick leave, and pension contributions.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  %  Pharmacists  Nature of the Work Pharmacists distribute prescription drugs to individuals. They also advise their patients, as well as physicians and other health practitioners, on the selection, dosages, interactions, and side ef­ fects of medications. Pharmacists monitor the health and prog­ ress of patients to ensure the safe and effective use of medica­ tion. Compounding—the actual mixing of ingredients to form medications—is a small part of a pharmacist’s practice, because most medicines are produced by pharmaceutical companies in a standard dosage and drug delivery form. Most pharmacists work in a community setting, such as a retail drugstore, or in  362 Occupational Outlook Handbook  a health care facility, such as a hospital, nursing home, mental health institution, or neighborhood health clinic. Pharmacists in community pharmacies dispense medications, counsel patients on the use of prescription and over-the-counter medications, and advise physicians about patients’ medication therapy. They also advise patients about general health top­ ics such as diet, exercise, and stress management, and provide information on products such as durable medical equipment or home health care supplies. In addition, they may complete third-party insurance forms and other paperwork. Those who own or manage community pharmacies may sell non-healthrelated merchandise, hire and supervise personnel, and over­ see the general operation of the pharmacy. Some community pharmacists provide specialized services to help patients with conditions such as diabetes, asthma, smoking cessation, or high blood pressure; others also are trained to administer vaccina­ tions. Pharmacists in health care facilities dispense medications and advise the medical staff on the selection and effects of drugs. They may make sterile solutions to be administered intrave­ nously. They also plan, monitor and evaluate drug programs or regimens. They may counsel hospitalized patients on the use of drugs before the patients are discharged. Pharmacists who work in home health care monitor drug therapy and prepare infusions—solutions that are injected into patients—and other medications for use in the home. Some pharmacists specialize in specific drug therapy areas, such as intravenous nutrition support, oncology (cancer), nu­ clear pharmacy (used for chemotherapy), geriatric pharmacy, and psychiatric pharmacy (the use of drugs to treat mental dis­ orders). Most pharmacists keep confidential computerized records of patients’ drag therapies to prevent harmful drug interactions. Pharmacists are responsible for the accuracy of every prescrip­ tion that is filled, but they often rely upon pharmacy technicians and pharmacy aides to assist them in the dispensing process. Thus, the pharmacist may delegate prescription-filling and ad­ ministrative tasks and supervise their completion. Pharmacists also frequently oversee pharmacy students serving as interns. Increasingly, pharmacists are pursuing nontraditional phar­ macy work. Some are involved in research for pharmaceutical manufacturers, developing new drugs and testing their effects. Others work in marketing or sales, providing clients with ex­ pertise on the use, effectiveness, and possible side effects of drugs. Some pharmacists work for health insurance companies, developing pharmacy benefit packages and carrying out costbenefit analyses on certain drugs. Other pharmacists work for the government, managed care organizations, public health care services, the armed services, or pharmacy associations. Finally, some pharmacists are employed full time or part time as col­ lege faculty, teaching classes and performing research in a wide range of areas. Work environment. Pharmacists work in clean, well-light­ ed, and well-ventilated areas. Many pharmacists spend most of their workday on their feet. When working with sterile or dangerous pharmaceutical products, pharmacists wear gloves, masks, and other protective equipment.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  1 ' •■  1 ■?’;  Pharmacists counsel patients and answer questions about med­ ications. Most full-time salaried pharmacists work approximately 40 hours a week, and about 10 percent work more than 50 hours. Many community and hospital pharmacies are open for extend­ ed hours or around the clock, so pharmacists may be required to work nights, weekends, and holidays. Consultant pharmacists may travel to nursing homes or other facilities to monitor pa­ tients’ drug therapy. About 16 percent of pharmacists worked part time in 2006.  Training, Other Qualifications, and Advancement A license is required in all States, the District of Columbia, and all U.S. territories. In order to obtain a license, pharmacists must earn a Doctor of Pharmacy (Pharm.D.) degree from a col­ lege of pharmacy and pass several examinations. Education and training. Pharmacists must earn a Pharm. D. degree from an accredited college or school of pharmacy. The Pharm.D. degree has replaced the Bachelor of Pharmacy degree, which is no longer being awarded. To be admitted to a Pharm.D. program, an applicant must have completed at least 2 years of postsecondary study, although most applicants have completed 3 or more years. Other entry requirements usually include courses in mathematics and natural sciences, such as chemistry, biology, and physics, as well as courses in the hu­ manities and social sciences. In 2007, 92 colleges and schools of pharmacy were accredited to confer degrees by the Accredi­ tation Council for Pharmacy Education (ACPE). About 70 percent of Pharm.D. programs require applicants to take the Pharmacy College Admissions Test (PCAT). Courses offered at colleges of pharmacy are designed to teach students about all aspects of drug therapy. In addition, students learn how to communicate with patients and other health care providers about drug information and patient care. Students also learn professional ethics, concepts of public health, and medication distribution systems management. In addition to re­ ceiving classroom instruction, students in Pharm.D. programs spend about one-forth of their time in a variety of pharmacy practice settings under the supervision of licensed pharmacists. In the 2006-07 academic year, 70 colleges of pharmacy also awarded the master-of-science degree or the Ph.D. degree. Both degrees are awarded after the completion of a Pharm.D. degree and are designed for those who want additional clinical, labora­  Professional and Related Occupations 363  tory, and research experience. Areas of graduate study include pharmaceutics and pharmaceutical chemistry (physical and chemical properties of drugs and dosage forms), pharmacology (effects of drugs on the body), and pharmacy administration. Many master’s and Ph.D. degree holders go on to do research for a drug company or teach at a university. Other options for pharmacy graduates who are interested in further training include 1-year or 2-year residency programs or fellowships. Pharmacy residencies are postgraduate training programs in pharmacy practice and usually require the comple­ tion of a research project. These programs are often mandatory for pharmacists who wish to work in hospitals. Pharmacy fel­ lowships are highly individualized programs that are designed to prepare participants to work in a specialized area of pharma­ cy, such clinical practice or research laboratories. Some phar­ macists who own their own pharmacy obtain a master’s degree in business administration (MBA). Others may obtain a degree in public administration or public health. Licensure. A license to practice pharmacy is required in all States, the District of Columbia, and all U.S. territories. To obtain a license, a prospective pharmacist must graduate from a college of pharmacy that is accredited by the ACPE and pass a series of examinations. All States, U.S. territories, and the District of Columbia require the North American Pharmacist Licensure Exam (NAPLEX), which tests pharmacy skills and knowledge. Forty-four States and the District of Columbia also require the Multistate Pharmacy Jurisprudence Exam (MPJE), which tests pharmacy law. Both exams are administered by the National Association of Boards of Pharmacy (NABP). Each of the eight States and territories that do not require the MJPE has its own pharmacy law exam. In addition to the NAPLEX and MPJE, some States and territories require additional exams that are unique to their jurisdiction. All jurisdictions except California currently grant license transfers to qualified pharmacists who already are licensed by another jurisdiction. Many pharmacists are licensed to practice in more than one jurisdiction. Most jurisdictions require con­ tinuing education for license renewal. Persons interested in a career as a pharmacist should check with individual jurisdiction boards of pharmacy for details on license renewal requirements and license transfer procedures. Graduates of foreign pharmacy schools may also qualify for licensure in some U.S. States and territories. These indi­ viduals must apply for certification from the Foreign Pharmacy Graduate Examination Committee (FPGEC). Once certified, they must pass the Foreign Pharmacy Graduate Equivalency Examination (FPGEE), Test of English as a Foreign Language (TOEFL) exam, and Test of Spoken English (TSE) exam. They then must pass all of the exams required by the licensing ju­ risdiction, such as the NAPLEX and MJPE. Applicants who graduated from programs accredited by the Canadian Council  for Accreditation of Pharmacy Programs (CCAPP) between 1993 and 2004 are exempt from FPGEC certification and ex­ amination requirements. Other qualifications. Prospective pharmacists should have scientific aptitude, good interpersonal skills, and a desire to help others. They also must be conscientious and pay close attention to detail, because the decisions they make affect human lives. Advancement. In community pharmacies, pharmacists usu­ ally begin at the staff level. Pharmacists in chain drugstores may be promoted to pharmacy supervisor or manager at the store level, then to manager at the district or regional level, and later to an executive position within the chain’s headquarters. Hospital pharmacists may advance to supervisory or adminis­ trative positions. After they gain experience and secure the nec­ essary capital, some pharmacists become owners or part owners of independent pharmacies. Pharmacists in the pharmaceuti­ cal industry may advance in marketing, sales, research, quality control, production, or other areas.  Employment Pharmacists held about 243,000 jobs in 2006. About 62 percent worked in community pharmacies that were either independent­ ly owned or part of a drugstore chain, grocery store, department store, or mass merchandiser. Most community pharmacists were salaried employees, but some were self-employed owners. About 23 percent of pharmacists worked in hospitals. A small proportion worked in mail-order and Internet pharmacies, phar­ maceutical wholesalers, offices of physicians, and the Federal Government.  Job Outlook Employment is expected to increase much faster than the aver­ age through 2016. As a result of rapid growth and the need to replace workers who leave the occupation, job prospects should be excellent. Employment change. Employment of pharmacists is ex­ pected to grow by 22 percent between 2006 and 2016, which is much faster than the average for all occupations. The increas­ ing numbers of middle-aged and elderly people—who use more prescription drugs than younger people—will continue to spur demand for pharmacists throughout the projection period. Oth­ er factors likely to increase the demand for pharmacists include scientific advances that will make more drug products available and the coverage of prescription drags by a greater number of health insurance plans and Medicare. As the use of prescription drugs increases, demand for phar­ macists will grow in most practice settings, such as community pharmacies, hospital pharmacies, and mail-order pharmacies. As the population ages, assisted living facilities and home care organizations should see particularly rapid growth. Demand will also increase as cost conscious insurers, in an attempt to  Projections data from the National Employment Matrix Occupational Title Pharmacists............................................................... .............................  soc  Code 29-1051  Employment, 2006 243,000  Projected employment, 2016 296,000  Change, 2006-2016 Number Percent 53,000 22  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  364 Occupational Outlook Handbook  improve preventative care, use pharmacists in areas such as pa­ tient education and vaccination administration. Demand is also increasing in managed care organizations where pharmacists analyze trends and patterns in medication use, and in pharmacoeconomics—the cost and benefit analysis of different drug therapies. New jobs also are being created in disease management—the development of new methods for curing and controlling diseases—and in sales and marketing. Rapid growth is also expected in pharmacy informatics—the use of information technology to improve patient care. Job prospects. Excellent opportunities are expected for phar­ macists over the 2006 to 2016 period. Job openings will result from rapid employment growth, and from the need to replace workers who retire or leave the occupation for other reasons.  y American Pharmacists Association, 1100 15th Street, NW. Suite 400., Washington, DC 20005. Internet: http://www.aphanet.org Information on the North American Pharmacist Licensure Exam (NAPLEX) and the Multistate Pharmacy Jurisprudence Exam (MPJE) is available from: y National Association of Boards of Pharmacy, 1600 Feehanville Dr., Mount Prospect, IL 60056. Internet: http://www.nabp.net State licensure requirements are available from each State’s board of pharmacy. Information on specific college entrance requirements, curriculums, and financial aid is available from any college of pharmacy.  Earnings  Physical Therapists  Median annual of wage-and-salary pharmacists in May 2006 were $94,520. The middle 50 percent earned between $83,180 and $108,140 a year. The lowest 10 percent earned less than $67,860, and the highest 10 percent earned more than $119,480 a year. Median annual earnings in the industries employing the largest numbers of pharmacists in May 2006 were: Department stores............................................................... $99,050 Grocery stores....................................................................... 95,600 Pharmacies and drug stores................................................... 94,640 General medical and surgical hospitals................................. 93,640 According to a 2006 survey by Drug Topics Magazine, phar­ macists in retail settings earned an average of $92,291 per year, while pharmacists in institutional settings earned an average of $97,545. Full-time pharmacists earned an average of $102,336, while part-time pharmacists earned an average of $55,589.  Related Occupations Pharmacy technicians and pharmacy aides also work in phar­ macies. Persons in other professions who may work with phar­ maceutical compounds include biological scientists, medical scientists, and chemists and materials scientists. Increasingly, pharmacists are involved in patient care and therapy, work that they have in common with physicians and surgeons.  Sources of Additional Information For information on pharmacy as a career, preprofessional and professional requirements, programs offered by colleges of pharmacy, and student financial aid, contact: y American Association of Colleges of Pharmacy, 1426 Prince St., Alexandria, VA 22314. Internet: http://www.aacp.org General information on careers in pharmacy is available from: y American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Internet: http://www.ashp.org y National Association of Chain Drug Stores, 413 N. Lee St., P.O. Box 1417-D49, Alexandria, VA 22313-1480. Internet: http://www.nacds.org y Academy ofManaged Care Pharmacy, lOONorthPittSt.,Suite 400, Alexandria, VA 22314. Internet: http://www.amcp.org   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  (0*NET 29-1123.00)  Significant Points •  Employment is expected to increase much faster than  •  average. Job opportunities should be good, particularly in acute hospital, rehabilitation, and orthopedic settings.  •  Physical therapists need a master’s degree from an ac­ credited physical therapy program and a State license, requiring passing scores on national and State exami­ nations.  •  About 6 out of 10 physical therapists work in hospi­ tals or in offices of physical therapists.  Nature of the Work Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or dis­ ease. They restore, maintain, and promote overall fitness and health. Their patients include accident victims and individuals with disabling conditions such as low-back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy. Therapists examine patients’ medical histories and then test and measure the patients’ strength, range of motion, balance and coordination, posture, muscle performance, respiration, and motor function. Next, physical therapists develop plans de­ scribing a treatment strategy and its anticipated outcome. Treatment often includes exercise, especially for patients who have been immobilized or who lack flexibility, strength, or endurance. Physical therapists encourage patients to use their muscles to increase their flexibility and range of motion. More advanced exercises focus on improving strength, balance, coor­ dination, and endurance. The goal is to improve how an indi­ vidual functions at work and at home. Physical therapists also use electrical stimulation, hot packs or cold compresses, and ultrasound to relieve pain and reduce swelling. They may use traction or deep-tissue massage to re­ lieve pain and improve circulation and flexibility. Therapists also teach patients to use assistive and adaptive devices, such as  Professional and Related Occupations 365  Physical therapists use traction or deep-tissue massage to re­ lieve pain. crutches, prostheses, and wheelchairs. They also may show pa­ tients how to do exercises at home to expedite their recovery. As treatment continues, physical therapists document the patient’s progress, conduct periodic examinations, and modify treatments when necessary. Physical therapists often consult and practice with a variety of other professionals, such as physicians, dentists, nurses, educa­ tors, social workers, occupational therapists, speech-language pathologists, and audiologists. Some physical therapists treat a wide range of ailments; oth­ ers specialize in areas such as pediatrics, geriatrics, orthope­ dics, sports medicine, neurology, and cardiopulmonary physi­ cal therapy. Work environment. Physical therapists practice in hospi­ tals, clinics, and private offices that have specially equipped facilities. They also treat patients in hospital rooms, homes, or schools. These jobs can be physically demanding because ther­ apists often have to stoop, kneel, crouch, lift, and stand for long periods. In addition, physical therapists move heavy equipment and lift patients or help them turn, stand, or walk. In 2006, most full-time physical therapists worked a 40-hour week; some worked evenings and weekends to fit their patients’ schedules. About 1 in 5 physical therapists worked part time.  degree might be the required entry-level degree. Master’s de­ gree programs typically last 2 years, and doctoral degree pro­ grams last 3 years. Physical therapist education programs start with basic sci­ ence courses such as biology, chemistry, and physics and then introduce specialized courses, including biomechanics, neuro­ anatomy, human growth and development, manifestations of disease, examination techniques, and therapeutic procedures. Besides getting classroom and laboratory instruction, students receive supervised clinical experience. Among the undergraduate courses that are useful when one applies to a physical therapist education program are anatomy, biology, chemistry, social science, mathematics, and physics. Before granting admission, many programs require volunteer experience in the physical therapy department of a hospital or clinic. For high school students, volunteering with the school athletic trainer is a good way to gain experience. Licensure. All States require physical therapists to pass na­ tional and State licensure exams before they can practice. They must also graduate from an accredited physical therapist educa­ tion program. Other qualifications. Physical therapists should have strong interpersonal skills so that they can educate patients about their physical therapy treatments and communicate with patients’ families. Physical therapists also should be compassionate and possess a desire to help patients. Advancement. Physical therapists are expected to continue their professional development by participating in continuing education courses and workshops. In fact, a number of States require continuing education as a condition of maintaining li­ censure.  Employment Physical therapists held about 173,000 jobs in 2006. The num­ ber of jobs is greater than the number of practicing physical therapists because some physical therapists hold two or more jobs. For example, some may work in a private practice, but also work part time in another health care facility. About 6 out of 10 physical therapists worked in hospitals or in offices of physical therapists. Other jobs were in the home health care services industry, nursing care facilities, outpatient care centers, and offices of physicians. Some physical thera­ pists were self-employed in private practices, seeing individual patients and contracting to provide services in hospitals, reha­ bilitation centers, nursing care facilities, home health care agen­ cies, adult day care programs, and schools. Physical therapists also teach in academic institutions and conduct research.  Training, Other Qualifications, and Advancement  Job Outlook  Physical therapists need a master’s degree from an accredited physical therapy program and a State license, requiring passing scores on national and State examinations. Education and training. According to the American Physi­ cal Therapy Association, there were 209 accredited physical therapist education programs in 2007. Of the accredited pro­ grams, 43 offered master’s degrees and 166 offered doctoral degrees. Only master’s degree and doctoral degree programs are accredited, in accordance with the Commission on Accredi­ tation in Physical Therapy Education. In the future, a doctoral  Employment of physical therapists is expected to grow much faster than average. Job opportunities will be good, especially in acute hospital, rehabilitation, and orthopedic settings. Employment change. Employment of physical therapists is expected to grow 27 percent from 2006 to 2016, much faster than the average for all occupations. The impact of proposed Federal legislation imposing limits on reimbursement for ther­ apy services may adversely affect the short-term job outlook for physical therapists. However, the long-run demand for physical therapists should continue to rise as new treatments   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  366 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Physical therapists............................................ .....................................  SOC Code 29-1123  Projected employment, 2016 220,000  Employment, 2006 173,000  Change, 2006-2016 Number Percent 47,000 27  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  and techniques expand the scope of physical therapy practices. Moreover, demand will be spurred by the increasing numbers of individuals with disabilities or limited function. The increasing elderly population will drive growth in the demand for physical therapy services. The elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. Also, the baby-boom gen­ eration is entering the prime age for heart attacks and strokes, increasing the demand for cardiac and physical rehabilitation. And increasing numbers of children will need physical therapy as technological advances save the lives of a larger proportion of newborns with severe birth defects. Future medical developments also should permit a higher percentage of trauma victims to survive, creating additional de­ mand for rehabilitative care. In addition, growth may result from advances in medical technology that could permit the treatment of an increasing number of disabling conditions that were unbeatable in the past. Widespread interest in health promotion also should increase demand for physical therapy services. A growing number of employers are using physical therapists to evaluate worksites, develop exercise programs, and teach safe work habits to em­ ployees. Job prospects. Job opportunities will be good for licensed physical therapists in all settings. Job opportunities should be particularly good in acute hospital, rehabilitation, and orthope­ dic settings, where the elderly are most often treated. Physi­ cal therapists with specialized knowledge of particular types of treatment also will have excellent job prospects.  Earnings Median annual earnings of physical therapists were $66,200 in May 2006. The middle 50 percent earned between $55,030 and $78,080. The lowest 10 percent earned less than $46,510, and the highest 10 percent earned more than $94,810. Median an­ nual earnings in the industries employing the largest numbers of physical therapists in May 2006 were: Home health care services.................................................. $70,920 Nursing care facilities........................................................... 68,650 General medical and surgical hospitals.................................66,630 Offices of physicians............................................................. 65,900 Offices of physical, occupational and speech therapists, and audiologists.............................65,150  Related Occupations Physical therapists rehabilitate people with physical disabili­ ties. Others who work in the rehabilitation field include au­ diologists, chiropractors, occupational therapists, recreational   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  therapists, rehabilitation counselors, respiratory therapists, and speech-language pathologists.  Sources of Additional Information Additional career information and a list of accredited educa­ tional programs in physical therapy are available from: y American Physical Therapy Association, 1111 North Fairfax St, Alexandria, VA 22314-1488. Internet: http://www.apta.org  Physician Assistants (0*NET 29-1071.00)  Significant Points •  Physician assistant programs usually last at least 2 years; admission requirements vary by program, but many require at least 2 years of college and some health care experience.  •  All States require physician assistants to complete an accredited education program and to pass a national exam in order to obtain a license.  •  Employment is projected to grow much faster than average as health care establishments increasingly use physician assistants to contain costs.  •  Job opportunities should be good, particularly in ru­ ral and inner-city clinics.  Nature of the Work Physician assistants (PAs) practice medicine under the supervi­ sion of physicians and surgeons. They should not be confused with medical assistants, who perform routine clinical and cleri­ cal tasks. (Medical assistants are discussed elsewhere in the Handbook.) PAs are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine and treat patients, order and interpret laboratory tests and x-rays, and make diagnoses. They also treat minor injuries, by suturing, splinting, and cast­ ing. PAs record progress notes, instruct and counsel patients, and order or carry out therapy. In 48 States and the District of Columbia, physician assistants may prescribe some medica­ tions. In some establishments, a PA is responsible for manage­ rial duties, such as ordering medical supplies or equipment and supervising technicians and assistants.  Professional and Related Occupations 367  Physician assistants may be the principal care providers in ru­ ral or inner city clinics, where a physician is present for only one or two days each week. Physician assistants work under the supervision of a physi­ cian. However, PAs may be the principal care providers in rural or inner city clinics where a physician is present for only one or two days each week. In such cases, the PA confers with the supervising physician and other medical professionals as needed and as required by law. PAs also may make house calls or go to hospitals and nursing care facilities to check on patients, after which they report back to the physician. The duties of physician assistants are determined by the su­ pervising physician and by State law. Aspiring PAs should in­ vestigate the laws and regulations in the States in which they wish to practice. Many PAs work in primary care specialties, such as general internal medicine, pediatrics, and family medicine. Other spe­ cialty areas include general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide preoperative and postoperative care and may work as first or second assistants during major surgery. Work environment. Although PAs usually work in a com­ fortable, well-lighted environment, those in surgery often stand for long periods. At times, the job requires a considerable amount of walking. Schedules vary according to the practice setting, and often depend on the hours of the supervising physi­ cian. The workweek of hospital-based PAs may include week­ ends, nights, or early morning hospital rounds to visit patients. These workers also may be on call. PAs in clinics usually work a 40-hour week.  Training, Other Qualifications, and Advancement Physician assistant programs usually last at least 2 years. Ad­ mission requirements vary by program, but many require at least 2 years of college and some health care experience. All   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  States require that PAs complete an accredited, formal educa­ tion program and pass a National exam to obtain a license. Education and training. Physician assistant education pro­ grams usually last at least 2 years and are full time. Most pro­ grams are in schools of allied health, academic health centers, medical schools, or 4-year colleges; a few are in community colleges, the military, or hospitals. Many accredited PA pro­ grams have clinical teaching affiliations with medical schools. In 2007, 136 education programs for physician assistants were accredited or provisionally accredited by the American Academy of Physician Assistants. More than 90 of these pro­ grams offered the option of a master’s degree, and the rest of­ fered either a bachelor’s degree or an associate degree. Most applicants to PA educational programs already have a bache­ lor’s degree. Admission requirements vary, but many programs require 2 years of college and some work experience in the health care field. Students should take courses in biology, English, chem­ istry, mathematics, psychology, and the social sciences. Many PAs have prior experience as registered nurses, and others come from varied backgrounds, including military corpsman or medics and allied health occupations such as respiratory therapists, physical therapists, and emergency medical techni­ cians and paramedics. PA education includes classroom instruction in biochem­ istry, pathology, human anatomy, physiology, microbiology, clinical pharmacology, clinical medicine, geriatric and home health care, disease prevention, and medical ethics. Students obtain supervised clinical training in several areas, including family medicine, internal medicine, surgery, prenatal care and gynecology, geriatrics, emergency medicine, psychiatry, and pediatrics. Sometimes, PA students serve one or more of these rotations under the supervision of a physician who is seeking to hire a PA. The rotations often lead to permanent employment. Licensure. All States and the District of Columbia have legislation governing the qualifications or practice of physi­ cian assistants. All jurisdictions require physician assistants to pass the Physician Assistant National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA) and open only to graduates of accredited PA education programs. Only those successfully completing the examination may use the credential “Physician Assistant-Certified.” To remain certified, PAs must complete 100 hours of continuing medical education every 2 years. Ev­ ery 6 years, they must pass a recertification examination or complete an alternative program combining learning experi­ ences and a take-home examination. Other qualifications. Physician assistants must have a de­ sire to serve patients and be self-motivated. PAs also must have a good bedside manner, emotional stability, and the ability to make decisions in emergencies. Physician assistants must be willing to study throughout their career to keep up with medi­ cal advances. Certification and advancement. Some PAs pursue addi­ tional education in a specialty such as surgery, neonatology, or emergency medicine. PA postgraduate educational programs are available in areas such as internal medicine, rural primary  368 Occupational Outlook Handbook  care, emergency medicine, surgery, pediatrics, neonatology, and occupational medicine. Candidates must be graduates of an accredited program and be certified by the NCCPA. As they attain greater clinical knowledge and experience, PAs can advance to added responsibilities and higher earnings. However, by the very nature of the profession, clinically prac­ ticing PAs always are supervised by physicians.  Employment Physician assistants held about 66,000 jobs in 2006. The num­ ber of jobs is greater than the number of practicing PAs be­ cause some hold two or more jobs. For example, some PAs work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Acad­ emy of Physician Assistants, about 15 percent of actively prac­ ticing PAs worked in more than one clinical job concurrently in 2006. More than half of jobs for PAs were in the offices of physi­ cians. About a quarter were in hospitals, public or private. The rest were mostly in outpatient care centers, including health maintenance organizations; the Federal Government; and pub­ lic or private colleges, universities, and professional schools. A few were self-employed.  Job Outlook Employment is expected to grow much faster than the aver­ age as health care establishments increasingly use physician assistants to contain costs. Job opportunities for PAs should be good, particularly in rural and inner city clinics, as these set­ tings typically have difficulty attracting physicians. Employment change. Employment of physician assistants is expected to grow 27 percent from 2006 to 2016, much fast­ er than the average for all occupations. Projected rapid job growth reflects the expansion of health care industries and an emphasis on cost containment, which results in increasing use of PAs by health care establishments. Physicians and institutions are expected to employ more PAs to provide primary care and to assist with medical and surgi­ cal procedures because PAs are cost-effective and productive members of the health care team. Physician assistants can re­ lieve physicians of routine duties and procedures. Telemedi­ cine—using technology to facilitate interactive consultations between physicians and physician assistants—also will expand the use of physician assistants. Besides working in traditional office-based settings, PAs should find a growing number of jobs in institutional settings such as hospitals, academic medical centers, public clinics, and prisons. PAs also may be needed to augment medical staffing in inpatient teaching hospital settings as the number of hours physician residents are permitted to work is reduced, encour­  aging hospitals to use PAs to supply some physician resident services. Job prospects. Job opportunities for PAs should be good, particularly in rural and inner-city clinics because those set­ tings have difficulty attracting physicians. In addition to job openings from employment growth, openings will result from the need to replace physician assistants who retire or leave the occupation permanently during the 2006-16 decade. Oppor­ tunities will be best in States that allow PAs a wider scope of practice, such as allowing PAs to prescribe medications.  Earnings Median annual earnings of wage-and-salary physician as­ sistants were $74,980 in May 2006. The middle 50 percent earned between $62,430 and $89,220. The lowest 10 percent earned less than $43,100, and the highest 10 percent earned more than $102,230. Median annual earnings in the industries employing the largest numbers of physician assistants in May 2006 were: Outpatient care centers........................................................$80,960 General medical and surgical hospitals................................76,710 Offices of physicians.............................................................74,160 According to the American Academy of Physician Assis­ tants, median income for physician assistants in full-time clini­ cal practice was $80,356 in 2006; median income for first-year graduates was $69,517. Income varies by specialty, practice setting, geographical location, and years of experience. Em­ ployers often pay for their employees’ liability insurance, reg­ istration fees with the Drug Enforcement Administration, State licensing fees, and credentialing fees.  Related Occupations Other health care workers who provide direct patient care that requires a similar level of skill and training include audiolo­ gists, occupational therapists, physical therapists, registered nurses, and speech-language pathologists.  Sources of Additional Information For information on a career as a physician assistant, including a list of accredited programs, contact: 'y American Academy of Physician Assistants Information Center, 950 North Washington St., Alexandria, VA 22314. Internet: http://www.aapa.org For eligibility requirements and a description of the Physi­ cian Assistant National Certifying Examination, contact: y National Commission on Certification of Physician Assistants, Inc., 12000 Findley Rd., Suite 200, Duluth, GA 30097. Internet: http://www.nccpa.net  Projections data from the National Employment Matrix Occupational Title Physician assistants...................................... ................................  soc  Code 29-1071  Employment, 2006 66,000  Projected employment, 2016 83,000  Change, 2006-2016 Number Percent 18,000 27  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 369  Physicians and Surgeons (0*NET 29-1061.00, 29-1062.00, 29-1063.00, 29-1064.00, 29-1065.00, 29-1066.00, 29-1067.00, 29-1069.99)  Significant Points •  Many physicians and surgeons work long, irregular hours; more than one-third of full-time physicians worked 60 hours or more a week in 2006.  •  Acceptance to medical school is highly competitive.  •  Formal education and training requirements are among the most demanding of any occupation, but earnings are among the highest.  •  Job opportunities should be very good, particularly in rural and low-income areas.  Nature of the Work Physicians and surgeons diagnose illnesses and prescribe and administer treatment for people suffering from injury or dis­ ease. Physicians examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive health care. There are two types of physicians: M.D.—Doctor of Medi­ cine—and D.O.—Doctor of Osteopathic Medicine. M.D.s also are known as allopathic physicians. While both M.D.s and D.O.s may use all accepted methods of treatment, including drugs and surgery, D.O.s place special emphasis on the body’s musculoskeletal system, preventive medicine, and holistic pa­ tient care. D.O.s are most likely to be primary care special­ ists although they can be found in all specialties. About half of D.O.s practice general or family medicine, general internal medicine, or general pediatrics. Physicians work in one or more of several specialties, includ­ ing, but not limited to, anesthesiology, family and general med­ icine, general internal medicine, general pediatrics, obstetrics and gynecology, psychiatry, and surgery. Anesthesiologists focus on the care of surgical patients and pain relief. Like other physicians, they evaluate and treat pa­ tients and direct the efforts of their staffs. Through continual monitoring and assessment, these critical care specialists are responsible for maintenance of the patient’s vital life func­ tions—heart rate, body temperature, blood pressure, breath­ ing—during surgery. They also work outside of the operating room, providing pain relief in the intensive care unit, during labor and delivery, and for those who suffer from chronic pain. Anesthesiologists confer with other physicians and surgeons about appropriate treatments and procedures before, during, and after operations. Family and general practitioners often provide the first point of contact for people seeking health care, by acting as the tradi­ tional family doctor. They assess and treat a wide range of con­ ditions, from sinus and respiratory infections to broken bones. Family and general practitioners typically have a base of regu­ lar, long-term patients. These doctors refer patients with more  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  serious conditions to specialists or other health care facilities for more intensive care. General internists diagnose and provide nonsurgical treat­ ment for a wide range of problems that affect internal organ systems, such as the stomach, kidneys, liver, and digestive tract. Internists use a variety of diagnostic techniques to treat patients through medication or hospitalization. Like general practitio­ ners, general internists commonly act as primary care special­ ists. They treat patients referred from other specialists, and, in turn they refer patients to other specialists when more complex care is required. General pediatricians care for the health of infants, children, teenagers, and young adults. They specialize in the diagnosis and treatment of a variety of ailments specific to young people and track patients’ growth to adulthood. Like most physicians, pediatricians work with different health care workers, such as nurses and other physicians, to assess and treat children with various ailments. Most of the work of pediatricians involves treating day-to-day illnesses—minor injuries, infectious diseas­ es, and immunizations-—that are common to children, much as a general practitioner treats adults. Some pediatricians special­ ize in pediatric surgery or serious medical conditions, such as autoimmune disorders or serious chronic ailments. Obstetricians and gynecologists (OB/GYNs) specialize in women’s health. They are responsible for women’s general medical care, and they also provide care related to pregnancy and the reproductive system. Like general practitioners, OB/ GYNs attempt to prevent, diagnose, and treat general health problems, but they focus on ailments specific to the female anatomy, such as cancers of the breast or cervix, urinary tract and pelvic disorders, and hormonal disorders. OB/GYNs also specialize in childbirth, treating and counseling women throughout their pregnancy, from giving prenatal diagnoses to assisting with delivery and providing postpartum care. Psychiatrists are the primary caregivers in the area of mental health. They assess and treat mental illnesses through a com­ bination of psychotherapy, psychoanalysis, hospitalization, and medication. Psychotherapy involves regular discussions with patients about their problems; the psychiatrist helps them find solutions through changes in their behavioral patterns, the ex­ ploration of their past experiences, or group and family therapy sessions. Psychoanalysis involves long-term psychotherapy and counseling for patients. In many cases, medications are ad­ ministered to correct chemical imbalances that cause emotional problems. Psychiatrists also may administer electroconvulsive therapy to those of their patients who do not respond to, or who cannot take, medications. Surgeons specialize in the treatment of injury, disease, and deformity through operations. Using a variety of instruments, and with patients under anesthesia, a surgeon corrects physical deformities, repairs bone and tissue after injuries, or performs preventive surgeries on patients with debilitating diseases or disorders. Although a large number perform general surgery, many surgeons choose to specialize in a specific area. One of the most prevalent specialties is orthopedic surgery: the treat­ ment of the musculoskeletal system. Others include neurologi­ cal surgery (treatment of the brain and nervous system), car­ diovascular surgery, otolaryngology (treatment of the ear, nose,  370 Occupational Outlook Handbook  di' O  Physicians increasingly practice in groups or health care or­ ganizations that provide backup coverage and allow for more time off. and throat), and plastic or reconstructive surgery. Like other physicians, surgeons also examine patients, perform and inter­ pret diagnostic tests, and counsel patients on preventive health care. Other physicians and surgeons work in a number of other medical and surgical specialists, including allergists, cardiolo­ gists, dermatologists, emergency physicians, gastroenterolo­ gists, ophthalmologists, pathologists, and radiologists. Work environment. Many physicians—primarily general and family practitioners, general internists, pediatricians, OB/ GYNs, and psychiatrists—work in small private offices or clin­ ics, often assisted by a small staff of nurses and other admin­ istrative personnel. Increasingly, physicians are practicing in groups or health care organizations that provide backup cover­ age and allow for more time off. Physicians in a group practice or health care organization often work as part of a team that coordinates care for a number of patients; they are less inde­ pendent than the solo practitioners of the past. Surgeons and anesthesiologists usually work in well-lighted, sterile environ­ ments while performing surgery and often stand for long peri­ ods. Most work in hospitals or in surgical outpatient centers. Many physicians and surgeons work long, irregular hours. Over one-third of full-time physicians and surgeons worked 60 hours or more a week in 2006. Only 8 percent of all physicians and surgeons worked part-time, compared with 15 percent for all occupations. Physicians and surgeons must travel frequently between office and hospital to care for their patients. While on call, a physician will deal with many patients’ concerns over the phone and make emergency visits to hospitals or nursing homes.  Training, Other Qualifications, and Advancement The common path to practicing as a physician requires 8 years of education beyond high school and 3 to 8 additional years of internship and residency. All States, the District of Columbia, and U.S. territories license physicians. Education and training. Formal education and training re­ quirements for physicians are among the most demanding of any occupation—4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency,   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  depending on the specialty selected. A few medical schools of­ fer combined undergraduate and medical school programs that last 6 years rather than the customary 8 years. Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and or­ ganic chemistry. Students also take courses in the humanities and the social sciences. Some students volunteer at local hospi­ tals or clinics to gain practical experience in the health profes­ sions. The minimum educational requirement for entry into medi­ cal school is 3 years of college; most applicants, however, have at least a bachelor’s degree, and many have advanced degrees. There are 146 medical schools in the United States—126 teach allopathic medicine and award a Doctor of Medicine (M.D.) degree; 20 teach osteopathic medicine and award the Doctor of Osteopathic Medicine (D.O.) degree. Acceptance to medical school is highly competitive. Ap­ plicants must submit transcripts, scores from the Medical Col­ lege Admission Test, and letters of recommendation. Schools also consider an applicant’s character, personality, leadership qualities, and participation in extracurricular activities. Most schools require an interview with members of the admissions committee. Students spend most of the first 2 years of medical school in laboratories and classrooms, taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbi­ ology, pathology, medical ethics, and laws governing medicine. They also learn to take medical histories, examine patients, and diagnose illnesses. During their last 2 years, students work with patients under the supervision of experienced physicians in hos­ pitals and clinics, learning acute, chronic, preventive, and reha­ bilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness. Following medical school, almost all M.D.s enter a residen­ cy—graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.s serve a 12-month rotating internship after graduation and before entering a residency, which may last 2 to 6 years. A physician’s training is costly. According to the Association of American Medical Colleges, in 2004 more than 80 percent of medical school graduates were in debt for educational ex­ penses.  Licensure and certification. All States, the District of Co­ lumbia, and U.S. territories license physicians. To be licensed, physicians must graduate from an accredited medical school, pass a licensing examination, and complete 1 to 7 years of grad­ uate medical education. Although physicians licensed in one State usually can get a license to practice in another without further examination, some States limit reciprocity. Graduates of foreign medical schools generally can qualify for licensure after passing an examination and completing a U.S. residency. M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years in residency training, depending on the specialty. A final examination immediately after residency or after 1 or 2 years of practice also is necessary for certification by a member board of the American Board of Medical Special-  Professional and Related Occupations 371  Table 1. Percent distribution of active physicians in patient care by specialty, 2005 Total...................................................................................... Primary care ........................................................................ Family medicine and general practice.......................... Internal medicine............................................................ Obstetrics & gynecology................................................. Pediatrics........................................................................... Specialties............................................................................. Anesthesiology................................................................. Psychiatry......................................................................... Surgical specialties, selected......................................... All other specialties.........................................................  Percent 100.0 40.4 12.3 15.0 5.5 7.5 59.6 5.2 5.1 10.8 38.5  SOURCE: American Medical Association, Physician Characteristics and Distribution in the US, 2007.  ists (ABMS) or the American Osteopathic Association (AOA). The ABMS represents 24 boards related to medical specialties ranging from allergy and immunology to urology. The AOA has approved 18 specialty boards, ranging from anesthesiology to surgery. For certification in a subspecialty, physicians usu­ ally need another 1 to 2 years of residency. Other qualifications. People who wish to become physicians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical educa­ tion and practice. Physicians also must have a good bedside manner, emotional stability, and the ability to make decisions in emergencies. Prospective physicians must be willing to study throughout their career to keep up with medical advances. Advancement. Some physicians and surgeons advance by gaining expertise in specialties and subspecialties and by de­ veloping a reputation for excellence among their peers and pa­ tients. Many physicians and surgeons start their own practice or join a group practice. Others teach residents and other new doctors, and some advance to supervisory and managerial roles in hospitals, clinics, and other settings.  Employment Physicians and surgeons held about 633,000 jobs in 2006; ap­ proximately 15 percent were self-employed. About half of wage-and-salary physicians and surgeons worked in offices of physicians, and 18 percent were employed by hospitals. Others practiced in Federal, State, and local governments, including colleges, universities, and professional schools; private colleg­ es, universities, and professional schools; and outpatient care centers. According to 2005 data from the American Medical Associa­ tion (AMA), about two in five physicians in patient care were in primary care, but not in a subspecialty of primary care. (See table 1.)  A growing number of physicians are partners or wage-andsalary employees of group practices. Organized as clinics or as associations of physicians, medical groups can more easily afford expensive medical equipment, can share support staff, and benefit from other business advantages. According to the AMA, the New England and Middle At­ lantic States have the highest ratio of physicians to population; the South Central and Mountain States have the lowest. D.O.s are more likely than M.D.s to practice in small cities and towns and in rural areas. M.D.s tend to locate in urban areas, close to hospitals and education centers.  Job Outlook Employment of physicians and surgeons is expected to grow faster than the average for all occupations. Job opportunities should be very good, especially for physicians and surgeons willing to practice in specialties—including family practice, internal medicine, and OB/GYN—or in rural and low-income areas where there is a perceived shortage of medical practitio­ ners. Employment change. Employment of physicians and sur­ geons is projected to grow 14 percent from 2006 to 2016, faster than the average for all occupations. Job growth will occur be­ cause of continued expansion of health care related industries. The growing and aging population will drive overall growth in the demand for physician services, as consumers continue to demand high levels of care using the latest technologies, diag­ nostic tests, and therapies. Demand for physicians’ services is highly sensitive to chang­ es in consumer preferences, health care reimbursement poli­ cies, and legislation. For example, if changes to health cover­ age result in consumers facing higher out-of-pocket costs, they may demand fewer physician services. Patients relying more on other health care providers—such as physician assistants, nurse practitioners, optometrists, and nurse anesthetists—also may temper demand for physician services. In addition, new technologies will increase physician productivity. These tech­ nologies include electronic medical records, test and prescrip­ tion orders, billing, and scheduling. Job prospects. Opportunities for individuals interested in be­ coming physicians and surgeons are expected to be very good. In addition to job openings from employment growth, numer­ ous openings will result from the need to replace physicians and surgeons who retire over the 2006-16 decade. Unlike their predecessors, newly trained physicians face radically different choices of where and how to practice. New physicians are much less likely to enter solo practice and more likely to take salaried jobs in group medical practices, clinics, and health networks. Reports of shortages in some specialties, such as general or family practice, internal medicine, and OB/GYN, or in rural  Projections data from the National Employment Matrix  soc  Occupational Title Physicians and surgeons..........................................  Code  ..................  29-1060  Employment,  2006 633,000  Projected employment,  2016 723,000  Change,  2006-2016  Number  90,000  Percent  14  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  don Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  372 Occupational Outlook Handbook  Table 2. Median compensation for physicians, 2005 Specialty Anesthesiology..................................... Surgery: General.................................. Obstetrics/gynecology: General.......... Psychiatry: General.............................. Internal medicine: General.................. Pediatrics: General............................... Family practice (without obstetrics)...  Less than two years in specialty $259,948 228,839 203,270 173,922 141,912 132,953 137,119  Over one year in specialty $321,686 282,504 247,348 180,000 166,420 161,331 156,010  SOURCE: Medical Group Management Association, Physician Compen­ sation and Production Report, 2005.  or low-income areas should attract new entrants, encouraging schools to expand programs and hospitals to increase avail­ able residency slots. However, because physician training is so lengthy, employment change happens gradually. In the short term, to meet increased demand, experienced physicians may work longer hours, delay retirement, or take measures to in­ crease productivity, such as using more support staff to provide services. Opportunities should be particularly good in rural and low-income areas, as some physicians find these areas unat­ tractive because of less control over work hours, isolation from medical colleagues, or other reasons.  Earnings Earnings of physicians and surgeons are among the highest of any occupation. The Medical Group Management Associa­ tion’s Physician Compensation and Production Survey, reports that median total compensation for physicians in 2005 varied by specialty, as shown in table 2. Total compensation for phy­ sicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bo­ nus and incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation. Self-employed physicians—those who own or are part own­ ers of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health in­ surance and retirement.  Related Occupations Physicians work to prevent, diagnose, and treat diseases, dis­ orders, and injuries. Other health care practitioners who need similar skills and who exercise critical judgment include chi­ ropractors, dentists, optometrists, physician assistants, podia­ trists, registered nurses, and veterinarians.  y Association of American Medical Colleges, Section for Student Services, 2450 N St.NW., Washington, DC 20037. Internet: http://www.aamc.org/students For general information on physicians, contact: y American Medical Association, 515 N. State St., Chicago, IL 60610. Internet: http://www.ama-assn.org y American Osteopathic Association, Department of Communications, 142 East Ontario St., Chicago, IL 60611. Internet: http://www.osteopathic.org For information about various medical specialties, contact: y American Academy of Family Physicians, Resident Student Activities Department, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211. Internet: http://fmignet.aafp.org y American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Internet: http://www.aap.org y American Board ofMedical Specialties, 1007 Church St., Suite 404, Evanston, IL 60201. Internet: http://www.abms.org y American College of Obstetricians and Gynecologists, 409 12th St.SW., P.O. Box 96920, Washington, DC 20090. Internet: http://www.acog.org y American College of Physicians, 190 North Independence Mall West, Philadelphia, PA 19106. Internet: http://www.acponline.org y American College of Surgeons, Division of Education, 633 North Saint Clair St., Chicago, IL 60611. Internet: http://www.facs.org y American Psychiatric Association, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209. Internet: http://www.psych.org y American Society of Anesthesiologists, 520 N. Northwest Hwy., Park Ridge, IL 60068. Internet: http://www.asahq.org/career/homepage.htm Information on Federal scholarships and loans is available from the directors of student financial aid at schools of medi­ cine. Information on licensing is available from State boards of examiners.  Podiatrists (Q**NET 29-1081.00)  Significant Points  •  Podiatrists must be licensed, requiring 3 to 4 years of undergraduate education, the completion of a 4-year podiatric college program, and passing scores on na­ tional and State examinations.  •  While the occupation is small, job opportunities should be good for entry-level graduates of accredited podiatric medicine programs.  •  Opportunities for newly trained podiatrists will be better in group medical practices, clinics, and health networks than in traditional, solo practices.  •  Podiatrists enjoy very high earnings.  Sources of Additional Information For a list of medical schools and residency programs, as well as general information on premedical education, financial aid, and medicine as a career, contact: y American Association of Colleges of Osteopathic MediciNE., 5550 Friendship Blvd., Suite 310, Chevy ChaSE., MD 20815. Internet: http://www.aacom.org  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 373  Nature of the Work Americans spend a great deal of time on their feet. As the Na­ tion becomes more active across all age groups, the need for foot care will become increasingly important. The human foot is a complex structure. It contains 26 bones—plus muscles, nerves, ligaments, and blood vessels— and is designed for balance and mobility. The 52 bones in the feet make up about one-fourth of all the bones in the human body. Podiatrists, also known as doctors of podiatric medicine (DPMs), diagnose and treat disorders, diseases, and injuries of the foot and lower leg. Podiatrists treat corns, calluses, ingrown toenails, bunions, heel spurs, and arch problems; ankle and foot injuries, deformi­ ties, and infections; and foot complaints associated with dia­ betes and other diseases. To treat these problems, podiatrists prescribe drugs and physical therapy, set fractures, and perform surgery. They also fit corrective shoe inserts called orthotics, design plaster casts and strappings to correct deformities, and design custom-made shoes. Podiatrists may use a force plate or scanner to help design the orthotics: patients walk across a plate connected to a computer that “reads” their feet, picking up pressure points and weight distribution. From the computer readout, podiatrists order the correct design or recommend an­ other kind of treatment. To diagnose a foot problem, podiatrists also order x-rays and laboratory tests. The foot may be the first area to show signs of serious conditions such as arthritis, diabetes, and heart disease. For example, patients with diabetes are prone to foot ulcers and infections because of poor circulation. Podiatrists consult with  Podiatrists diagnose and treat disorders of the feet and ankles.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  and refer patients to other health practitioners when they detect symptoms of these disorders. Most podiatrists have a solo practice, although more are forming group practices with other podiatrists or health practi­ tioners. Some specialize in surgery, orthopedics, primary care, or public health. Besides these board-certified specialties, po­ diatrists may practice other specialties, such as sports medicine, pediatrics, dermatology, radiology, geriatrics, or diabetic foot care. Podiatrists who are in private practice are responsible for run­ ning a small business. They may hire employees, order sup­ plies, and keep records, among other tasks. In addition, some educate the community on the benefits of foot care through speaking engagements and advertising. Work environment. Podiatrists usually work in small private offices or clinics, sometimes supported by a small staff of assis­ tants and other administrative personnel. They also may spend time visiting patients in nursing homes or performing surgery at hospitals or ambulatory surgical centers. Podiatrists with pri­ vate practices set their own hours but may work evenings and weekends to accommodate their patients. Podiatrists usually treat fewer emergencies than other doctors.  Training, Other Qualifications, and Advancement Podiatrists must be licensed, requiring 3 to 4 years of under­ graduate education, the completion of a 4-year podiatric col­ lege program, and passing scores on national and State exami­ nations. Education and training. Prerequisites for admission to a college of podiatric medicine include the completion of at least 90 semester hours of undergraduate study, an acceptable grade point average, and suitable scores on the Medical College Ad­ mission Test. (Some colleges also may accept the Dental Ad­ mission Test or the Graduate Record Exam.) Admission to podiatric colleges usually requires at least 8 semester hours each of biology, inorganic chemistry, organic chemistry, and physics and at least 6 hours of English. The sci­ ence courses should be those designed for premedical students. Extracurricular and community activities, personal interviews, and letters of recommendation are also important. About 95 percent of podiatric students have at least a bachelor’s degree. In 2007, there were seven colleges of podiatric medicine ful­ ly accredited by the Council on Podiatric Medical Education. Colleges of podiatric medicine offer a 4-year program whose core curriculum is similar to that in other schools of medicine. During the first 2 years, students receive classroom instruction in basic sciences, including anatomy, chemistry, pathology, and pharmacology. Third-year and fourth-year students have clini­ cal rotations in private practices, hospitals, and clinics. Dur­ ing these rotations, they learn how to take general and podiatric histories, perform routine physical examinations, interpret tests and findings, make diagnoses, and perform therapeutic pro­ cedures. Graduates receive the degree of Doctor of Podiatric Medicine (DPM). Most graduates complete a hospital-based residency program after receiving a DPM. Residency programs last from 2 to 4 years. Residents receive advanced training in podiatric medi­ cine and surgery and serve clinical rotations in anesthesiology,  374 Occupational Outlook Handbook  internal medicine, pathology, radiology, emergency medicine, and orthopedic and general surgery. Residencies lasting more than 1 year provide more extensive training in specialty areas. Licensure. All States and the District of Columbia require a license for the practice of podiatric medicine. Each State de­ fines its own licensing requirements, although many States grant reciprocity to podiatrists who are licensed in another State. Ap­ plicants for licensure must be graduates of an accredited college of podiatric medicine and must pass written and oral examina­ tions. Some States permit applicants to substitute the exami­ nation of the National Board of Podiatric Medical Examiners, given in the second and fourth years of podiatric medical col­ lege, for part or all of the written State examination. In general, States require a minimum of 2 years of postgraduate residency training in an approved health care institution. For licensure renewal, most States require continuing education. Other qualifications. People planning a career in podiatry should have scientific aptitude, manual dexterity, interpersonal skills, and a friendly bedside manner. In private practice, podia­ trists also should have good business sense. Certification and advancement. There are a number of certifying boards for the podiatric specialties of orthopedics, primary medicine, and surgery. Certification has requirements beyond licensure. Each board requires advanced training, the completion of written and oral examinations, and experience as a practicing podiatrist. Most managed-care organizations pre­ fer board-certified podiatrists. Podiatrists may advance to become professors at colleges of podiatric medicine, department chiefs in hospitals, or general health administrators.  Employment Podiatrists held about 12,000 jobs in 2006. About 24 percent of podiatrists were self-employed. Most podiatrists were solo practitioners, although more are entering group practices with other podiatrists or other health practitioners. Solo practitio­ ners primarily were unincorporated self-employed workers, al­ though some also were incorporated wage and salary workers in offices of other health practitioners. Other podiatrists were employed by hospitals, long-term care facilities, the Federal Government, and municipal health departments.  Job Outlook Employment is expected to increase about as fast as average because of increasing consumer demand for podiatric medicine services. Job prospects should be good. Employment change. Employment of podiatrists is expected to increase 9 percent from 2006 to 2016, about as fast as the av­ erage for all occupations. More people will turn to podiatrists for foot care because of the rising number of injuries sustained by a more active and increasingly older population.  Medicare and most private health insurance programs cover acute medical and surgical foot services, as well as diagnostic xrays and leg braces. Details of such coverage vary among plans. However, routine foot care, including the removal of corns and calluses, is not usually covered unless the patient has a systemic condition that has resulted in severe circulatory problems or ar­ eas of desensitization in the legs or feet. Like dental services, podiatric care is often discretionary and, therefore, more depen­ dent on disposable income than some other medical services. Employment of podiatrists would grow even faster were it not for continued emphasis on controlling the costs of specialty health care. Insurers will balance the cost of sending patients to podiatrists against the cost and availability of substitute practi­ tioners, such as physicians and physical therapists. Job prospects. Although the occupation is small and most podiatrists continue to practice until retirement, job opportu­ nities should be good for entry-level graduates of accredited podiatric medicine programs. Job growth and replacement needs should create enough job openings for the supply of new podiatric medicine graduates. Opportunities will be better for board-certified podiatrists because many managed-care organi­ zations require board certification. Newly trained podiatrists will find more opportunities in group medical practices, clinics, and health networks than in traditional solo practices. Estab­ lishing a practice will be most difficult in the areas surrounding colleges of podiatric medicine, where podiatrists concentrate.  Earnings Podiatrists enjoy very high earnings. Median annual earnings of salaried podiatrists were $108,220 in 2006. Additionally, a survey by Podiatry Management Magazine reported median net income of $114,000 in 2006. Podiatrists in partnerships tended to earn higher net incomes than those in solo practice. A sala­ ried podiatrist typically receives heath insurance and retirement benefits from their employer, whereas self-employed chiroprac­ tors must provide for their own health insurance and retirement. Also, solo practitioners must absorb the costs of running their own offices.  Related Occupations Other workers, who apply medical knowledge to prevent, diag­ nose, and treat muscle and bone disorders and injuries include athletic trainers, chiropractors, massage therapists, occupation­ al therapists, physical therapists, and physicians and surgeons. Workers who specialize in developing orthopedic shoe inserts, braces, and prosthetic limbs are orthotists and prosthetists.  Sources of Additional Information For information on a career in podiatric medicine, contact: y American Podiatric Medical Association, 9312 Old Georgetown Rd., Bethesda, MD 20814-1621. Internet: http://www.apma.org  Projections data from the National Employment Matrix Projected Change, 2006-2016 employment, Code 2016 Number Percent 1,100 9 29-1081 13,000 12,000 Podiatrists................................................................. ............................. NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2006  Professional and Related Occupations 375  Information on colleges of podiatric medicine and their en­ trance requirements, curricula, and student financial aid is avail­ able from: y American Association of Colleges of Podiatric MediciNE., 15850 Crabbs Branch Way, Suite 320, Rockville, MD 20855­ 2622. Internet: http://www.aacpm.org  Radiation Therapists (0*NET 29-1124.00)  Significant Points  • • •  A bachelor’s degree, associate degree, or certificate in radiation therapy is generally required. Good job opportunities are expected. Employment is projected to grow much faster than the average for all occupations.  Nature of the Work Treating cancer in the human body is the principal use of radia­ tion therapy. As part of a medical radiation oncology team, ra­ diation therapists use machines—called linear accelerators—to administer radiation treatment to patients. Linear accelerators, used in a procedure called external beam therapy, project highenergy x-rays at targeted cancer cells. As the x-rays collide with human tissue, they produce highly energized ions that can shrink and eliminate cancerous tumors. Radiation therapy is sometimes used as the sole treatment for cancer, but is usually used in conjunction with chemotherapy or surgery. The first step in the radiation therapy process is simulation. During simulation, the radiation therapist uses an x-ray imag­ ing machine or computer tomography (CT) scan to pinpoint the location of the tumor. The therapist then positions the patient and adjusts the linear accelerator so that, when treatment be­ gins, radiation exposure is concentrated on the tumor cells. The radiation therapist then develops a treatment plan in conjunc­ tion with a radiation oncologist (a physician who specializes in therapeutic radiology), and a dosimetrist (a technician who calculates the dose of radiation that will be used for treatment). The therapist later explains the treatment plan to the patient and answers any questions that the patient may have. The next step in the process is treatment. To begin, the ra­ diation therapist positions the patient and adjusts the linear accelerator according to the guidelines established in simula­ tion. Then, from a separate room that is protected from the x-ray radiation, the therapist operates the linear accelerator and monitors the patient’s condition through a TV monitor and an intercom system. Treatment can take anywhere from 10 to 30 minutes and is usually administered once a day, 5 days a week, for 2 to 9 weeks. During the treatment phase, the radiation therapist monitors the patient’s physical condition to determine if any adverse side effects are taking place. The therapist must also be aware of the patient’s emotional wellbeing. Because many patients are under stress and are emotionally fragile, it is important for the   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  therapist to maintain a positive attitude and provide emotional support. Radiation therapists keep detailed records of their patients’ treatments. These records include information such as the dose of radiation used for each treatment, the total amount of radia­ tion used to date, the area treated, and the patient’s reactions. Radiation oncologists and dosimetrists review these records to ensure that the treatment plan is working, to monitor the amount of radiation exposure that the patient has received, and to keep side effects to a minimum. Radiation therapists also assist medical radiation physicists, workers who monitor and adjust the linear accelerator. Because radiation therapists often work alone during the treatment phase, they need to be able to check the linear accelerator for problems and make any adjustments that are needed. Therapists also may assist dosimetrists with routine aspects of dosimetry, the pro­ cess used to calculate radiation dosages. Work environment. Radiation therapists work in hospitals or in cancer treatment centers. These places are clean, well light­ ed, and well ventilated. Therapists do a considerable amount of lifting and must be able to help disabled patients get on and off treatment tables. They spend most of their time on their feet Radiation therapists generally work 40 hours a week, and un­ like those in other health care occupations, they normally work only during the day. However, because radiation therapy emer-  mmSmi  ..............  Radiation therapists work in hospitals and cancer treatment centers.  376 Occupational Outlook Handbook  gencies do occur, some therapists are required to be on call and may have to work outside of their normal hours. Working with cancer patients can be stressful, but many ra­ diation therapists also find it rewarding. Because they work around radioactive materials, radiation therapists take great care to ensure that they are not exposed to dangerous levels of radiation. Following standard safety procedures can prevent overexposure.  Training, Other Qualifications, and Advancement A bachelor’s degree, associate degree, or certificate in radiation therapy generally is required. Many States also require radia­ tion therapists to be licensed. With experience, therapists can advance to managerial positions. Education and training. Employers usually require appli­ cants to complete an associate or a bachelor’s degree program in radiation therapy. Individuals also may become qualified by completing an associate or a bachelor’s degree program in ra­ diography, which is the study of radiological imaging, and then completing a 12-month certificate program in radiation therapy. Radiation therapy programs include core courses on radiation therapy procedures and the scientific theories behind them. In addition, such programs often include courses on human anato­ my and physiology, physics, algebra, precalculus, writing, pub­ lic speaking, computer science, and research methodology. In 2007 there were 123 radiation therapy programs accredited by the American Registry of Radiologic Technologists (ARRT). Licensure. In 2007, 32 States required radiation therapists to be licensed by a State accrediting board. Licensing require­ ments vary by State, but many States require applicants to pass the ARRT certification examination. Further information is available from individual State licensing offices. Certification and other qualifications. Some States, as well as many employers, require that radiation therapists be certified by ARRT. To become ARRT-certified, an applicant must com­ plete an accredited radiation therapy program, adhere to ARRT ethical standards, and pass the ARRT certification examination. The examination and accredited academic programs cover ra­ diation protection and quality assurance, clinical concepts in radiation oncology, treatment planning, treatment delivery, and patient care and education. Candidates also must demonstrate competency in several clinical practices including patient care activities; simulation procedures; dosimetry calculations; fab­ rication of beam modification devices; low-volume, high-risk procedures, and the application of radiation. ARRT certification is valid for 1 year, after which therapists must renew their certification. Requirements for renewal in­ clude abiding by the ARRT ethical standards, paying annual dues, and satisfying continuing education requirements. Con­ tinuing education requirements must be met every 2 years and include either the completion of 24 credits of radiation thera­  py-related courses or the attainment of ARRT certification in a discipline other than radiation therapy. Certification renewal, however, may not be required by all States or employers that require initial certification. All radiation therapists need good communication skills be­ cause their work involves a great deal of patient interaction. Individuals interested in becoming radiation therapists should be psychologically capable of working with cancer patients. They should be caring and empathetic because they work with patients who are ill and under stress. They should be able to keep accurate, detailed records. They also should be physically fit because they work on their feet for long periods and lift and move disabled patients. Advancement. Experienced radiation therapists may ad­ vance to manage radiation therapy programs in treatment cen­ ters or other health care facilities. Managers generally continue to treat patients while taking on management responsibilities. Other advancement opportunities include teaching, technical sales, and research. With additional training and certification, therapists also can become dosimetrists, who use complex mathematical formulas to calculate proper radiation doses.  Employment Radiation therapists held about 15,000 jobs in 2006. About 73 percent worked in hospitals, and about 17 percent worked in the offices of physicians. A small proportion worked in outpatient care centers.  Job Outlook Employment is expected to increase much faster than the aver­ age from 2006 to 2016, and job prospects should be good. Employment change. Employment of radiation therapists is projected to grow by 25 percent between 2006 and 2016, which is much faster than the average for all occupations. As the U.S. population grows and an increasing share of it is in the older age groups, the number of people needing treatment is expect­ ed to increase and to spur demand for radiation therapists. In addition, as radiation technology advances and is able to treat more types of cancer, radiation therapy will be prescribed more often. Job prospects. Job prospects are expected to be good. Job openings will result from employment growth and from the need to replace workers who retire or leave the occupation for other reasons. Applicants who are certified should have the best opportunities.  Earnings Median annual earnings of wage-and-salary radiation thera­ pists were $66,170 in May 2006. The middle 50 percent earned between $54,170 and $78,550. The lowest 10 percent earned less than $44,840, and the highest 10 percent earned more than  Projections data from the National Employment Matrix Occupational Title Radiation therapists................................................. ...........................  soc  Employment,  Code  2006  29-1124  15,000  Projected employment,  2016 18,000  Change,  2006-2016 Number  3,600  Percent  25  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 377  $92,110. Median annual earnings in the industries that em­ ployed the largest numbers of radiation therapists in May 2006 are as follows: Outpatient care centers........................................................ $73,810 Offices of physicians............................................................. 70,050 General medical and surgical hospitals.................................63,580 Some employers also reimburse their employees for the cost of continuing education.  Related Occupations Radiation therapists use advanced machinery to administer medical treatment to patients. Other occupations that perform similar duties include radiologic technologists and technicians, diagnostic medical sonographers, nuclear medicine technolo­ gists, cardiovascular technologists and technicians, dental hy­ gienists, respiratory therapists, physical therapist assistants and aides, registered nurses, and physicians and surgeons. Other occupations that build relationships with patients and provide them with emotional support include nursing, psychi­ atric, and home health aides; counselors; psychologists; social workers; and social and human service assistants.  Sources of Additional Information Information on certification by the American Registry of Ra­ diologic Technologists and on accredited radiation therapy pro­ grams may be obtained from: > American Registry of Radiologic Technologists, 1255 Northland Dr., St.Paul, MN 55120. Internet: http://www.arrt.org Information on careers in radiation therapy may be obtained from: > American Society of Radiologic Technologists, 15000 Central Ave., SE., Albuquerque, NM 87123. Internet: http://www.asrt.org  games, dance and movement, drama, music, and community outings, therapists improve and maintain the physical, mental, and emotional well-being of their clients. Therapists help in­ dividuals reduce depression, stress, and anxiety; recover basic motor functioning and reasoning abilities; build confidence; and socialize effectively so that they can enjoy greater inde­ pendence and reduce or eliminate the effects of their illness or disability. In addition, therapists help people with disabili­ ties integrate into the community by teaching them how to use community resources and recreational activities. Recreational therapists are different from recreation workers, who organize recreational activities primarily for enjoyment. (Recreation workers are discussed elsewhere in the Handbook.) In acute health care settings, such as hospitals and rehabilita­ tion centers, recreational therapists treat and rehabilitate indi­ viduals with specific health conditions, usually in conjunction or collaboration with physicians, nurses, psychologists, social workers, and physical and occupational therapists. In long­ term and residential care facilities, recreational therapists use leisure activities—especially structured group programs—to improve and maintain their clients’ general health and well-be­ ing. They also may provide interventions to prevent the client from suffering further medical problems and complications. Recreational therapists assess clients using information from observations, medical records, standardized assessments, the medical staff, the clients’ families, and the clients themselves. They then develop and carry out therapeutic interventions consistent with the clients’ needs and interests. For example, they may encourage clients who are isolated from others or who have limited social skills to play games with others, and they may teach right-handed people with right-side paralysis how to use their unaffected left side to throw a ball or swing a racket. Recreational therapists may instruct patients in relax­ ation techniques to reduce stress and tension, stretching and  Recreational Therapists (0*NET 29-1125.00)  Significant Points  •  Recreational therapists will experience competition for jobs.  •  A bachelor’s degree in therapeutic recreation is the usual requirement for entry-level positions. Recreational therapists should be comfortable work­ ing with persons who are ill or who have disabili­ ties.  •  Nature of the Work Recreational therapists, also referred to as therapeutic recre­ ation specialists, provide treatment services and recreation ac­ tivities for individuals with disabilities or illnesses. Using a variety of techniques, including arts and crafts, animals, sports,   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Recreational therapists use various techniques, including cog­ nitive tests, to treat clients and maintain their well-being.  378 Occupational Outlook Handbook  New Hampshire required licensure to practice as a recreational therapist. Certification and other qualifications. Although certifica­ tion is usually voluntary, most employers prefer to hire candi­ dates who are certified therapeutic recreation specialists. In 2006, about 3 out of 4 recreational therapists worked in a clini­ cal setting, which often requires certification by the National Council for Therapeutic Recreation Certification. The council offers the Certified Therapeutic Recreation Specialist creden­ tial to candidates who have a bachelor’s or graduate degree from an accredited educational institution, pass a written certi­ fication examination, and complete a supervised internship of at least 480 hours. Therapists must meet additional require­ ments to maintain certification. Therapists can also earn certifications in specific areas, such as art therapy and aquatic therapy. Recreational therapists must be comfortable working with people who are ill or disabled. Therapists must be patient, tactful, and persuasive when working with people who have a variety of special needs. Ingenuity, a sense of humor, and imagination are needed to adapt activities to individual needs, and good physical coordination is necessary to demonstrate or participate in recreational activities. Advancement. Therapists may advance to supervisory or administrative positions. Some teach, conduct research, or consult for health or social services agencies.  limbering exercises, proper body mechanics for participation in recreational activities, pacing and energy conservation tech­ niques, and team activities. As they work, therapists observe and document a patient’s participation, reactions, and prog­ ress. Community-based recreational therapists may work in park and recreation departments, special-education programs for school districts, or assisted-living, adult day care, and substance abuse rehabilitation centers. In these programs, therapists use interventions to develop specific skills, while providing oppor­ tunities for exercise, mental stimulation, creativity, and fun. Those few who work in schools help counselors, teachers, and parents address the special needs of students, including easing disabled students’ transition into adult life. Work environment. Recreational therapists provide servic­ es in special activity rooms but also plan activities and prepare documentation in offices. When working with clients during community integration programs, they may travel locally to teach clients how to use public transportation and other public areas, such as parks, playgrounds, swimming pools, restau­ rants, and theaters. Therapists often lift and carry equipment. Recreational therapists generally work a 40-hour week that may include some evenings, weekends, and holidays.  Training, Other Qualifications, and Advancement A bachelor’s degree with a major or concentration in therapeu­ tic recreation is the usual requirement for entry-level positions. Some States regulate recreational therapists, but requirements  Employment Recreational therapists held about 25,000 jobs in 2006. About 70 percent were in nursing and residential care facilities and hospitals. Others worked in State and local government agen­ cies and in community care facilities for the elderly, including assisted-living facilities. The rest worked primarily in resi­ dential mental retardation, mental health, and substance abuse facilities; individual and family services; Federal Government agencies; educational services; and outpatient care centers. Only a small number of therapists were self-employed, gener­ ally contracting with long-term care facilities or community agencies to develop and oversee programs.  vary.  Education and training. Most entry-level recreational ther­ apists need a bachelor’s degree in therapeutic recreation, or in recreation with a concentration in therapeutic recreation. Peo­ ple may qualify for paraprofessional positions with an associ­ ate degree in therapeutic recreation or another subject related to health care. An associate degree in recreational therapy; training in art, drama, or music therapy; or qualifying work experience may be sufficient for activity director positions in nursing homes. Approximately 130 academic programs prepare students to become recreational therapists. Most offer bachelor’s de­ grees, although some also offer associate, master’s, or doctoral degrees. Therapeutic recreation programs include courses in assessment, treatment and program planning, intervention design, and evaluation. Students also study human anatomy, physiology, abnormal psychology, medical and psychiatric ter­ minology, characteristics of illnesses and disabilities, profes­ sional ethics, and the use of assistive devices and technology. Licensure. Some States regulate recreational therapists through licensure, registration, or regulation of titles. Re­ quirements vary by State. In 2006, North Carolina, Utah, and  Job Outlook Overall employment of recreational therapists is expected to grow more slowly than the average for all occupations. Com­ petition for jobs is expected. Employment change. Employment of recreational thera­ pists is expected to increase 4 percent from 2006 to 2016, slower than the average for all occupations. Employment of recreational therapists will grow to meet the therapy needs of the increasing number of older adults. In nursing care facili­ ties—the largest industry employing recreational therapists— employment will grow slightly faster than the occupation as a  Projections data from the National Employment Matrix _ Occupational Title Recreational therapists..........................................................................  r  , Code  , mP0^^Cnt'  Projected employment,  Change, 2006-2016  29-112525,00026,0009004_  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. _____________________________________________  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  2  Professional and Related Occupations 379  whole as the number of older adults continues to grow. Fast employment growth is expected in the residential and outpa­ tient settings that serve people who are physically disabled, cognitively disabled, or elderly or who have mental illness or substance abuse problems Employment is expected to decline in hospitals, however, as services shift to outpatient settings and employers emphasize cost containment. Health care facilities will support a growing number of jobs in adult day care and outpatient programs offering short-term mental health and alcohol or drug abuse services. Rehabilita­ tion, home health care, and transitional programs will provide additional jobs. Job prospects. Recreational therapists will experience com­ petition for jobs. Job opportunities should be best for people with a bachelor’s degree in therapeutic recreation or in rec­ reation with courses in therapeutic recreation. Opportunities also should be good for therapists who hold specialized certifi­ cations such as aquatic therapy, meditation, or crisis interven­ tion. Recreational therapists might experience more competi­ tion for jobs in certain regions of the country.  Earnings Median annual earnings of recreational therapists were $34,990 in May 2006. The middle 50 percent earned between $26,780 and $44,850. The lowest 10 percent earned less than $20,880, and the highest 10 percent earned more than $55,530. Median annual earnings in the industries employing the largest num­ bers of recreational therapists in May 2006 were: General medical and surgical hospitals............................. $39,320 State government...................................................................38,260 Psychiatric and substance abuse hospitals........................... 37,560 Nursing care facilities........................................................... 30,440 Community care facilities for the elderly............................ 28,980  Related Occupations Recreational therapists primarily design activities to help people with disabilities lead more fulfilling and independent lives. Other workers who have similar jobs are occupational therapists, physical therapists, recreation workers, rehabilita­ tion counselors, and teachers—special education.  Sources of Additional Information For information and materials on careers and academic pro­ grams in recreational therapy, contact: y American Therapeutic Recreation Association, 1414 Prince St., Suite 204, Alexandria, VA 22314-2853. Internet: http://www.atra-tr.org y National Therapeutic Recreation Society, 22377 Belmont Ridge Rd., Ashbum, VA 20148-4501. Internet: http://www.nrpa.org/content/default.aspx?documentid=530 Information on certification may be obtained from: y National Council for Therapeutic Recreation Certification, 7 Elmwood Dr., New City, NY 10956. Internet: http://www.nctrc.org For information on licensure requirements, contact the appro­ priate recreational therapy regulatory agency for your State.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Registered Nurses (0*NET 29-1111.00) Significant Points  • • •  •  Regi stered nurses constitute the largest health care oc­ cupation, with 2.5 million jobs. About 59 percent of jobs are in hospitals. The three major educational paths to registered nurs­ ing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Registered nurses are projected to generate about 587,000 new jobs over the 2006-16 period, one of the largest numbers among all occupations; overall job opportunities are expected to be excellent, but may vary by employment setting.  Nature of the Work Registered nurses (RNs), regardless of specialty or work set­ ting, treat patients, educate patients and the public about vari­ ous medical conditions, and provide advice and emotional sup­ port to patients’ family members. RNs record patients’ medical histories and symptoms, help perform diagnostic tests and ana­ lyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabili­ tation. RNs teach patients and their families how to manage their illness or injury, explaining post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication and physical therapy. Some RNs work to pro­ mote general health by educating the public on warning signs and symptoms of disease. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions. When caring for patients, RNs establish a plan of care or con­ tribute to an existing plan. Plans may include numerous activi­ ties, such as administering medication, including careful check­ ing of dosages and avoiding interactions; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treat­ ments; observing the patient and recording those observations; and consulting with physicians and other health care clinicians. Some RNs provide direction to licensed practical nurses and nursing aids regarding patient care. RNs with advanced edu­ cational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority. RNs can specialize in one or more areas of patient care. There generally are four ways to specialize. RNs can choose a particular work setting or type of treatment, such as periopera­ tive nurses, who work in operating rooms and assist surgeons. RNs also may choose to specialize in specific health condi­ tions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs also can  380 Occupational Outlook Handbook  choose to work with a well-defined population, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer. There are many options for RNs who specialize in a work setting or type of treatment. Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians’ offices or in clinics. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconfer­ encing, the Internet, or by telephone. Critical care nurses pro­ vide care to patients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units. Emergency, or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions. Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by helicopter or airplane to the nearest medical facility. Holistic nurses provide care such as acupuncture, massage and aroma therapy, and bio­ feedback, which are meant to treat patients’ mental and spiri­ tual health in addition to their physical health. Home health care nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a reha­ bilitation, long-term care, or skilled nursing facility. Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for ter­ minally ill patients. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins. Long- term care nurses provide health care services on a recurring basis to patients with chronic physical or mental disor­ ders, often in long-term care or skilled nursing facilities. Medi­ cal-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diagnoses. Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services, and help employers implement health and safety standards. Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedure. Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery. Psychiatric-mental health nurses treat patients with personality and mood disorders. Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses. Rehabilitation nurses care for patients with temporary and permanent disabili­ ties. Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection. RNs specializing in a particular disease, ailment, or health care condition are employed in virtually all work settings, in­ cluding physicians’ offices, outpatient treatment facilities, home health care agencies, and hospitals. Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other addictions. Intellectual and developmental disabilities nurses   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently, and speak­ ing or other communication. Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections. Genetics nurses provide early de­ tection screenings, counseling, and treatment of patients with genetic disorders, including cystic fibrosis and Huntington’s disease. HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring. Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic injury, ulcers, or arterial disease; provide postopera­ tive care for patients with openings that allow for alternative methods of bodily waste elimination; and treat patients with urinary and fecal incontinence. RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or critical care units, specialty clinics, and outpatient care facilities. Car­ diovascular nurses treat patients with coronary heart disease and those who have had heart surgery, providing services such as postoperative rehabilitation. Dermatology nurses treat pa­ tients with disorders of the skin, such as skin cancer and psoria­ sis. Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue. Gynecol­ ogy nurses provide care to women with disorders of the repro­ ductive system, including endometriosis, cancer, and sexually transmitted diseases. Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension, or substance abuse. Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures. Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma, and to patients undergoing eye surgery. Orthopedic nurses care for patients with muscular and skeletal problems, including arthri­ tis, bone fractures, and muscular dystrophy. Otorhinolaryngol­ ogy nurses care for patients with ear, nose, and throat disorders, such as cleft palates, allergies, and sinus disorders. Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis. Urology nurses care for patients with disorders of the kidneys, urinary tract, and male reproductive organs, including infections, kidney and bladder stones, and cancers. RNs who specialize by population provide preventive and acute care in all health care settings to the segment of the popu­ lation in which they specialize, including newborns (neonatol­ ogy), children and adolescents (pediatrics), adults, and the el­ derly (gerontology or geriatrics). RNs also may provide basic health care to patients outside of health care settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United  States and abroad providing care to patients in areas with short­ ages of health care workers. Most RNs work as staff nurses as members of a team provid­ ing critical health care . However, some RNs choose to become advanced practice nurses, who work independently or in col­ laboration with physicians, and may focus on the provision of primary care services. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health. Nurse anesthe­ tists provide anesthesia and related care before and after surgi­ cal, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management. Nurse-midwives provide primary care to women, including gynecological exams, family planning ad­ vice, prenatal care, assistance in labor and delivery, and neona­ tal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and health care services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia. Some nurses have jobs that require little or no direct patient care, but still require an active RN license. Case managers en­ sure that all of the medical needs of patients with severe inju­ ries and severe or chronic illnesses are met. Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity, and traumatic accident. Infection control nurses identify, track, and control infectious outbreaks in health care facilities and develop programs for out­ break prevention and response to biological terrorism. Legal nurse consultants assist lawyers in medical cases by interview­ ing patients and witnesses, organizing medical records, deter­ mining damages and costs, locating evidence, and educating lawyers about medical issues. Nurse administrators supervise nursing staff, establish work schedules and budgets, maintain medical supply inventories, and manage resources to ensure high-quality care. Nurse educators plan, develop, imple­ ment, and evaluate educational programs and curricula for the professional development of student nurses and RNs. Nurse informaticists manage and communicate nursing data and in­ formation to improve decision making by consumers, patients, nurses, and other health care providers. RNs also may work as health care consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors. Work environment. Most RNs work in well-lighted, com­ fortable health care facilities. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites. RNs may spend considerable time walking, bending, stretching, and standing. Patients in hospitals and nursing care facilities require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on call—available to work on short notice. Nurses who work in offices, schools, and other settings that do not provide 24-hour care are more likely to work regular  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 381  INPRSH  Registered nurses who work in schools provide general health care to students. business hours. About 21 percent of RNs worked part time in 2006, and 7 percent held more than one job. Nursing has its hazards, especially in hospitals, nursing care facilities, and clinics, where nurses may be in close contact with individuals who have infectious diseases and with toxic, harm­ ful, or potentially hazardous compounds, solutions, and medi­ cations. RNs must observe rigid, standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases. RNs also may suffer emotional strain from caring for patients suffering unrelieved intense pain, close personal contact with patients’ families, the need to make critical decisions, and ethical dilem­ mas and concerns.  Training, Other Qualifications, and Advancement The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor’s de­ gree program. Individuals then must complete a national licens­ ing examination in order to obtain a nursing license. Further training or education can qualify nurses to work in specialty areas, and may help improve advancement opportunities. Education and training. There are three major educational paths to registered nursing—a bachelor’s of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2006, 709 nursing programs offered degrees at the bachelor’s level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 850 RN programs granted associate degrees. Diploma programs, administered in hospitals, last about 3 years. Only about 70 programs offered diplomas. Generally, licensed graduates of any of the three types of educational pro­ grams qualify for entry-level positions. Many RNs with an ADN or diploma later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advan­  382 Occupational Outlook Handbook  tage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. In 2006, there were 629 RN-to-BSN programs in the United States. Accelerated master’s degree in nursing (MSN) programs also are available by combining 1 year of an accelerated BSN program with 2 years of graduate study. In 2006, there were 149 RN-to-MSN programs. Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving into nursing. In 2006, 197 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individu­ als who already hold a degree. MSN programs also are avail­ able for individuals who hold a bachelor’s or higher degree in another field. Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN or MSN program because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with a bachelor’s or master’s degree. A bachelor’s degree often is necessary for administrative positions and is a prereq­ uisite for admission to graduate nursing programs in research, consulting, and teaching, and all four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nursemidwives, and nurse practitioners. Individuals who complete a bachelor’s receive more training in areas such as communica­ tion, leadership, and critical thinking, all of which are becom­ ing more important as nursing care becomes more complex. Additionally, bachelor’s degree programs offer more clinical experience in nonhospital settings. Education beyond a bache­ lor’s degree can also help students looking to enter certain fields or increase advancement opportunities. In 2006, 448 nursing schools offered master’s degrees, 108 offered doctoral degrees, and 58 offered accelerated BSN-to-doctoral programs. All four advanced practice nursing specialties require at least a master’s degree. Most programs include about 2 years of full­ time study and require a BSN degree for entry; some programs require at least 1 to 2 years of clinical experience as an RN for admission. In 2006, there were 342 master’s and post-master’s programs offered for nurse practitioners, 230 master’s and post­ master’s programs for clinical nurse specialists, 106 programs for nurse anesthetists, and 39 programs for nurse-midwives. All nursing education programs include classroom instruc­ tion and supervised clinical experience in hospitals and other health care facilities. Students take courses in anatomy, physi­ ology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students. Supervised clinical experience is provided in hospital depart­ ments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics. Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing exami­ nation, known as the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed in more than one State, either   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  by examination or by the endorsement of a license issued by another State. The Nurse Licensure Compact Agreement al­ lows a nurse who is licensed and permanently resides in one of the member States to practice in the other member States without obtaining additional licensure. In 2006, 20 states were members of the Compact, while 2 more were pending member­ ship. All States require periodic renewal of licenses, which may require continuing education. Certification is common, and sometimes required, for the four advanced practice nursing specialties—clinical nurse spe­ cialists, nurse anesthetists, nurse-midwives, and nurse practi­ tioners. Upon completion of their educational programs, most advanced practice nurses become nationally certified in their area of specialty. Certification also is available in specialty ar­ eas for all nurses. In some States, certification in a specialty is required in order to practice that specialty. Foreign-educated and foreign-born nurses wishing to work in the United States must obtain a work visa. To obtain the visa, nurses must undergo a federal screening program to ensure that their education and licensure are comparable to that of a U.S. educated nurse, that they have proficiency in written and spo­ ken English, and that they have passed either the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualify­ ing Examination or the NCLEX-RN. CGFNS administers the VisaScreen Program. (The Commission is an immigration-neu­ tral, nonprofit organization that is recognized internationally as an authority on credentials evaluation in the health care field.) Nurses educated in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom, or foreign-bom nurses who were educated in the United States, are exempt from the language proficiency testing. In addition to these national re­ quirements, foreign-bom nurses must obtain state licensure in order to practice in the United States. Each State has its own requirements for licensure. Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses. Advancement. Some RNs start their careers as licensed prac­ tical nurses or nursing aides, and then go back to school to re­ ceive their RN degree. Most RNs begin as staff nurses in hospi­ tals, and with experience and good performance often move to other settings or are promoted to more responsible positions. In management, nurses can advance from assistant unit manger or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief nurse. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment. Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based, and chronic care. Employers—including hospitals, insurance com­ panies, pharmaceutical manufacturers, and managed care or­ ganizations, among others—need RNs for health planning and  Professional and Related Occupations 383  development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.  Employment As the largest health care occupation, registered nurses held about 2.5 million jobs in 2006. Hospitals employed the major­ ity of RNs, with 59 percent of jobs. Other industries also em­ ployed large shares of workers. About 8 percent of jobs were in offices of physicians, 5 percent in home health care services, 5 percent in nursing care facilities, 4 percent in employment services, and 3 percent in outpatient care centers. The remain­ der worked mostly in government agencies, social assistance agencies, and educational services. About 21 percent of RNs worked part time.  Job Outlook Overall job opportunities for registered nurses are expected to be excellent, but may vary by employment and geographic set­ ting. Employment of RNs is expected to grow much faster than the average for all occupations through 2016 and, because the occupation is very large, many new jobs will result. In fact, registered nurses are projected to generate 587,000 new jobs, among the largest number of new jobs for any occupation. Ad­ ditionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the oc­ cupation. Employment change. Employment of registered nurses is expected to grow 23 percent from 2006 to 2016, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly. However, employment of RNs will not grow at the same rate in every industry. The projected growth rates for RNs in the industries with the highest employment of these workers are: Percent Offices of physicians.................................................................... 39 Home health care services........................................................... 39 Outpatient care centers, except mental health and substance abuse...........................................................................34 Employment services................................................................... 27 General medical and surgical hospitals, public and private..........................................................................................22 Nursing care facilities.................................................................. 20 Employment is expected to grow more slowly in hospitals— health care’s largest industry—than in most other health care  industries. While the intensity of nursing care is likely to in­ crease, requiring more nurses per patient, the number of inpa­ tients (those who remain in the hospital for more than 24 hours) is not likely to grow by much. Patients are being discharged earlier, and more procedures are being done on an outpatient basis, both inside and outside hospitals. Rapid growth is ex­ pected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy. More and more sophisticated procedures, once performed only in hospitals, are being performed in physicians’ offices and in outpatient care centers, such as freestanding ambulatory surgical and emergency centers. Accordingly, employment is expected to grow very fast in these places as health care in gen­ eral expands. Employment in nursing care facilities is expected to grow because of increases in the number of elderly, many of whom require long-term care. However, this growth will be relatively slower than in other health care industries because of the desire of patients to be treated at home or in residential care facilities, and the increasing availability of that type of care. The finan­ cial pressure on hospitals to discharge patients as soon as possi­ ble should produce more admissions to nursing and residential care facilities and to home health care. Job growth also is ex­ pected in units that provide specialized long-term rehabilitation for stroke and head injury patients, as well as units that treat Alzheimer’s victims. Employment in home health care is expected to increase rapidly in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures. Rapid employment growth in employment services industry is expected as hospitals, physician’s offices, and other health care establishments utilize temporary workers to fill short-term staffing needs. And as the demand for nurses grows, temporary nurses will be needed more often, further contributing to em­ ployment growth in this industry. Job prospects. Overall job opportunities are expected to be excellent for registered nurses. Employers in some parts of the country and in certain employment settings report difficulty in attracting and retaining an adequate number of RNs, primar­ ily because of an aging RN workforce and a lack of younger workers to fill positions. Enrollments in nursing programs at all levels have increased more rapidly in the past few years as stu­ dents seek jobs with stable employment. However, many quali­ fied applicants are being turned away because of a shortage of nursing faculty. The need for nursing faculty will only increase as many instructors near retirement. Many employers also are relying on foreign-educated nurses to fill vacant positions.  Projections data from the National Employment Matrix Projected Change, employment, 2006-2016 2016 Number Percent Registered nurses..................................................... ............................. 29-1111 2,505,000 3,092,000 587,000 23 NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  Occupational Title  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc Code  Employment, 2006  384 Occupational Outlook Handbook  Even though overall employment opportunities for all nurs­ ing specialties are expected to be excellent, they can vary by employment setting. Despite the slower employment growth in hospitals, job opportunities should still be excellent because of the relatively high turnover of hospital nurses. RNs working in hospitals frequently work overtime and night and weekend shifts and also treat seriously ill and injured patients, all of which can contribute to stress and burnout. Hospital departments in which these working conditions occur most frequently—critical care units, emergency departments, and operating rooms—generally will have more job openings than other departments. To attract and retain qualified nurses, hospitals may offer signing bonus­ es, family-friendly work schedules, or subsidized training. A growing number of hospitals also are experimenting with online bidding to fill open shifts, in which nurses can volunteer to fill open shifts at premium wages. This can decrease the amount of mandatory overtime that nurses are required to work. Although faster employment growth is projected in physi­ cians’ offices and outpatient care centers, RNs may face greater competition for these positions because they generally offer regular working hours and more comfortable working environ­ ments. There also may be some competition for jobs in em­ ployment services, despite a high rate of employment growth, because a large number of workers are attracted by the indus­ try’s relatively high wages and the flexibility of the work in this industry. Generally, RNs with at least a bachelor’s degree will have better job prospects than those without a bachelor’s. In ad­ dition, all four advanced practice specialties—clinical nurse specialists, nurse practitioners, nurse-midwives, and nurse anesthetists—will be in high demand, particularly in medically underserved areas such as inner cities and rural areas. Rela­ tive to physicians, these RNs increasingly serve as lower-cost primary care providers.  Earnings Median annual earnings of registered nurses were $57,280 in May 2006. The middle 50 percent earned between $47,710 and $69,850. The lowest 10 percent earned less than $40,250, and the highest 10 percent earned more than $83,440. Median an­ nual earnings in the industries employing the largest numbers of registered nurses in May 2006 were: Employment services.......................................................... $64,260 General medical and surgical hospitals.................................58,550 Home health care services.................................................... 54,190 Offices of physicians............................................................. 53,800 Nursing care facilities........................................................... 52,490 Many employers offer flexible work schedules, child care, educational benefits, and bonuses.  Related Occupations Because of the number of specialties for registered nurses, and the variety of responsibilities and duties, many other health care occupations are similar in some aspect of the job. Other oc­ cupations that deal directly with patients when providing care include licensed practical and licensed vocational nurses, phy­ sicians and surgeons, athletic trainers, respiratory therapists,  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  massage therapists, dietitians and nutritionists, occupational therapists, physical therapists, and emergency medical tech­ nicians and paramedics. Other occupations that use advanced medical equipment to treat patients include cardiovascular tech­ nologists and technicians, diagnostic medical sonographers, ra­ diologic technologists and technicians, radiation therapists, and surgical technologists. Workers who also assist other health care professionals in providing care include nursing, psychi­ atric, and home health aides; physician assistants; and dental hygienists. Some nurses take on a management role, similar to medical and health services managers.  Sources of Additional Information For information on a career as a registered nurse and nursing education, contact: y National League for Nursing, 61 Broadway, New York, NY 10006. Internet: http://www.nln.org For information on baccalaureate and graduate nursing edu­ cation, nursing career options, and financial aid, contact: y American Association of Colleges of Nursing, 1 Dupont Circle NW„ Suite 530, Washington, DC 20036. Internet: http ://www.aacn.nche.edu For additional information on registered nurses, including credentialing, contact: y American Nurses Association, 8515 Georgia Ave., Suite 400, Silver Spring, MD 20910. Internet: http://nursingworld.org For information on the NCLEX-RN exam and a list of indi­ vidual State boards of nursing, contact: y National Council of State Boards of Nursing, 111 E. Wacker Dr., Suite 2900, Chicago, IL 60611. Internet: http://www.ncsbn.org For information on the nursing population, including work­ force shortage facts, contact: y Bureau of Health Professions, 5600 Fishers LaNE., Room 8-05, Rockville, MD 20857. Internet: http://bhpr.hrsa.gov For information on obtaining U.S. certification and work vi­ sas for foreign-educated nurses, contact: y Commission on Graduates of Foreign Nursing Schools, 3600 Market St., Suite 400, Philadelphia, PA 19104. Internet: http://www.cgfns.org For a list of accredited clinical nurse specialist programs, contact: y National Association of Clinical Nurse Specialists, 2090 Linglestown Rd., Suite 107, Harrisburg, PA 17110. Internet: http://www.nacns.org For information on nurse anesthetists, including a list of ac­ credited programs, contact: y American Association of Nurse Anesthetists, 222 Prospect Ave., Park Ridge, IL 60068. For information on nurse-midwives, including a list of ac­ credited programs, contact: y American College of Nurse-Midwives, 8403 Colesville Rd., Suite 1550, Silver Spring, MD 20910. Internet: http://www.midwife.org For information on nurse practitioners, including a list of ac­ credited programs, contact: y American Academy of Nurse Practitioners, P.O. Box 12846, Austin, TX 78711. Internet: http://www.aanp.org  Professional and Related Occupations 385  For information on nurse practitioners education, contact: V National Organization of Nurse Practitioner Faculties, 1522 K St. NW„ Suite 702, Washington, DC 20005. Internet: http://www.nonpf.org For information on critical care nurses, contact: y American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Internet: http://www.aacn.org For additional information on registered nurses in all fields and specialties, contact: V AmericanSocietyofRegisteredNurses, 1001 Bridgeway,Suite 411, Sausalito, CA 94965. Internet: http://www.asrn.org  Respiratory Therapists (0*NET 29-1126.00, 29-2054.00)  Significant Points  •  Job opportunities should be very good.  •  An associate degree is the minimum educational re­ quirement, but a bachelor’s or master’s degree may be important for advancement.  •  All States, except Alaska and Hawaii, require respira­ tory therapists to be licensed. Hospitals will account for the vast majority of job openings, but a growing number of openings will arise in other settings.  •  Nature of the Work Respiratory therapists and respiratory therapy technicians— also known as respiratory care practitioners—evaluate, treat, and care for patients with breathing or other cardiopulmonary disorders. Practicing under the direction of a physician, respi­ ratory therapists assume primary responsibility for all respi­ ratory care therapeutic treatments and diagnostic procedures, including the supervision of respiratory therapy technicians. Respiratory therapy technicians follow specific, well-defined respiratory care procedures under the direction of respiratory therapists and physicians. In clinical practice, many of the daily duties of therapists and technicians overlap. However, therapists generally have greater responsibility than technicians. For example, respiratory thera­ pists consult with physicians and other health care staff to help develop and modify patient care plans. Respiratory therapists also are more likely to provide complex therapy requiring con­ siderable independent judgment, such as caring for patients on life support in intensive-care units of hospitals. In this Hand­ book statement, the term respiratory therapist includes both re­ spiratory therapists and respiratory therapy technicians. Respiratory therapists evaluate and treat all types of patients, ranging from premature infants whose lungs are not fully de­ veloped to elderly people whose lungs are diseased. Respira­ tory therapists provide temporary relief to patients with chronic asthma or emphysema, and they give emergency care to patients who are victims of a heart attack, stroke, drowning, or shock.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  To evaluate patients, respiratory therapists interview them, perform limited physical examinations, and conduct diagnostic tests. For example, respiratory therapists test a patient’s breath­ ing capacity and determine the concentration of oxygen and other gases in a patient’s blood. They also measure a patient’s pH, which indicates the acidity or alkalinity of the blood. To evaluate a patient’s lung capacity, respiratory therapists have the patient breathe into an instrument that measures the volume and flow of oxygen during inhalation and exhalation. By com­ paring the reading with the norm for the patient’s age, height, weight, and sex, respiratory therapists can provide information that helps determine whether the patient has any lung deficien­ cies. To analyze oxygen, carbon dioxide, and blood pH levels, therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician, who then makes treatment decisions. To treat patients, respiratory therapists use oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications—liquid medications suspended in a gas that forms a mist which is in­ haled. They teach patients how to inhale the aerosol properly to ensure its effectiveness. When a patient has difficulty get­ ting enough oxygen into his or her blood, therapists increase the patient’s concentration of oxygen by placing an oxygen mask or nasal cannula on the patient and setting the oxygen flow at the level prescribed by a physician. Therapists also connect patients who cannot breathe on their own to ventilators that de­ liver pressurized oxygen into the lungs. The therapists insert a tube into the patient’s trachea, or windpipe; connect the tube to the ventilator; and set the rate, volume, and oxygen concentra­ tion of the oxygen mixture entering the patient’s lungs. Therapists perform regular assessments of patients and equipment. If a patient appears to be having difficulty breath­ ing or if the oxygen, carbon dioxide, or pH level of the blood is abnormal, therapists change the ventilator setting according to the doctor’s orders or check the equipment for mechanical problems. Respiratory therapists perform chest physiotherapy on pa­ tients to remove mucus from their lungs and make it easier for them to breathe. Therapists place patients in positions that help drain mucus, and then vibrate the patients’ rib cages, often by tapping on the chest, and tell the patients to cough. Chest phys­ iotherapy may be needed after surgery, for example, because anesthesia depresses respiration. As a result, physiotherapy may be prescribed to help get the patient’s lungs back to normal and to prevent congestion. Chest physiotherapy also helps pa­ tients suffering from lung diseases, such as cystic fibrosis, that cause mucus to collect in the lungs. Therapists who work in home care teach patients and their families to use ventilators and other life-support systems. In addition, these therapists visit patients in their homes to inspect and clean equipment, evaluate the home environment, and en­ sure that patients have sufficient knowledge of their diseases and the proper use of their medications and equipment. Thera­ pists also make emergency visits if equipment problems arise. In some hospitals, therapists perform tasks that fall outside their traditional role. Therapists are becoming involved in areas such as pulmonary rehabilitation, smoking cessation counsel­ ing, disease prevention, case management, and polysomnogra-  386 Occupational Outlook Handbook  Respiratory therapists sometimes conduct diagnostic tests to evaluate patients. phy—the diagnosis of breathing disorders during sleep, such as apnea. Respiratory therapists also increasingly treat critical care patients, either as part of surface and air transport teams or as part of rapid-response teams in hospitals. Work environment. Respiratory therapists generally work between 35 and 40 hours a week. Because hospitals operate around the clock, therapists may work evenings, nights, or weekends. They spend long periods standing and walking be­ tween patients’ rooms. In an emergency, therapists work under the stress of the situation. Respiratory therapists employed in home health care must travel frequently to patients’ homes. Respiratory therapists are trained to work with gases stored under pressure. Adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of in­ jury. As in many other health occupations, respiratory thera­ pists are exposed to infectious diseases, but by carefully follow­ ing proper procedures they can minimize the risks.  Training, Other Qualifications, and Advancement An associate degree is the minimum educational requirement, but a bachelor’s or master’s degree may be important for ad­ vancement. All States, except Alaska and Hawaii, require re­ spiratory therapists to be licensed. Education and training. An associate degree is required to become a respiratory therapist. Training is offered at the post­ secondary level by colleges and universities, medical schools, vocational-technical institutes, and the Armed Forces. Most programs award associate or bachelor’s degree and prepare graduates for jobs as advanced respiratory therapists. A limited number of associate degree programs lead to jobs as entry-level respiratory therapists. According to the Commission on Ac­ creditation of Allied Health Education Programs (CAAHEP), 45 entry-level and 334 advanced respiratory therapy programs were accredited in the United States in 2006. Among the areas of study in respiratory therapy programs are human anatomy and physiology, pathophysiology, chemistry, physics, microbiology, pharmacology, and mathematics. Other courses deal with therapeutic and diagnostic procedures and tests, equipment, patient assessment, cardiopulmonary resus­ citation, the application of clinical practice guidelines, patient care outside of hospitals, cardiac and pulmonary rehabilitation,   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  respiratory health promotion and disease prevention, and medi­ cal recordkeeping and reimbursement. High school students interested in applying to respiratory therapy programs should take courses in health, biology, math­ ematics, chemistry, and physics. Respiratory care involves basic mathematical problem solving and an understanding of chemical and physical principles. For example, respiratory care workers must be able to compute dosages of medication and calculate gas concentrations. Licensure and certification. A license is required to practice as a respiratory therapist, except in Alaska and Hawaii. Also, most employers require respiratory therapists to maintain a car­ diopulmonary resuscitation (CPR) certification. Licensure is usually based, in large part, on meeting the re­ quirements for certification from the National Board for Re­ spiratory Care (NBRC). The board offers the Certified Respi­ ratory Therapist (CRT) credential to those who graduate from entry-level or advanced programs accredited by CAAHEP or the Committee on Accreditation for Respiratory Care (CoARC) and who also pass an exam. The board also awards the Registered Respiratory Therapist (RRT) to CRTs who have graduated from advanced programs and pass two separate examinations. Supervisory positions and intensive-care specialties usually require the RRT. Other qualifications. Therapists should be sensitive to a patient’s physical and psychological needs. Respiratory care practitioners must pay attention to detail, follow instructions, and work as part of a team. In addition, operating advanced equipment requires proficiency with computers. Advancement. Respiratory therapists advance in clinical practice by moving from general care to the care of critically ill patients who have significant problems in other organ systems, such as the heart or kidneys. Respiratory therapists, especially those with a bachelor’s or master’s degree, also may advance to supervisory or managerial positions in a respiratory therapy department. Respiratory therapists in home health care and equipment rental firms may become branch managers. Some respiratory therapists advance by moving into teaching posi­ tions. Some others use the knowledge gained as a respiratory therapist to work in another industry, such as developing, mar­ keting, or selling pharmaceuticals and medical devices.  Employment Respiratory therapists held about 122,000 jobs in 2006. About 79 percent of jobs were in hospitals, mainly in departments of respiratory care, anesthesiology, or pulmonary medicine. Most of the remaining jobs were in offices of physicians or other health practitioners, consumer-goods rental firms that supply respiratory equipment for home use, nursing care facilities, and home health care services. Holding a second job is relatively common for respiratory therapists. About 12 percent held an­ other job, compared with 5 percent of workers in all occupa­ tions.  Job Outlook Faster-than-average employment growth is projected for respi­ ratory therapists. Job opportunities should be very good, es­ pecially for respiratory therapists with cardiopulmonary care skills or experience working with infants.  Professional and Related Occupations 387  Projections data from the National Employment Matrix Occupational Title Respiratory therapists.................................................... .................... Respiratory therapists............................................... ........................ Respiratory therapy technicians.............................. ........................  soc Code 29-1126 29-2054  Projected employment, 2016 145,000 126,000 19,000  Employment, 2006 122,000 102,000 19,000  Change, 2006-2016 Number Percent 23,000 19 23,000 23 200 1  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  Employment change. Employment of respiratory therapists is expected to grow 19 percent from 2006 to 2016, faster than the average for all occupations. The increasing demand will come from substantial growth in the middle-aged and elderly population—a development that will heighten the incidence of cardiopulmonary disease. Growth in demand also will result from the expanding role of respiratory therapists in case man­ agement, disease prevention, emergency care, and the early de­ tection of pulmonary disorders. Older Americans suffer most from respiratory ailments and cardiopulmonary diseases such as pneumonia, chronic bronchi­ tis, emphysema, and heart disease. As their numbers increase, the need for respiratory therapists is expected to increase as well. In addition, advances in inhalable medications and in the treatment of lung transplant patients, heart attack and accident victims, and premature infants (many of whom are dependent on a ventilator during part of their treatment) will increase the demand for the services of respiratory care practitioners. Job prospects. Job opportunities are expected to be very good. The vast majority of job openings will continue to be in hospitals. However, a growing number of openings are ex­ pected to be outside of hospitals, especially in home health care services, offices of physicians or other health practitioners, con­ sumer-goods rental firms, or in the employment services indus­ try as a temporary worker in various settings.  Earnings Median annual earnings of wage-and-salary respiratory thera­ pists were $47,420 in May 2006. The middle 50 percent earned between $40,840 and $56,150. The lowest 10 percent earned less than $35,200, and the highest 10 percent earned more than $64,190. Median annual earnings of wage-and-salary respiratory ther­ apy technicians were $39,120 in May 2006. The middle 50 percent earned between $32,050 and $46,930. The lowest 10 percent earned less than $25,940, and the highest 10 percent earned more than $56,220.  Related Occupations Under the supervision of a physician, respiratory therapists ad­ minister respiratory care and life support to patients with heart and lung difficulties. Other workers who care for, treat, or train people to improve their physical condition include registered nurses, occupational therapists, physical therapists, radiation therapists, and athletic trainers. Respiratory care practitioners work with advanced medical technology, as do other health care technicians including cardiovascular technologists and techni­ cians, nuclear medicine technologists, radiologic technologists and technicians, and diagnostic medical sonographers.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Sources of Additional Information Information concerning a career in respiratory care is available from: y American Association for Respiratory Care, 9425 N. MacArthur Blvd., Suite 100, Irving, TX 75063. Internet: http://www.aarc.org For a list of accredited educational programs for respiratory care practitioners, contact either of the following organiza­ tions: y Commission on Accreditation for Allied Health Education Programs, 1361 Park St., Clearwater, FL 33756. Internet: http://www.caahep.org y Committee on Accreditation for Respiratory Care, 1248 Harwood Rd„ Bedford, TX 76021. Information on gaining credentials in respiratory care and a list of State licensing agencies can be obtained from: y National Board for Respiratory Care, Inc., 18000 W. 105th St., Olathe, KS 66061. Internet: http://www.nbrc.org  Speech-Language Pathologists (0*NET 29-1127.00)  Significant Points •  About half worked in educational services; most oth­ ers were employed by health care and social assis­ tance facilities. A master’s degree in speech-language pathology is the standard credential required for licensing in most States.  •  Excellent job opportunities are expected.  Nature of the Work Speech-language pathologists, sometimes called speech ther­ apists, assess, diagnose, treat, and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing, and fluency. Speech-language pathologists work with people who cannot produce speech sounds or cannot produce them clearly; those with speech rhythm and fluency problems, such as stuttering; people with voice disorders, such as inappropriate pitch or harsh voice; those with problems understanding and produc­ ing language; those who wish to improve their communication skills by modifying an accent; and those with cognitive com­ munication impairments, such as attention, memory, and prob­  388 Occupational Outlook Handbook  lem solving disorders. They also work with people who have swallowing difficulties. Speech, language, and swallowing difficulties can result from a variety of causes including stroke, brain injury or deteriora­ tion, developmental delays or disorders, learning disabilities, cerebral palsy, cleft palate, voice pathology, mental retardation, hearing loss, or emotional problems. Problems can be congeni­ tal, developmental, or acquired. Speech-language pathologists use special instruments and qualitative and quantitative assess­ ment methods, including standardized tests, to analyze and di­ agnose the nature and extent of impairments. Speech-language pathologists develop an individualized plan of care, tailored to each patient’s needs. For individuals with little or no speech capability, speech-language pathologists may select augmentative or alternative communication methods, in­ cluding automated devices and sign language, and teach their use. They teach patients how to make sounds, improve their voices, or increase their oral or written language skills to com­ municate more effectively. They also teach individuals how to strengthen muscles or use compensatory strategies to swallow without choking or inhaling food or liquid. Speech-language pathologists help patients develop, or recover, reliable commu­ nication and swallowing skills so patients can fulfill their edu­ cational, vocational, and social roles. Speech-language pathologists keep records on the initial evaluation, progress, and discharge of clients. This helps pin­ point problems, tracks client progress, and justifies the cost of treatment when applying for reimbursement. They counsel in­ dividuals and their families concerning communication disor­ ders and how to cope with the stress and misunderstanding that often accompany them. They also work with family members to recognize and change behavior patterns that impede commu­ nication and treatment and show them communication-enhanc­ ing techniques to use at home. Most speech-language pathologists provide direct clinical services to individuals with communication or swallowing disorders. In medical facilities, they may perform their job in conjunction with physicians, social workers, psychologists, and other therapists. Speech-language pathologists in schools collaborate with teachers, special educators, interpreters, other school personnel, and parents to develop and implement in­ dividual or group programs, provide counseling, and support classroom activities. Some speech-language pathologists conduct research on how people communicate. Others design and develop equipment or techniques for diagnosing and treating speech problems. Work environment. Speech-language pathologists usually work at a desk or table in clean comfortable surroundings. In medical settings, they may work at the patient’s bedside and as­ sist in positioning the patient. In schools, they may work with students in an office or classroom. Some work in the client’s home. Although the work is not physically demanding, it requires attention to detail and intense concentration. The emotional needs of clients and their families may be demanding. Most full-time speech-language pathologists work 40 hours per week. Those who work on a contract basis may spend a substantial amount of time traveling between facilities.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  \11 .......  i  Speech-language pathologists tailor a plan of care for each pa­ tient.  Training, Other Qualifications, and Advancement A master’s degree is the most common level of education among speech-language pathologists. Licensure or certifica­ tion requirements also exist, but vary by State. Education and training. Most speech-language pathologist jobs require a master’s degree. In 2007, more than 230 colleges and universities offered graduate programs in speech-language pathology accredited by the Council on Academic Accredita­ tion in Audiology and Speech-Language Pathology. While graduation from an accredited program is not always required to become a speech-language pathologist, it may be helpful in obtaining a license or may be required to obtain a license in some States. Speech-language pathology courses cover anatomy, physiol­ ogy, and the development of the areas of the body involved in speech, language, and swallowing; the nature of disorders; prin­ ciples of acoustics; and psychological aspects of communica­ tion. Graduate students also learn to evaluate and treat speech, language, and swallowing disorders and receive supervised clinical training in communication disorders. Licensure and certification. In 2007, 47 States regulated speech-language pathologists through licensure or registra­ tion. A passing score on the national examination on speechlanguage pathology, offered through the Praxis Series of the Educational Testing Service, is required. Other usual require­ ments include 300 to 375 hours of supervised clinical experi­ ence and 9 months of postgraduate professional clinical experi­ ence. Forty-one States have continuing education requirements for licensure renewal. Medicaid, Medicare, and private health insurers generally require a practitioner to be licensed to qualify for reimbursement. Only 12 States require this same license to practice in the public schools. The other States issue a teaching license or certificate that typically requires a master’s degree from an ap­ proved college or university. Some States will grant a provi­ sional teaching license or certificate to applicants with a bach­ elor’s degree, but a master’s degree must be earned within 3 to 5 years. A few States grant a full teacher’s certificate or license to bachelor’s degree applicants.  Professional and Related Occupations 389  In some States, the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) offered by the Ameri­ can Speech-Language-Hearing Association meets some or all of the requirements for licensure. To earn a CCC, a person must have a graduate degree from an accredited university, 400 hours of supervised clinical experience, complete a 36-week postgraduate clinical fellowship, and pass the Praxis Series ex­ amination in speech-language pathology administered by the Educational Testing Service. Contact your State’s Licensing Board for details on your State’s requirements. Other qualifications. Speech-language pathologists should be able to effectively communicate diagnostic test results, diag­ noses, and proposed treatment in a manner easily understood by their patients and their families. They must be able to approach problems objectively and be supportive. Because a patient’s progress may be slow, patience, compassion, and good listening skills are necessary. Advancement. As speech-language pathologists gain clini­ cal experience and engage in continuing professional educa­ tion, many develop expertise with certain populations, such as preschoolers and adolescents, or disorders, such as aphasia and learning disabilities. Some may obtain board recognition in a specialty area, such as child language, fluency, or feeding and swallowing. Experienced clinicians may become mentors or supervisors of other therapists or be promoted to administrative positions.  Employment Speech-language pathologists held about 110,000 jobs in 2006. About half were employed in educational services, primarily in preschools and elementary and secondary schools. Others were employed in hospitals; offices of other health practitioners, in­ cluding speech-language pathologists; nursing care facilities; home health care services; individual and family services; out­ patient care centers; and child day care centers. A few speech-language pathologists are self-employed in pri­ vate practice. They contract to provide services in schools, of­ fices of physicians, hospitals, or nursing care facilities, or work as consultants to industry.  Job Outlook Average employment growth is projected. Job opportunities are expected to be excellent. Employment change. Employment of speech-language pa­ thologists is expected to grow 11 percent from 2006 to 2016, about as fast as the average for all occupations. As the members of the baby boom generation continue to age, the possibility of neurological disorders and associated speech, language, and swallowing impairments increases. Medical advances also are improving the survival rate of premature infants and trauma and  stroke victims, who then need assessment and sometimes treat­ ment. Employment in educational services will increase with the growth in elementary and secondary school enrollments, in­ cluding enrollment of special education students. Federal law guarantees special education and related services to all eligible children with disabilities. Greater awareness of the importance of early identification and diagnosis of speech and language disorders in young children will also increase employment. In health care facilities, restrictions on reimbursement for therapy services may limit the growth of speech-language pa­ thologist jobs in the near term. However, the long-run demand for therapists should continue to rise as growth in the number of individuals with disabilities or limited function spurs demand for therapy services. The number of speech-language pathologists in private prac­ tice will rise because of the increasing use of contract services by hospitals, schools, and nursing care facilities. Job prospects. The combination of growth in the occupation and an expected increase in retirements over the coming years should create excellent job opportunities for speech-language pathologists. Opportunities should be particularly favorable for those with the ability to speak a second language, such as Spanish. Job prospects also are expected to be especially favor­ able for those who are willing to relocate, particularly to areas experiencing difficulty in attracting and hiring speech-language pathologists.  Earnings Median annual earnings of wage-and-salary speech-language pathologists were $57,710 in May 2006. The middle 50 percent earned between $46,360 and $72,410. The lowest 10 percent earned less than $37,970, and the highest 10 percent earned more than $90,400. Median annual earnings in the industries employing the largest numbers of speech-language pathologists were: Nursing care facilities.........................................................$70,180 Offices of other health practitioners..................................... 63,240 General medical and surgical hospitals................................ 61,970 Elementary and secondary schools...................................... 53,110 Some employers may reimburse speech-language patholo­ gists for their required continuing education credits.  Related Occupations Speech-language pathologists specialize in the prevention, di­ agnosis, and treatment of speech and language problems. Work­ ers in related occupations include audiologists, occupational therapists, optometrists, physical therapists, psychologists, and recreational therapists. Speech-language pathologists in school  Projections data from the National Employment Matrix  soc  Occupational Title Speech-language pathologists..................................  Code  .................  29-1127  Employment,  2006 110,000  Projected employment,  2016 121,000  Change,  2006-2016  Number  12,000  Percent  11  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  390 Occupational Outlook Handbook  systems often work closely with special education teachers in assisting students with disabilities.  Sources of Additional Information State licensing boards can provide information on licensure requirements. State departments of education can supply in­ formation on certification requirements for those who wish to work in public schools. For information on careers in speech-language pathology, a description of the CCC-SLP credential, and a listing of accred­ ited graduate programs in speech-language pathology, contact: y American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, MD 20852. Internet: http://www.asha.org  Veterinarians (0*NET 29-1131.00) Significant Points  • • •  •  Veterinarians should have an affinity for animals and the ability to get along with their owners. Graduation from an accredited college of veterinary medicine and a State license are required. Competition for admission to veterinary school is keen; however, graduates should have excellent job opportunities. About 3 out of 4 veterinarians work in private prac­ tice.  Nature of the Work Veterinarians care for the health of pets, livestock, and ani­ mals in zoos, racetracks, and laboratories. Some veterinarians use their skills to protect humans against diseases carried by animals and conduct clinical research on human and animal health problems. Others work in basic research, broadening our knowledge of animals and medical science, and in applied research, developing new ways to use knowledge. Most veterinarians diagnose animal health problems; vacci­ nate against diseases, such as distemper and rabies; medicate animals suffering from infections or illnesses; treat and dress wounds; set fractures; perform surgery; and advise owners about animal feeding, behavior, and breeding. According to the American Medical Veterinary Association, more than 70 percent of veterinarians who work in private medical practices predominately, or exclusively, treat small ani­ mals. Small-animal practitioners usually care for companion animals, such as dogs and cats, but also treat birds, reptiles, rab­ bits, ferrets, and other animals that can be kept as pets. About one-fourth of all veterinarians work in mixed animal practices, where they see pigs, goats, cattle, sheep, and some wild animals in addition to companion animals. A small number of private-practice veterinarians work exclu­ sively with large animals, mostly horses or cattle; some also care for various kinds of food animals. These veterinarians  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  usually drive to farms or ranches to provide veterinary services for herds or individual animals. Much of this work involves preventive care to maintain the health of the animals. These veterinarians test for and vaccinate against diseases and consult with farm or ranch owners and managers regarding animal pro­ duction, feeding, and housing issues. They also treat and dress wounds, set fractures, and perform surgery, including cesarean sections on birthing animals. Other veterinarians care for zoo, aquarium, or laboratory animals. Veterinarians of all types eu­ thanize animals when necessary. Veterinarians who treat animals use medical equipment such as stethoscopes, surgical instruments, and diagnostic equip­ ment, including radiographic and ultrasound equipment. Vet­ erinarians working in research use a full range of sophisticated laboratory equipment. Veterinarians contribute to human as well as animal health. A number of veterinarians work with physicians and scientists as they research ways to prevent and treat various human health problems. For example, veterinarians contributed greatly in conquering malaria and yellow fever, solved the mystery of botulism, produced an anticoagulant used to treat some people with heart disease, and defined and developed surgical tech­ niques for humans, such as hip and knee joint replacements and limb and organ transplants. Today, some determine the effects of drug therapies, antibiotics, or new surgical techniques by testing them on animals. Some veterinarians are involved in food safety and inspec­ tion. Veterinarians who are livestock inspectors, for example, check animals for transmissible diseases, such as E. coli, ad­ vise owners on the treatment of their animals, and may quar­ antine animals. Veterinarians who are meat, poultry, or egg product inspectors examine slaughtering and processing plants, check live animals and carcasses for disease, and enforce gov­ ernment regulations regarding food purity and sanitation. More veterinarians are finding opportunities in food security as they ensure that the Nation has abundant and safe food supplies. Veterinarians involved in food security often work along the Nation’s borders as animal and plant health inspectors, where they examine imports and exports of animal products to prevent disease here and in foreign countries. Many of these workers are employed by the Department of Homeland Security or the Department of Agriculture’s Animal and Plant Health Inspec­ tion Service division. Work environment. Veterinarians in private or clinical practice often work long hours in a noisy indoor environment. Sometimes they have to deal with emotional or demanding pet owners. When working with animals that are frightened or in pain, veterinarians risk being bitten, kicked, or scratched. Veterinarians in large-animal practice spend time driving be­ tween their office and farms or ranches. They work outdoors in all kinds of weather and may have to treat animals or perform surgery, under unsanitary conditions. Veterinarians working in nonclinical areas, such as public health and research, have working conditions similar to those of other professionals in those lines of work. These veterinar­ ians enjoy clean, well-lit offices or laboratories and spend much of their time dealing with people rather than animals.  Professional and Related Occupations 391  Most veterinarians perform clinical work in private practices on small animals. Veterinarians often work long hours. Those in group prac­ tices may take turns being on call for evening, night, or week­ end work; solo practitioners may work extended and weekend hours, responding to emergencies or squeezing in unexpected appointments.  Training, Other Qualifications, and Advancement Veterinarians must obtain a Doctor of Veterinary Medicine de­ gree and a State license. There is keen competition for admis­ sion to veterinary school. Education and training. Prospective veterinarians must graduate with a Doctor of Veterinary Medicine (D.V.M. or V.M.D.) degree from a 4-year program at an accredited college of veterinary medicine. There are 28 colleges in 26 States that meet accreditation standards set by the Council on Education of the American Veterinary Medical Association (AVMA). The prerequisites for admission to veterinary programs vary. Many programs do not require a bachelor’s degree for entrance, but all require a significant number of credit hours—ranging from 45 to 90 semester hours—at the undergraduate level. However, most of the students admitted have completed an un­ dergraduate program and earned a bachelor’s degree. Appli­ cants without a degree face a difficult task gaining admittance. Preveterinary courses should emphasize the sciences. Veteri­ nary medical colleges typically require applicants to have taken classes in organic and inorganic chemistry, physics, biochemis­ try, general biology, animal biology, animal nutrition, genetics, vertebrate embryology, cellular biology, microbiology, zoolo­ gy, and systemic physiology. Some programs require calculus; some require only statistics, college algebra and trigonometry, or pre-calculus. Most veterinary medical colleges also require some courses in English or literature, other humanities, and the social sciences. Increasingly, courses in general business man­ agement and career development have become a standard part of the curriculum to teach new graduates how to effectively run a practice. In addition to satisfying preveterinary course requirements, applicants must submit test scores from the Graduate Record Examination (GRE), the Veterinary College Admission Test (VCAT), or the Medical College Admission Test (MCAT), de­ pending on the preference of the college to which they are ap­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  plying. Currently, 22 schools require the GRE, 4 require the VCAT, and 2 accept the MCAT. There is keen competition for admission to veterinary school. The number of accredited veterinary colleges has remained largely the same since 1983, but the number of applicants has risen significantly. Only about 1 in 3 applicants was accepted in 2005. New graduates with a Doctor of Veterinary Medicine degree may begin to practice veterinary medicine once they receive their license, but many new graduates choose to enter a 1-year intern­ ship. Interns receive a small salary but often find that their in­ ternship experience leads to better paying opportunities later, rel­ ative to those of other veterinarians. Veterinarians who then seek board certification also must complete a 3- to 4-year residency program that provides intensive training in one of the 20 AVMArecognized veterinary specialties including internal medicine, oncology, pathology, dentistry, nutrition, radiology, surgery, der­ matology, anesthesiology, neurology, cardiology, ophthalmol­ ogy, preventive medicine, and exotic small-animal medicine. Licensure. All States and the District of Columbia require that veterinarians be licensed before they can practice. The only exemptions are for veterinarians working for some Federal agencies and some State governments. Licensing is controlled by the States and is not strictly uniform, although all States require the successful completion of the D.V.M. degree—or equivalent education—and a passing grade on a national board examination, the North American Veterinary Licensing Exam. This 8-hour examination consists of 360 multiple-choice ques­ tions covering all aspects of veterinary medicine as well as vi­ sual materials designed to test diagnostic skills. The Educational Commission for Foreign Veterinary Gradu­ ates grants certification to individuals trained outside the United States who demonstrate that they meet specified requirements for English language and clinical proficiency. This certification fulfills the educational requirement for licensure in all States. Most States also require candidates to pass a State jurispru­ dence examination covering State laws and regulations. Some States do additional testing on clinical competency as well. There are few reciprocal agreements between States, veterinar­ ians who wish to practice in a different State usually must first pass that State’s examinations. Other qualifications. When deciding whom to admit, some veterinary medical colleges place heavy consideration on a can­ didate’s veterinary and animal experience. Formal experience, such as work with veterinarians or scientists in clinics, agribusi­ ness, research, or some area of health science, is particularly advantageous. Less formal experience, such as working with animals on a farm or ranch or at a stable or animal shelter, also can be helpful. Students must demonstrate ambition and an eagerness to work with animals. Prospective veterinarians must have good manual dexterity. They should have an affinity for animals and the ability to get along with their owners, especially pet owners, who usually have strong bonds with their pets. Veterinarians who intend to go into private practice should possess excellent communica­ tion and business skills, because they will need to manage their practice and employees successfully and to promote, market, and sell their services.  392 Occupational Outlook Handbook  Advancement. Most veterinarians begin as employees in established group practices. Despite the substantial financial investment in equipment, office space, and staff, many veteri­ narians with experience eventually set up their own practice or purchase an established one. Newly trained veterinarians can become U.S. Government meat and poultry inspectors, disease-control workers, animal welfare and safety workers, epidemiologists, research assis­ tants, or commissioned officers in the U.S. Public Health Ser­ vice or various branches of the U.S. Armed Forces. A State license may be required. Nearly all States have continuing education requirements for licensed veterinarians. Requirements differ by State and may involve attending a class or otherwise demonstrating knowledge of recent medical and veterinary advances.  Employment Veterinarians held about 62,000 jobs in 2006. According to the American Veterinary Medical Association, about 3 out of 4 veterinarians were employed in a solo or group practice. Most others were salaried employees of another veterinary practice. Data from the U.S. Bureau of Labor Statistics show that the Federal Government employed about 1,400 civilian veterinar­ ians, chiefly in the U.S. Departments of Agriculture, Health and Human Services, and, increasingly, Homeland Security. Other employers of veterinarians are State and local governments, col­ leges of veterinary medicine, medical schools, research labora­ tories, animal food companies, and pharmaceutical companies. A few veterinarians work for zoos, but most veterinarians car­ ing for zoo animals are private practitioners who contract with the zoos to provide services, usually on a part-time basis. In addition, many veterinarians hold veterinary faculty posi­ tions in colleges and universities and are classified as teachers. (See the statement on teachers—postsecondary elsewhere in the Handbook.) Job Outlook Employment is expected to increase much faster than average. Excellent job opportunities are expected. Employment change. Employment of veterinarians is ex­ pected to increase 35 percent over the 2006-16 decade, much faster than the average for all occupations. Veterinarians usu­ ally practice in animal hospitals or clinics and care primarily for companion animals. Recent trends indicate particularly strong interest in cats as pets. Faster growth of the cat population is expected to increase the demand for feline medicine and veteri­ nary services, while demand for veterinary care for dogs should continue to grow at a more modest pace. Many pet owners are relatively affluent and consider their pets a member of the family. These owners are becoming more aware of the availability of advanced care and are more willing  to pay for intensive veterinary care than owners in the past. Fur­ thermore, the number of pet owners purchasing pet insurance is rising, increasing the likelihood that considerable money will be spent on veterinary care. More pet owners also will take advantage of nontraditional veterinary services, such as cancer treatment and preventive dental care. Modem veterinary services have caught up to hu­ man medicine; certain procedures, such as hip replacement, kidney transplants, and blood transfusions, which were once only available for humans, are now available for animals. Continued support for public health and food and animal safety, national disease control programs, and biomedical re­ search on human health problems will contribute to the demand for veterinarians, although the number of positions in these ar­ eas is limited. Homeland security also may provide opportuni­ ties for veterinarians involved in efforts to maintain abundant food supplies and minimize animal diseases in the U.S. and in foreign countries. Job prospects. Excellent job opportunities are expected be­ cause there are only 28 accredited schools of veterinary medi­ cine in the United States, resulting in a limited number of grad­ uates—about 2,700—each year. However, applicants face keen competition for admission to veterinary school. New graduates continue to be attracted to companion-animal medicine because they prefer to deal with pets and to live and work near heavily populated areas, where most pet owners live. Employment opportunities are good in cities and suburbs, but even better in rural areas because fewer veterinarians compete to work there. Beginning veterinarians may take positions requiring evening or weekend work to accommodate the extended hours of opera­ tion that many practices are offering. Some veterinarians take salaried positions in retail stores offering veterinary services. Self-employed veterinarians usually have to work hard and long to build a sufficient client base. The number of jobs for large-animal veterinarians is likely to grow more slowly than jobs for companion-animal veterinar­ ians. Nevertheless, job prospects should be better for veterinar­ ians who specialize in farm animals because of lower earnings in the farm-animal specialty and because many veterinarians do not want to work in rural or isolated areas. Veterinarians with training in food safety and security, animal health and welfare, and public health and epidemiology should have the best opportunities for a career in the Federal Govern­ ment.  Earnings Median annual earnings of veterinarians were $71,990 in May 2006. The middle 50 percent earned between $56,450 and $94,880. The lowest 10 percent earned less than $43,530, and the highest 10 percent earned more than $133,150.  Projections data from the National Employment Matrix Projected Change, employment, 2006-2016 Code 2016 Number Percent Veterinarians............................................................ ............................. 29-1131 62,000 84,000 22,000 35 NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  lion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2006  Professional and Related Occupations 393  The average annual salary for veterinarians in the Federal Government was $84,335 in 2007. According to a survey by the American Veterinary Medical Association, average starting salaries of veterinary medical col­ lege graduates in 2006 varied by type of practice as follows: Large animals, exclusively.................................................. $61,029 Small animals, predominantly.............................................. 57,117 Small animals, exclusively.................................................... 56,241 Private clinical practice......................................................... 55,031 Large animals, predominantly............................................... 53,397 Mixed animals.......................................................................52,254 Equine (horses).....................................................................40,130  Related Occupations Veterinarians prevent, diagnose, and treat diseases, disorders, and injuries in animals. Those who do similar work for humans include chiropractors, dentists, optometrists, physicians and surgeons, and podiatrists. Veterinarians have extensive training in physical and life sciences, and some do scientific and medi­ cal research, as do biological scientists and medical scientists. Animal care and service workers and veterinary technologists and technicians also work extensively with animals. Like vet­ erinarians, they must have patience and feel comfortable with animals. However, the level of training required for these occu­ pations is substantially less than that needed by veterinarians.  Sources of Additional Information For additional information on careers in veterinary medicine, a list of U.S. schools and colleges of veterinary medicine, and ac­  creditation policies, send a letter-size, self-addressed, stamped envelope to: 'y American Veterinary Medical Association, 1931N.Meacham Rd., Suite 100, Schaumburg, IL 60173. Internet: http://www.avma.org For information on veterinary education, contact: y Association of American Veterinary Medical Colleges, 1101 Vermont Ave. NW., Suite 301, Washington, DC 20005. Internet: http://www.aavmc.org For information on scholarships, grants, and loans, contact the financial aid officer at the veterinary schools to which you wish to apply. For information on veterinarians working in zoos, see the Oc­ cupational Outlook Quarterly article “Wild jobs with wildlife,” online at: http://www.bls.gov/opub/ooq/2001/spring/art01.pdf. Information on obtaining a veterinary position with the Fed­ eral Government is available from the Office of Personnel Man­ agement through USAJOBS, the Federal Government’s official employment information system. This resource for locating and applying for job opportunities can be accessed through the Internet at http://www.usajobs.opm.gov or through an interac­ tive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not toll free, and charges may result. For advice on how to find and apply for Federal jobs, see the Occupational Outlook Quarterly article “How to get a job in the Federal Government,” online at: http://www.bls.gov/opub/ooq/2004/summer/art01.pdf  Health Technologists and Technicians Athletic Trainers (0*NET 29-9091.00)  Significant Points  •  Long hours, sometimes including nights and week­ ends, are common.  •  A bachelor’s degree is usually the minimum require­ ment, but many athletic trainers hold a master’s or doctoral degree.  •  Employment is projected to grow much faster than  average. • Job prospects should be good in the health care in­ dustry, but competition is expected for positions with sports teams. Nature of the Work Athletic trainers help prevent and treat injuries for people of all ages. Their clients include everyone from professional athletes  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  to industrial workers. Recognized by the American Medical Association as allied health professionals, athletic trainers spe­ cialize in the prevention, assessment, treatment, and rehabilita­ tion of musculoskeletal injuries. Athletic trainers often are one of the first heath care providers on the scene when injuries oc­ cur, and therefore they must be able to recognize, evaluate, and assess injuries and provide immediate care when needed. They also are heavily involved in the rehabilitation and recondition­ ing of injuries. Athletic trainers should not be confused with fit­ ness trainers or personal trainers, who are not health care work­ ers, but rather train people to become physically fit. (Fitness workers are discussed elsewhere in the Handbook.) Athletic trainers often help prevent injuries by advising on the proper use of equipment and applying protective or injurypreventive devices such as tape, bandages, and braces. Injury prevention also often includes educating people on what they should do to avoid putting themselves at risk for injuries. Athletic trainers work under the supervision of a licensed physician, and in cooperation with other health care providers. The level of medical supervision varies, depending upon the setting. Some athletic trainers meet with the team physician or consulting physician once or twice a week; others interact with a physician every day. The extent of the supervision ranges  394 Occupational Outlook Handbook  from discussing specific injuries and treatment options with a physician to performing evaluations and treatments as directed by a physician. Athletic trainers often have administrative responsibilities. These may include regular meetings with an athletic director or other administrative officer to deal with budgets, purchasing, policy implementation, and other business-related issues. Work environment. The work of athletic trainers requires frequent interaction with others. This includes consulting with physicians as well as frequent contact with athletes and patients to discuss and administer treatments, rehabilitation programs, injury-preventive practices, and other health-related issues. Many athletic trainers work indoors most of the time; others, especially those in some sports-related jobs, spend much of their time working outdoors. The job also might require stand­ ing for long periods, working with medical equipment or ma­ chinery, and being able to walk, run, kneel, crouch, stoop, or crawl. Travel may be required. Schedules vary by work setting. Athletic trainers in nons­ ports settings generally have an established schedule—usually about 40 to 50 hours per week—with nights and weekends off. Athletic trainers working in hospitals and clinics may spend part of their time working at other locations doing outreach. Most commonly, these outreach programs include conducting athletic training services and speaking at high schools, colleges, and commercial businesses. Athletic trainers in sports settings have schedules that are longer and more variable. These athletic trainers must be pres­ ent for team practices and games, which often are on evenings and weekends, and their schedules can change on short notice when games and practices have to be rescheduled. As a result, athletic trainers in sports settings may regularly work 6 or 7 days per week, including late hours. In high schools, athletic trainers who also teach may work 60 to 70 hours a week, or more. In National Collegiate Athletic Association Division I colleges and universities, athletic train­ ers generally work with one team; when that team’s sport is in season, working at least 50 to 60 hours a week is common. Athletic trainers in smaller colleges and universities often work with several teams and have teaching responsibilities. During  Ml___ i Athletic trainers apply protective devices such as tape, bandag­ es, and braces to help prevent injuries.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  the off-season, a 40-hour to 50-hour work week may be nor­ mal in most settings. Athletic trainers for professional sports teams generally work the most hours per week. During train­ ing camps, practices, and competitions, they may be required to work up to 12 hours a day. There is some stress involved with being an athletic trainer, as there is with most health-related occupations. Athletic trainers are responsible for their clients’ health, and sometimes have to make quick decisions that could affect the health or career of their clients. Athletics trainers also can be affected by the pres­ sure to win that is typical of competitive sports teams.  Training, Other Qualifications, and Advancement A bachelor’s degree is usually the minimum requirement to work as an athletic trainer, but many athletic trainers hold a master’s or doctoral degree. In 2006,46 States required athletic trainers to be licensed or hold some form of registration. Education and training. A bachelor’s degree from an ac­ credited college or university is required for almost all jobs as an athletic trainer. In 2006, there were more than 350 accredited programs nationwide. Students in these programs are educated both in the classroom and in clinical settings. Formal education includes many science and health-related courses, such as hu­ man anatomy, physiology, nutrition, and biomechanics. According to the National Athletic Trainers Association, 68 percent of athletic trainers have a master’s or doctoral degree. Athletic trainers may need a master’s or higher degree to be eligible for some positions, especially those in colleges and universities, and to increase their advancement opportunities. Because some positions in high schools involve teaching along with athletic trainer responsibilities, a teaching certificate or li­ cense could be required. Licensure and certification. In 2006, 46 States required athletic trainers to be licensed or registered; this requires cer­ tification from the Board of Certification, Inc. (BOC). For certification, athletic trainers need a bachelor’s degree from an accredited athletic training program. In addition, a successful candidate for BOC certification must pass a rigorous examina­ tion. To retain certification, credential holders must continue taking medical-related courses and adhere to the BOC stan­ dards of practice. In States where licensure is not required, certification is voluntary but may be helpful for those seeking jobs and advancement. Other qualifications. Because all athletic trainers deal di­ rectly with a variety of people, they need good social and com­ munication skills. They should be able to manage difficult situations and the stress associated with them, such as when disagreements arise with coaches, clients, or parents regarding suggested treatment. Athletic trainers also should be organized, be able to manage time wisely, be inquisitive, and have a strong desire to help people. Advancement. There are a number ways for athletic trainers to advance or move into related positions. Assistant athletic trainers may become head athletic trainers and, eventually, ath­ letic directors. Athletic trainers also might enter a physician group practice and assume a management role. Some athletic trainers move into sales and marketing positions, using their  Professional and Related Occupations 395  athletic trainer expertise to sell medical and athletic equip­ ment.  Employment Athletic trainers held about 17,000 jobs in 2006 and are found in every part of the country. Most athletic trainer jobs are relat­ ed to sports, although an increasing number also work in non­ sports settings. About 34 percent of athletic trainers worked in health care, including jobs in hospitals, offices of physicians, and offices of other health practitioners. Another 34 percent were found in public and private educational services, primar­ ily in colleges, universities, and high schools. About 20 percent worked in fitness and recreational sports centers.  Job Outlook Employment is projected to grow much faster than average. Job prospects should be good in the health care industry, but competition is expected for positions with sports teams. Employment change. Employment of athletic trainers is ex­ pected to grow 24 percent from 2006 to 2016, much faster than the average for all occupations. Job growth will be concen­ trated in the health care industry, including hospitals and offices of health practitioners. Fitness and recreation sports centers also will provide many new jobs, as these establishments be­ come more common and continue to need athletic trainers to care for their clients. Growth in positions with sports teams will be somewhat slower, however, as most professional sports clubs and colleges and universities already have complete ath­ letic training staffs. The demand for health care should grow dramatically as the result of advances in technology, increasing emphasis on pre­ ventive care, and an increasing number of older people who are more likely to need medical care. Athletic trainers will benefit from this expansion because they provide a cost-effective way to increase the number of health professionals in an office or other setting. Also, employers increasingly emphasize sports medicine, in which an immediate responder, such as an athletic trainer, is on site to help prevent injuries and provide immediate treatment for any injuries that do occur. Increased licensure requirements and regulation has led to a greater acceptance of athletic trainers as qualified health care providers. As a result, third-party reim­ bursement is expected to continue to grow for athletic training services. As athletic trainers continue to expand their services, more employers are expected to use these workers to realize the cost savings of providing health care in-house. There should be strong demand for athletic trainers in settings outside the sports world, especially those that focus on health care. Continuing efforts to have an athletic trainer in every high school reflect concern for the health of student-athletes as well as efforts to  provide more funding for schools, and may lead to growth in the number of athletic trainers employed in high schools. Job prospects. Job prospects should be good for athletic trainers in the health care industry. Those looking for a position with a sports team, however, may face competition. Turnover among athletic trainers is limited. When working with sports teams, many athletic trainers prefer to continue to work with the same coaches, administrators, and players when a good work­ ing relationship already exists. Because of relatively low turnover, the settings with the best job prospects will be the ones that are expected to have the most job growth, primarily positions in the heath care industry and fitness and recreational sports centers. Additional job oppor­ tunities are expected in elementary and secondary schools as more positions are created. Some of these positions also will require teaching responsibilities. There will be more compe­ tition for positions within colleges and universities as well as professional sports clubs. The occupation is expected to continue to change over the next decade, including more administrative responsibilities, adapting to new technology, and working with larger popula­ tions, and job seekers must be able to adapt to these changes.  Earnings Most athletic trainers work in full-time positions, and typically receive benefits. The salary of an athletic trainer depends on ex­ perience and job responsibilities, and varies by job setting. Me­ dian annual earnings of wage-and-salary athletic trainers were $36,560 in May 2006. The middle 50 percent earned between $28,920 and $45,690. The lowest 10 percent earned less than $21,940, while the top 10 percent earned more than $57,580. Many employers pay for some of the continuing education required for athletic trainers to remain certified, although the amount covered varies from employer to employer.  Related Occupations The American Medical Association recognizes athletic trainers as allied health professionals. They work under the direction of physicians and provide immediate and ongoing care for inju­ ries. Also, they provide education and advice on the prevention of injuries and work closely with injured patients to rehabilitate and recondition injuries, often through therapy. Other occu­ pations that may require similar responsibilities include emer­ gency medical technicians and paramedics, physical therapists, physician assistants, registered nurses, licensed practical and li­ censed vocational nurses, recreational therapists, occupational therapists, respiratory therapists, chiropractors, podiatrists, and massage therapists. There also are opportunities for athletic trainers to join the military, although they would not be classified as an athletic trainer. Enlisted soldiers and officers who are athletic trainers  Projections data from the National Employment Matrix Occupational Title Athletic trainers.  soc  Code  29-9091  Employment,  2006 17,000  Projected employment,  2016 21,000  Change,  2006-2016 Number  4,200  Percent  24  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  396 Occupational Outlook Handbook  are usually placed in another program, such as health educa­ tor or training specialist, in which their skills are useful. (For information on military careers, see the Handbook statement on job opportunities in the Armed Forces.) Sources of Additional Information For further information on careers in athletic training, contact: y National Athletic Trainers Association, 2952 Stemmons Freeway, Dallas, TX 75247. Internet: http://www.nata.org For further information on certification, contact: y Board of Certification, Inc., 4223 South 143rd Circle, Omaha, NE 68137. Internet: http://www.bocatc.org  Cardiovascular Technologists and Technicians (0*NET 29-2031.00) Significant Points  •  • •  Employment is expected to grow much faster than average; technologists and technicians trained to per­ form certain procedures will be in particular demand. About 3 out of 4 jobs are in hospitals. The vast majority of workers complete a 2-year junior or community college program.  Nature of the Work Cardiovascular technologists and technicians assist physicians in diagnosing and treating cardiac (heart) and peripheral vascu­ lar (blood vessel) ailments. Cardiovascular technologists and technicians schedule ap­ pointments perform ultrasound or cardiovascular procedures, review doctors’ interpretations and patient files, and monitor patients’ heart rates. They also operate and care for testing equipment, explain test procedures, and compare findings to a standard to identify problems. Other day-to-day activities vary significantly between specialties. Cardiovascular technologists may specialize in any of three areas of practice: invasive cardiology, echocardiography, or vascular technology. Invasive cardiology. Cardiovascular technologists specializ­ ing in invasive procedures are called cardiology technologists. They assist physicians with cardiac catheterization procedures in which a small tube, or catheter, is threaded through a patient’s artery from a spot on the patient’s groin to the heart. The proce­ dure can determine whether a blockage exists in the blood ves­ sels that supply the heart muscle. The procedure also can help to diagnose other problems. Part of the procedure may involve balloon angioplasty, which can be used to treat blockages of blood vessels or heart valves without the need for heart surgery. Cardiology technologists assist physicians as they insert a cath­ eter with a balloon on the end to the point of the obstruction. Another procedure using the catheter is electrophysiology test, which help locate the specific areas of heart tissue that give rise to the abnormal electrical impulses that cause arrhythmias.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Technologists prepare patients for cardiac catheterization by first positioning them on an examining table and then shaving, cleaning, and administering anesthesia to the top of their leg near the groin. During the procedures, they monitor patients’ blood pressure and heart rate with EKG equipment and notify the physician if something appears to be wrong. Technologists also may prepare and monitor patients during open-heart sur­ gery and during the insertion of pacemakers and stents that open up blockages in arteries to the heart and major blood vessels. Noninvasive technology. Technologists who specialize in vascular technology or echocardiography perform noninvasive tests using. Tests are called “noninvasive” if they do not require the insertion of probes or other instruments into the patient’s body. For example, procedures such as Doppler ultrasound transmit high-frequency sound waves into areas of the patient’s body and then processes reflected echoes of the sound waves to form an image. Technologists view the ultrasound image on a screen and may record the image on videotape or photograph it for interpretation and diagnosis by a physician. As the technol­ ogist uses the instrument to perform scans and record images, technologists check the image on the screen for subtle differ­ ences between healthy and diseased areas, decide which im­ ages to include in the report to the physician, and judge whether the images are satisfactory for diagnostic purposes. They also explain the procedure to patients, record any additional medi­ cal history the patient relates, select appropriate equipment set­ tings, and change the patient’s position as necessary. (See the statement on diagnostic medical sonographers elsewhere in the Handbook to learn more about other sonographers.) Vascular technology. Technicians who assist physicians in the diagnosis of disorders affecting the circulation are known as vascular technologists or vascular sonographers. Vascular technologists complete patients’ medical history, evaluate puls­ es and assess blood flow in arteries and veins by listening to the vascular flow sounds for abnormalities, and assure the appropri­ ate vascular test has been ordered. Then they perform a non­ invasive procedure using ultrasound instruments to record vas­ cular information such as vascular blood flow, blood pressure, oxygen saturation, cerebral circulation, peripheral circulation, and abdominal circulation. Many of these tests are performed during or immediately after surgery. Vascular technologists then provide a summary of findings to the physician to aid in patient diagnosis and management. Echocardiography. This area of practice includes giving electrocardiograms (EKGs) and sonograms of the heart. Car­ diovascular technicians who specialize in EKGs, stress testing, and those who perform Holter monitor procedures are known as cardiographic or electrocardiograph (or EKG) technicians. To take a basic EKG, which traces electrical impulses trans­ mitted by the heart, technicians attach electrodes to the patient’s chest, arms, and legs, and then manipulate switches on an EKG machine to obtain a reading. An EKG is printed out for inter­ pretation by the physician. This test is done before most kinds of surgery or as part of a routine physical examination, espe­ cially on persons who have reached middle age or who have a history of cardiovascular problems. EKG technicians with advanced training perform Holter monitor and stress testing. For Holter monitoring, technicians  Professional and Related Occupations 397  place electrodes on the patient’s chest and attach a portable EKG monitor to the patient’s belt. Following 24 or more hours of normal activity by the patient, the technician removes a tape from the monitor and places it in a scanner. After checking the quality of the recorded impulses on an electronic screen, the technician usually prints the information from the tape for anal­ ysis by a physician. Physicians use the output from the scanner to diagnose heart ailments, such as heart rhythm abnormalities or problems with pacemakers. For a treadmill stress test, EKG technicians document the patient’s medical history, explain the procedure, connect the pa­ tient to an EKG monitor, and obtain a baseline reading and rest­ ing blood pressure. Next, they monitor the heart’s performance while the patient is walking on a treadmill, gradually increasing the treadmill’s speed to observe the effect of increased exertion. Like vascular technologists and cardiac sonographers, cardiographic technicians who perform EKG, Holter monitor, and stress tests are known as “noninvasive” technicians. Technologists who use ultrasound to examine the heart chambers, valves, and vessels are referred to as cardiac sonog­ raphers, or echocardiographers. They use ultrasound instru­ mentation to create images called echocardiograms. An echo­ cardiogram may be performed while the patient is either resting or physically active. Technologists may administer medica­ tion to physically active patients to assess their heart function. Cardiac sonographers also may assist physicians who perform transesophageal echocardiography, which involves placing a tube in the patient’s esophagus to obtain ultrasound images. Work environment. Cardiovascular technologists and tech­ nicians spend a lot of time walking and standing, Heavy lifting may be involved to move equipment or transfer patients. These workers wear heavy protective aprons while conducting some procedures. Those who work in catheterization laboratories may face stressful working conditions because they are in close  011  / \ JM  I .... ,......if A*  About 3 out of 4 cardiovascular technologists and technicians work in hospitals.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  contact with patients with serious heart ailments. For example, some patients may encounter complications that have life-ordeath implications. Some cardiovascular technologists and technicians may have the potential for radiation exposure, which is kept to a mini­ mum by strict adherence to radiation safety guidelines. In ad­ dition, those who use sonography can be at an increased risk for musculoskeletal disorders such as carpel tunnel syndrome, neck and back strain, and eye strain. However, greater use of ergo­ nomic equipment and an increasing awareness will continue to minimize such risks. Technologists and technicians generally work a 5-day, 40hour week that may include weekends. Those in catheterization laboratories tend to work longer hours and may work evenings. They also may be on call during the night and on weekends. Training, Other Qualifications, and Advancement The most common level of education completed by cardiovas­ cular technologists and technicians is an associate degree. Cer­ tification, although not required in all cases, is available. Education and training. Although a few cardiovascular technologists, vascular technologists, and cardiac sonographers are currently trained on the job, most receive training in 2- to 4-year programs. The majority of technologists complete a 2year junior or community college program, but 4-year programs are increasingly available. The first year is dedicated to core courses and is followed by a year of specialized instruction in either invasive, noninvasive cardiovascular, or noninvasive vas­ cular technology. Those who are qualified in an allied health profession need to complete only the year of specialized in­ struction. The Joint Review Committee on Education in Cardiovascular Technology reviews education programs seeking accreditation. The Commission on Accreditation of Allied Health Profession­ als (CAAHEP) accredits these education programs; as of 2006, there were 31 programs accredited in cardiovascular technology in the United States. Similarly, those who want to study echo­ cardiography or vascular sonography may also attend CAA­ HEP accredited programs in diagnostic medical sonography. In 2006, there were 147 diagnostic medical sonography programs accredited by CAAHEP. Those who attend these accredited programs are eligible to obtain professional certification. Unlike most other cardiovascular technologists and techni­ cians, most EKG technicians are trained on the job by an EKG supervisor or a cardiologist. On-the-job training usually lasts about 8 to 16 weeks. Most employers prefer to train people al­ ready in the health care field—nursing aides, for example. Some EKG technicians are students enrolled in 2-year programs to become technologists, working part time to gain experience and make contact with employers. One-year certification programs exist for basic EKGs, Holter monitoring, and stress testing. Licensure and certification. Some States require workers in this occupation to be licensed. For information on a particu­ lar State, contact that State’s medical board. Certification is available from two organizations: Cardiovascular Credentialing International (CCI) and the American Registry of Diagnostic Medical Sonographers (ARDMS). The CCI offers four certi­ fications—Certified Cardiographic Technician (CCT), Regis­  398 Occupational Outlook Handbook  tered Cardiac Sonographer (RCS), Registered Vascular Special­ ist (RVS), and Registered Cardiovascular Invasive Specialist (RCIS). The ARDMS offers Registered Diagnostic Cardiac Sonographer (RDCS) and Registered Vascular Technologist (RVT) credentials. Some States require certification as part of licensure. In other States, certification is not required but many employers prefer it. Other qualifications. Cardiovascular technologists and tech­ nicians must be reliable, have mechanical aptitude, and be able to follow detailed instructions. A pleasant, relaxed manner for putting patients at ease is an asset. They must be articulate as they must communicate technically with physicians and also explain procedures simply to patients. Advancement. Technologists and technicians can advance to higher levels of the profession as many institutions structure the occupation with multiple levels, each having an increasing amount of responsibility. Technologists and technicians also can advance into supervisory or management positions. Other common possibilities include working in an educational setting or conducting laboratory work.  Employment Cardiovascular technologists and technicians held about 45,000 jobs in 2006. About 3 out of 4 jobs were in hospitals (public and private), primarily in cardiology departments. The remain­ ing jobs were mostly in offices of physicians, including cardi­ ologists, or in medical and diagnostic laboratories, including diagnostic imaging centers.  procedures. Individuals trained in Holter monitoring and stress testing are expected to have more favorable job prospects than those who can perform only a basic EKG. Medicaid has relaxed some of the rules governing reimburse­ ment for vascular exams, which is resulting in vascular studies becoming a more routine practice. As a result of increased use of these procedures, individuals with training in vascular stud­ ies should have more favorable employment opportunities. Job prospects. Some additional job openings for cardiovas­ cular technologists and technicians will arise from replacement needs as individuals transfer to other jobs or leave the labor force. Although growing awareness of musculoskeletal disor­ ders has made prevention easier, some cardiovascular technolo­ gists and technicians have been forced to leave the occupation early because of this disorder. It is not uncommon for cardiovascular technologists and tech­ nicians to move between the specialties within the occupation by obtaining certification in more than one specialty.  Earnings Median annual earnings of cardiovascular technologists and technicians were $42,300 in May 2006. The middle 50 percent earned between $29,900 and $55,670. The lowest 10 percent earned less than $23,670, and the highest 10 percent earned more than $67,410. Median annual earnings of cardiovascular technologists and technicians in 2006 were $41,960 in offices of physicians and $41,950 in general medical and surgical hos­ pitals.  Job Outlook  Related Occupations  Employment is expected to grow much faster than average; technologists and technicians trained to perform certain proce­ dures will be in particular demand. Employment change. Employment of cardiovascular tech­ nologists and technicians is expected to increase by 26 percent through the year 2016, much faster than the average for all oc­ cupations. Growth will occur as the population ages, because older people have a higher incidence of heart disease and other complications of the heart and vascular system. Procedures such as ultrasound are being performed more often as a replace­ ment for more expensive and more invasive procedures. Due to advances in medicine and greater public awareness, signs of vascular disease can be detected earlier, creating demand for cardiovascular technologists and technicians to perform various procedures. Employment of vascular technologists and echocardiographers will grow as advances in vascular technology and so­ nography reduce the need for more costly and invasive proce­ dures. Electrophysiology is also becoming a rapidly growing specialty. However, fewer EKG technicians will be needed, as hospitals train nursing aides and others to perform basic EKG  Cardiovascular technologists and technicians operate sophisti­ cated equipment that helps physicians and other health practi­ tioners to diagnose and treat patients. So do diagnostic medical sonographers, nuclear medicine technologists, radiation thera­ pists, radiologic technologists and technicians, and respiratory therapists.  Sources of Additional Information For general information about a career in cardiovascular tech­ nology, contact: y Alliance of Cardiovascular Professionals, Thalia Landing Offices, Bldg. 2, 4356 Bonney Rd., Suite 103, Virginia Beach, VA 23452-1200. Internet: http://www.acp-online.org For a list of accredited programs in cardiovascular technol­ ogy, contact: y Committee on Accreditation for Allied Health Education Programs, 1361 Park St, Clearwater, FL 33756. Internet: http://www.caahep.org V Society for Vascular Ultrasound, 4601 Presidents Dr., Suite 260, Lanham, MD 20706-4381. Internet: http://www.svunet.org  Projections data from the National Employment Matrix Change, Projected 2006-2016 employment, Code 2016 Number Percent 29-2031 45,000 57,000 12,000 26 Cardiovascular technologists and technicians..................... .............. NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  Occupational Title  lion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2006  Professional and Related Occupations 399  For information on echocardiography, contact:  y American Society of Echocardiography, 1500 Sunday Dr., Suite 102, Raleigh, NC 27607. Internet: http://www.asecho.org For information regarding registration and certification, con­ tact: V Cardiovascular Credentialing International, 1500 Sunday Dr., Suite 102, Raleigh, NC 27607. Internet: http://www.cci-onIine.org y American Registry of Diagnostic Medical Sonographers, 51 Monroe St., Plaza East ONE., Rockville, MD 20850-2400. Internet: http://www.ardms.org  Clinical Laboratory Technologists and Technicians (0*NET 29-2011.00, 29-2012.00)  Significant Points  •  Faster than average employment growth and excellent job opportunities are expected.  •  Clinical laboratory technologists usually have a bach­ elor’s degree with a major in medical technology or in one of the life sciences; clinical laboratory techni­ cians generally need either an associate degree or a certificate.  •  Most jobs will continue to be in hospitals, but em­ ployment will grow faster in other settings.  Nature of the Work Clinical laboratory testing plays a crucial role in the detection, diagnosis, and treatment of disease. Clinical laboratory tech­ nologists—also referred to as clinical laboratory scientists or medical technologists—and clinical laboratory technicians, also known as medical technicians or medical laboratory tech­ nicians, perform most of these tests. Clinical laboratory personnel examine and analyze body fluids, and cells. They look for bacteria, parasites, and other microorganisms; analyze the chemical content of fluids; match blood for transfusions; and test for drug levels in the blood that show how a patient is responding to treatment. Technologists also prepare specimens for examination, count cells, and look for abnormal cells in blood and body fluids. They use micro­ scopes, cell counters, and other sophisticated laboratory equip­ ment. They also use automated equipment and computerized instruments capable of performing a number of tests simultane­ ously. After testing and examining a specimen, they analyze the results and relay them to physicians. With increasing automation and the use of computer tech­ nology, the work of technologists and technicians has become less hands-on and more analytical. The complexity of tests performed, the level of judgment needed, and the amount of responsibility workers assume depend largely on the amount of education and experience they have. Clinical laboratory tech­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  nologists usually do more complex tasks than clinical labora­ tory technicians do. Clinical laboratory technologists perform complex chemi­ cal, biological, hematological, immunologic, microscopic, and bacteriological tests. Technologists microscopically examine blood and other body fluids. They make cultures of body flu­ id and tissue samples, to determine the presence of bacteria, fungi, parasites, or other microorganisms. Technologists ana­ lyze samples for chemical content or a chemical reaction and determine concentrations of compounds such as blood glucose and cholesterol levels. They also type and cross match blood samples for transfusions. Clinical laboratory technologists evaluate test results, devel­ op and modify procedures, and establish and monitor programs, to ensure the accuracy of tests. Some technologists supervise clinical laboratory technicians. Technologists in small laboratories perform many types of tests, whereas those in large laboratories generally specialize. Clinical chemistry technologists, for example, prepare speci­ mens and analyze the chemical and hormonal contents of body fluids. Microbiology technologists examine and identify bac­ teria and other microorganisms. Blood bank technologists, or immunohematology technologists, collect, type, and prepare blood and its components for transfusions. Immunology tech­ nologists examine elements of the human immune system and its response to foreign bodies. Cytotechnologists prepare slides of body cells and examine these cells microscopically for abnor­ malities that may signal the beginning of a cancerous growth. Molecular biology technologists perform complex protein and nucleic acid testing on cell samples. Clinical laboratory technicians perform less complex tests and laboratory procedures than technologists do. Technicians may prepare specimens and operate automated analyzers, for example, or they may perform manual tests in accordance with detailed instructions. They usually work under the supervision of medical and clinical laboratory technologists or laboratory managers. Like technologists, clinical laboratory technicians may work in several areas of the clinical laboratory or special­ ize in just one. Phlebotomists collect blood samples, for ex­ ample, and histotechnicians cut and stain tissue specimens for microscopic examination by pathologists. Work environment. Clinical laboratory personnel are trained to work with infectious specimens. When proper methods of infection control and sterilization are followed, few hazards ex­ ist. Protective masks, gloves, and goggles often are necessary to ensure the safety of laboratory personnel. Working conditions vary with the size and type of employ­ ment setting. Laboratories usually are well lighted and clean; however, specimens, solutions, and reagents used in the labora­ tory sometimes produce fumes. Laboratory workers may spend a great deal of time on their feet. Hours of clinical laboratory technologists and technicians vary with the size and type of employment setting. In large hos­ pitals or in independent laboratories that operate continuously, personnel usually work the day, evening, or night shift and may work weekends and holidays. Laboratory personnel in small facilities may work on rotating shifts, rather than on a regular  400 Occupational Outlook Handbook  4.**.  »• =  Clinical laboratory personnel look for bacteria, parasites, and other microorganisms; analyze the chemical content offluids; match blood for transfusions; and test for drug levels in the blood that show how a patient is responding to treatment. shift. In some facilities, laboratory personnel are on call several nights a week or on weekends, in case of an emergency. Training, Other Qualifications, and Advancement Clinical laboratory technologist generally require a bachelor’s degree in medical technology or in one of the life sciences; clinical laboratory technicians usually need an associate degree or a certificate. Education and training. The usual requirement for an entrylevel position as a clinical laboratory technologist is a bache­ lor’s degree with a major in medical technology or one of the life sciences; however, it is possible to qualify for some jobs with a combination of education and on-the-job and specialized training. Universities and hospitals offer medical technology programs. Bachelor’s degree programs in medical technology include courses in chemistry, biological sciences, microbiology, math­ ematics, and statistics, as well as specialized courses devoted to knowledge and skills used in the clinical laboratory. Many pro­ grams also offer or require courses in management, business, and computer applications. The Clinical Laboratory Improve­ ment Act requires technologists who perform highly complex tests to have at least an associate degree.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Medical and clinical laboratory technicians generally have either an associate degree from a community or junior college or a certificate from a hospital, a vocational or technical school, or the Armed Forces. A few technicians learn their skills on the job. The National Accrediting Agency for Clinical Laboratory Sci­ ences (NAACLS) fully accredits about 470 programs for medi­ cal and clinical laboratory technologists, medical and clinical laboratory technicians, histotechnologists and histotechnicians, cytogenetic technologists, and diagnostic molecular scientists. NAACLS also approves about 60 programs in phlebotomy and clinical assisting. Other nationally recognized agencies that ac­ credit specific areas for clinical laboratory workers include the Commission on Accreditation of Allied Health Education Pro­ grams and the Accrediting Bureau of Health Education Schools. Licensure. Some States require laboratory personnel to be li­ censed or registered. Licensure of technologists often requires a bachelor’s degree and the passing of an exam, but require­ ments vary by State and specialty. Information on licensure is available from State departments of health or boards of oc­ cupational licensing. Certification and other qualifications. Many employers pre­ fer applicants who are certified by a recognized professional as­ sociation. Associations offering certification include the Board of Registry of the American Society for Clinical Pathology, the American Medical Technologists, the National Credentialing Agency for Laboratory Personnel, and the Board of Registry of the American Association of Bioanalysts. These agencies have different requirements for certification and different organiza­ tional sponsors. In addition to certification, employers seek clinical labora­ tory personnel with good analytical judgment and the ability to work under pressure. Technologists in particular are expected to be good at problem solving. Close attention to detail is also essential for laboratory personnel because small differences or changes in test substances or numerical readouts can be cru­ cial to a diagnosis. Manual dexterity and normal color vision are highly desirable, and with the widespread use of automated laboratory equipment, computer skills are important. Advancement. Technicians can advance and become tech­ nologists through additional education and experience. Tech­ nologists may advance to supervisory positions in laboratory work or may become chief medical or clinical laboratory tech­ nologists or laboratory managers in hospitals. Manufacturers of home diagnostic testing kits and laboratory equipment and supplies also seek experienced technologists to work in product development, marketing, and sales. Professional certification and a graduate degree in medical technology, one of the biological sciences, chemistry, manage­ ment, or education usually speeds advancement. A doctorate usually is needed to become a laboratory director. Federal reg­ ulation requires directors of moderately complex laboratories to have either a master’s degree or a bachelor’s degree, combined with the appropriate amount of training and experience. Employment Clinical laboratory technologists and technicians held about 319,000 jobs in 2006. More than half of jobs were in hospitals.  Professional and Related Occupations 401  Most of the remaining jobs were in offices of physicians and in medical and diagnostic laboratories. A small proportion was in educational services and in all other ambulatory health care services.  Job Outlook Rapid job growth and excellent job opportunities are expected. Most jobs will continue to be in hospitals, but employment will grow faster in other settings. Employment change. Employment of clinical laboratory workers is expected to grow 14 percent between 2006 and 2016, faster than the average for all occupations. The volume of labo­ ratory tests continues to increase with both population growth and the development of new types of tests. Technological advances will continue to have opposing ef­ fects on employment. On the one hand, new, increasingly pow­ erful diagnostic tests will encourage additional testing and spur employment. On the other, research and development efforts targeted at simplifying routine testing procedures may enhance the ability of nonlaboratory personnel—physicians and patients in particular—to perform tests now conducted in laboratories. Although hospitals are expected to continue to be the major employer of clinical laboratory workers, employment is expect­ ed to grow faster in medical and diagnostic laboratories, offices of physicians, and all other ambulatory health care services. Job prospects. Job opportunities are expected to be excellent because the number of job openings is expected to continue to exceed the number of job seekers. Although significant, job growth will not be the only source of opportunities. As in most occupations, many additional openings will result from the need to replace workers who transfer to other occupations, retire, or stop working for some other reason.  Earnings Median annual wage-and-salary earnings of medical and clini­ cal laboratory technologists were $49,700 in May 2006. The middle 50 percent earned between $41,680 and $58,560. The lowest 10 percent earned less than $34,660, and the highest 10 percent earned more than $69,260. Median annual earnings in the industries employing the largest numbers of medical and clinical laboratory technologists were: Federal Government............................................................ $57,360 Medical and diagnostic laboratories..................................... 50,740 General medical and surgical hospitals.................................49,930 Offices of physicians............................................................. 45,420 Colleges, universities, and professional schools...................45,080  Median annual wage-and-salary earnings of medical and clinical laboratory technicians were $32,840 in May 2006. The middle 50 percent earned between $26,430 and $41,020. The lowest 10 percent earned less than $21,830, and the highest 10 percent earned more than $50,250. Median annual earnings in the industries employing the largest numbers of medical and clinical laboratory technicians were: General medical and surgical hospitals.............................. $34,200 Colleges, universities, and professional schools.................. 33,440 Offices of physicians.............................................................31,330 Medical and diagnostic laboratories.................................... 30,240 Other ambulatory health care services................................. 29,560 According to the American Society for Clinical Pathology, median hourly wages of staff clinical laboratory technologists and technicians in 2005 in various specialties and laboratory types were: Physician Private Specialty Hospital office clinic laboratory Cytotechnoligist..................... .. $26.39 $31.64 $25.69 Histotechnologist................... .. 21.50 21.63 23 29 Medical technologist.............. .. 21.77 20.00 20.00 Histotechnician...................... .. 18.50 20.86 18.27 Medical laboratory technician... .. 17.41 16.94 16.63 Phlebotomist.......................... .. 11.70 12.15 11.25  Related Occupations Clinical laboratory technologists and technicians analyze body fluids, tissue, and other substances, using a variety of tests. Similar or related procedures are performed by chemists and materials scientists, science technicians, and veterinary tech­ nologists and technicians.  Sources of Additional Information For a list of accredited and approved educational programs for clinical laboratory personnel, contact: y National Accrediting Agency for Clinical Laboratory Sciences, 8410 W. Bryn Mawr Ave., Suite 670, Chicago, IL 60631. Internet: http://www.naacls.org Information on certification is available from: y American Association of Bioanalysts, Board of Registry, 906 Olive St., Suite 1200, St.Louis, MO 63101. Internet: http://www.aab.org y American Medical Technologists, 10700 Higgins Rd„ Suite 150, Rosemont, IL 60018. Internet: http://www.amtl.com > American Society for Clinical Pathology, 33 West Monroe Street, Suite 1600, Chicago, IL 60603. Internet: http://www.ascp.org  Projections data from the National Employment Matrix Occupational Title Clinical laboratory technologists and technicians. Medical and clinical laboratory technologists .. Medical and clinical laboratory technicians....  soc Code 29-2010 29-2011 29-2012  Employment, 2006 319,000 167,000 151,000  Projected employment, 2016 362,000 188,000 174,000  Change, 2006-2016 Number Percent 43,000 14 21,000 12 23,000 15  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  402 Occupational Outlook Handbook  y National Credentialing Agency for Laboratory Personnel, P.O. Box 15945, Lenexa, KS 66285. Internet: http://www.nca-info.org Additional career information is available from: y American Association of Blood Banks, 8101 Glenbrook Rd., Bethesda, MD 20814. Internet: http://www.aabb.org y American Society for Clinical Laboratory Science, 6701 Democracy Blvd., Suite 300, Bethesda, MD 20817. Internet: http://www.ascls.org y American Society for Cytopathology, 400 West 9th St., Suite 201, Wilmington, DE 19801. Internet: http://www.cytopathology.org y Clinical Laboratory Management Association, 989 Old Eagle School Rd., Suite 815, WayNE., PA 19087. Internet: http://www.clma.org  Dental Hygienists (0*NET 29-2021.00) Significant Points  •  A degree from an accredited dental hygiene school and a State license are required for this job.  •  Dental hygienists rank among the fastest growing oc­ cupations.  •  Job prospects are expected to remain excellent.  •  More than half work part time, and flexible schedul­ ing is a distinctive feature of this job.  Nature of the Work Dental hygienists remove soft and hard deposits from teeth, teach patients how to practice good oral hygiene, and provide other preventive dental care. They examine patients’ teeth and gums, recording the presence of diseases or abnormalities. Dental hygienists use an assortment of different tools to com­ plete their tasks. Hand and rotary instruments and ultrasonic devices are used to clean and polish teeth, including removing calculus, stains, and plaque. Hygienists use x-ray machines to take dental pictures, and sometimes develop the film. They may use models of teeth to explain oral hygiene, perform root planning as a periodontal therapy, or apply cavity-preventa­ tive agents such as fluorides and pit and fissure sealants. In some States, hygienists are allowed to administer anesthetics, while in others they administer local anesthetics using syringes. Some States also allow hygienists to place and carve filling ma­ terials, temporary fillings, and periodontal dressings; remove sutures; and smooth and polish metal restorations. Dental hygienists also help patients develop and maintain good oral health. For example, they may explain the relation­ ship between diet and oral health or inform patients how to select toothbrushes and show them how to brush and floss their teeth. Hygienists sometimes make a diagnosis and other times may prepare clinical and laboratory diagnostic tests for the dentist   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  to interpret. Hygienists sometimes work chair side with the dentist during treatment. Work environment. Dental hygienists work in clean, welllighted offices. Important health safeguards include strict ad­ herence to proper radiological procedures and the use of ap­ propriate protective devices when administering anesthetic gas. Dental hygienists also wear safety glasses, surgical masks, and gloves to protect themselves and patients from infectious dis­ eases. Flexible scheduling is a distinctive feature of this job. Full­ time, part-time, evening, and weekend schedules are widely available. Dentists frequently hire hygienists to work only 2 or 3 days a week, so hygienists may hold jobs in more than one dental office. More than half of all dental hygienists worked part time—less than 35 hours a week.  Training, Other Qualifications, and Advancement Prospective dental hygienists must become licensed in the State in which they wish to practice. A degree from an accredited dental hygiene school is usually required along with licensure examinations. Education and training. A high school diploma and col­ lege entrance test scores are usually required for admission to a dental hygiene program. High school students interested in becoming a dental hygienist should take courses in biology, chemistry, and mathematics. Also, some dental hygiene pro­ grams require applicants to have completed at least 1 year of college. Specific entrance requirements vary from one school to another. In 2006, there were 286 dental hygiene programs accredited by the Commission on Dental Accreditation. Most dental hy­ giene programs grant an associate degree, although some also offer a certificate, a bachelor’s degree, or a master’s degree. A  A ’  ~  -  ■■  ..  ,  •-S  ’N.  Dental hygienists use hand and rotary instruments to clean and polish teeth.  Professional and Related Occupations 403  minimum of an associate degree or certificate in dental hygiene is generally required for practice in a private dental office. A bachelor’s or master’s degree usually is required for research, teaching, or clinical practice in public or school health pro­ grams. Schools offer laboratory, clinical, and classroom instruction in subjects such as anatomy, physiology, chemistry, microbiol­ ogy, pharmacology, nutrition, radiography, histology (the study of tissue structure), periodontology (the study of gum diseases), pathology, dental materials, clinical dental hygiene, and social and behavioral sciences. Licensure. Dental hygienists must be licensed by the State in which they practice. Nearly all States require candidates to graduate from an accredited dental hygiene school and pass both a written and clinical examination. The American Dental Association’s Joint Commission on National Dental Examinations administers the written examination, which is accepted by all States and the District of Columbia. State or regional testing agencies administer the clinical examination. In addition, most States require an examination on the legal aspects of dental hygiene practice. Alabama is the only State that allows candidates to take its examinations if they have been trained through a State-regulated on-the-job program in a dentist’s office. Other qualifications. Dental hygienists should work well with others because they work closely with dentists and den­ tal assistants as well as dealing directly with patients. Hy­ gienists also need good manual dexterity, because they use dental instruments within a patient’s mouth, with little room for error. Employment Dental hygienists held about 167,000 jobs in 2006. Because multiple job holding is common in this field, the number of jobs exceeds the number of hygienists. Almost all jobs for dental hygienists were in offices of dentists. A very small number worked for employment services, offices of physicians, or other industries. Job Outlook Dental hygienists rank among the fastest growing occupations, and job prospects are expected to remain excellent. Employment change. Employment of dental hygienists is expected to grow 30 percent through 2016, much faster than the average for all occupations. This projected growth ranks dental hygienists among the fastest growing occupations, in re­ sponse to increasing demand for dental care and the greater use of hygienists. The demand for dental services will grow because of popula­ tion growth, older people increasingly retaining more teeth, and  a growing focus on preventative dental care. To meet this de­ mand, facilities that provide dental care, particularly dentists’ offices, will increasingly employ dental hygienists, and more hygienists per office, to perform services that have been per­ formed by dentists in the past. Job prospects. Job prospects are expected to remain excel­ lent. Older dentists, who have been less likely to employ dental hygienists, are leaving the occupation and will be replaced by recent graduates, who are more likely to employ one or more hygienists. In addition, as dentists’ workloads increase, they are expected to hire more hygienists to perform preventive den­ tal care, such as cleaning, so that they may devote their own time to more complex procedures. Earnings Median hourly earnings of dental hygienists were $30.19 in May 2006. The middle 50 percent earned between $24.63 and $35.67 an hour. The lowest 10 percent earned less than $19.45, and the highest 10 percent earned more than $41.60 an hour. Earnings vary by geographic location, employment setting, and years of experience. Dental hygienists may be paid on an hourly, daily, salary, or commission basis. Benefits vary substantially by practice setting and may be contingent upon full-time employment. According to the American Dental Association, 86 percent of hygienists receive hospital and medical benefits. Related Occupations Other workers supporting health practitioners in an office set­ ting include dental assistants, medical assistants, occupational therapist assistants and aides, physical therapist assistants and aides, physician assistants, and registered nurses. Dental hy­ gienists sometimes work with radiation technology, as do ra­ diation therapists. Sources of Additional Information For information on a career in dental hygiene, including educa­ tional requirements, contact: y Division of Education, American Dental Hygienists Association, 444 N. Michigan Ave., Suite 3400, Chicago, IL 60611. Internet: http://www.adha.org For information about accredited programs and educational requirements, contact: y Commission on Dental Accreditation, American Dental Association, 211 E. Chicago Ave., Suite 1814, Chicago, IL 60611. Internet: http://www.ada.org The State Board of Dental Examiners in each State can sup­ ply information on licensing requirements.  Projections data from the National Employment Matrix Occupational Title Dental hygienists................................................  soc  Employment,  Code  2006 167,000  Projected employment, 2016 217.000  Change, 2006-2016  Number 50,000  Percent 30  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  404 Occupational Outlook Handbook  Diagnostic Medical Sonographers (0*NET 29-2032.00) Significant Points  •  Job opportunities should be favorable.  •  Employment growth is expected to be faster than av­ erage as sonography becomes an increasingly attrac­ tive alternative to radiologic procedures.  •  More than half of all sonographers were employed by hospitals, and most of the rest were employed by of­ fices of physicians, medical and diagnostic laborato­ ries, and mobile imaging services.  •  Sonographers may train in hospitals, vocational-tech­ nical institutions, colleges and universities, and the Armed Forces; employers prefer those who trained in accredited programs and who are registered.  Nature of the Work Diagnostic imaging embraces several procedures that aid in di­ agnosing ailments. The most familiar procedures are the x-ray and the magnetic resonance imaging; however, not all imaging technologies use ionizing radiation or radio waves. Sonogra­ phy, or ultrasonography, is the use of sound waves to generate an image for the assessment and diagnosis of various medical conditions. Sonography commonly is associated with obstet­ rics and the use of ultrasound imaging during pregnancy, but this technology has many other applications in the diagnosis and treatment of medical conditions throughout the body. Diagnostic medical sonographers use special equipment to direct nonionizing, high frequency sound waves into areas of the patient’s body. Sonographers operate the equipment, which collects reflected echoes and forms an image that may be vid­ eotaped, transmitted, or photographed for interpretation and di­ agnosis by a physician. Sonographers begin by explaining the procedure to the pa­ tient and recording any medical history that may be relevant to the condition being viewed. They then select appropriate equipment settings and direct the patient to move into positions that will provide the best view. To perform the exam, sonogra­ phers use a transducer, which transmits sound waves in a coneor rectangle-shaped beam. Although techniques vary with the area being examined, sonographers usually spread a special gel on the skin to aid the transmission of sound waves. Viewing the screen during the scan, sonographers look for subtle visual cues that contrast healthy areas with unhealthy ones. They decide whether the images are satisfactory for diag­ nostic purposes and select which ones to store and show to the physician. Sonographers take measurements, calculate values, and analyze the results in preliminary findings for the physi­ cians. In addition to working directly with patients, diagnostic med­ ical sonographers keep patient records and adjust and maintain equipment. They also may prepare work schedules, evaluate   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  equipment purchases, or manage a sonography or diagnostic imaging department. Diagnostic medical sonographers may specialize in obstetric and gynecologic sonography (the female reproductive system), abdominal sonography (the liver, kidneys, gallbladder, spleen, and pancreas), neurosonography (the brain), or breast sonogra­ phy. In addition, sonographers may specialize in vascular so­ nography or cardiac sonography. (Vascular sonographers and cardiac sonographers are covered in the Handbook statement on cardiovascular technologists and technicians.) Obstetric and gynecologic sonographers specialize in the imaging of the female reproductive system. Included in the discipline is one of the more well-known uses of sonography: examining the fetus of a pregnant woman to track the baby’s growth and health. Abdominal sonographers inspect a patient’s abdominal cav­ ity to help diagnose and treat conditions primarily involving the gallbladder, bile ducts, kidneys, liver, pancreas, spleen, and male reproductive system. Abdominal sonographers also are able to scan parts of the chest, although studies of the heart us­ ing sonography usually are done by echocardiographers. Neurosonographers focus on the nervous system, including the brain. In neonatal care, neurosonographers study and diag­ nose neurological and nervous system disorders in premature infants. They also may scan blood vessels to check for abnor­ malities indicating a stroke in infants diagnosed with sickle-cell anemia. Like other sonographers, neurosonographers operate transducers to perform the sonogram, but use frequencies and beam shapes different from those used by obstetric and abdomi­ nal sonographers. Breast sonographers use sonography to study diseases of the breasts. Sonography aids mammography in the detection of breast cancer. Breast sonography can also track tumors, blood —  Diagnostic medical sonographers use special equipment to di­ rect nonionizing, high frequency sound waves into areas of the patient’s body.  Professional and Related Occupations 405  supply conditions, and assist in the accurate biopsy of breast tissue. Breast sonographers use high-frequency transducers, made exclusively to study breast tissue. Work environment. Sonographers typically work in health care facilities that are clean. They usually work at diagnostic imaging machines in darkened rooms, but also may perform procedures at patients’ bedsides. Sonographers may be on their feet for long periods of time and may have to lift or turn dis­ abled patients. In addition, the nature of their work can put sonographers at an increased risk for musculoskeletal disorders such as carpel tunnel syndrome, neck and back strain, and eye strain: however, greater use of ergonomic equipment and an in­ creasing awareness will continue to minimize such risks Some sonographers work as contract employees and may travel to several health care facilities in an area. Similarly, some sonographers work with mobile imaging service providers and travel to patients and use mobile diagnostic imaging equipment to provide service in areas that otherwise do not have the access to such services. Most full-time sonographers work about 40 hours a week. Hospital-based sonographers may have evening and weekend hours and times when they are on call and must be ready to report to work on short notice. Training, Other Qualifications, and Advancement Diagnostic medical sonography is an occupation where there is no preferred level of education and several avenues of educa­ tion are widely accepted by employers. Although no level of education is preferred, employers do prefer sonographers who trained in accredited programs and who are registered. Education and training. There are several avenues for entry into the field of diagnostic medical sonography. Sonographers may train in hospitals, vocational-technical institutions, col­ leges and universities, and the Armed Forces. Some training programs prefer applicants with a background in science or ex­ perience in other health care professions. Some also may con­ sider high school graduates with courses in mathematics and science, as well as applicants with liberal arts backgrounds, but this practice is infrequent. Colleges and universities offer formal training in both 2- and 4-year programs, culminating in an associate or a bachelor’s degree. Two-year programs are most prevalent. Course work includes classes in anatomy, physiology, instrumentation, basic physics, patient care, and medical ethics. A few 1-year programs that may result in a certificate also are accepted as proper education by employers. These pro­ grams typically are satisfactory education for workers already in health care who seek to increase their marketability by train­ ing in sonography. These programs are not accredited. The Commission on Accreditation for Allied Health Educa­ tion Programs (CAAHEP) accredited 147 training programs in  2006. These programs typically are the formal training pro­ grams offered by colleges and universities. Some hospital pro­ grams are accredited as well. Certification and other qualifications. Although no State requires licensure in diagnostic medical sonography, organi­ zations such as the American Registry for Diagnostic Medi­ cal Sonography (ARDMS) certify the skills and knowledge of sonographers through credentialing, including registration. Because registration provides an independent, objective mea­ sure of an individual’s professional standing, many employers prefer to hire registered sonographers. Sonographers registered by the ARDMS are Registered Diagnostic Medical Sonogra­ phers (RDMS). Registration with ARDMS requires passing a general physical principles and instrumentation examination, in addition to passing an exam in a specialty such as obstetric and gynecologic sonography, abdominal sonography, or neuro­ sonography. Sonographers must complete a required number of continuing education hours to maintain registration with the ARDMS and to stay abreast of technological advancements re­ lated to the occupation. Sonographers need good communication and interpersonal skills because they must be able to explain technical procedures and results to their patients, some of whom may be nervous about the exam or the problems it may reveal. Good handeye coordination is particularly important to obtaining quality images. It is also important that sonographers enjoy learning because continuing education is the key to sonographers stay­ ing abreast of the ever-changing field of diagnostic medicine. A background in mathematics and science is helpful for sonog­ raphers as well. Advancement. Sonographers specializing in one particular discipline often seek competency in others. For example, ob­ stetric sonographers might seek training in abdominal sonog­ raphy to broaden their opportunities and increase their market­ ability. Sonographers may also have advancement opportunities in education, administration, research, sales, or technical advis­ ing. Employment Diagnostic medical sonographers held about 46,000 jobs in 2006. More than half of all sonographer jobs were in public and private hospitals. The rest were typically in offices of phy­ sicians, medical and diagnostic laboratories, and mobile imag­ ing services. Job Outlook Faster-than-average employment growth is expected. Job op­ portunities should be favorable. Employment change. Employment of diagnostic medical so­ nographers is expected to increase by about 19 percent through  Projections data from the National Employment Matrix Occupational Title Diagnostic medical sonographers........................... .......................  soc  Employment,  Code  2006  29-2032  46,000  Projected employment, 2016 54,000  Change, 2006-2016  Number 8,700  Percent 19  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  406 Occupational Outlook Handbook  2016—faster than the average for all occupations—as the popu­ lation ages, increasing the demand for diagnostic imaging and therapeutic technology. Additional job growth is expected as sonography becomes an increasingly attractive alternative to radiologic procedures, as patients seek safer treatment methods. Unlike most diagnos­ tic imaging methods, sonography does not involve radiation, so harmful side effects and complications from repeated use are less likely for both the patient and the sonographer. Sonograph­ ic technology is expected to evolve rapidly and to spawn many new sonography procedures, such as 3D- and 4D-sonography for use in obstetric and ophthalmologic diagnosis. However, high costs and approval by the Federal Government may limit the rate at which some promising new technologies are adopted. Ultrasound currently is only approved for cardiovascular im­ aging but is awaiting Federal Government approval for other applications. Hospitals will remain the principal employer of diagnostic medical sonographers. However, employment is expected to grow more rapidly in offices of physicians and in medical and diagnostic laboratories, including diagnostic imaging centers. Healthcare facilities such as these are expected to grow very rapidly through 2016 because of the strong shift toward outpa­ tient care, encouraged by third-party payers and made possible by technological advances that permit more procedures to be performed outside the hospital. Job prospects. Job opportunities should be favorable. In ad­ dition to job openings from growth, some openings will arise from the need to replace sonographers who retire or leave the occupation permanently for some other reason. Pain caused by musculoskeletal disorders has made it difficult for sonogra­ phers to perform well. Some are forced to leave the occupation early because of this disorder.  For information on becoming a registered diagnostic medical sonographer, contact: y American Registry for Diagnostic Medical Sonography, 51 Monroe St., Plaza East 1, Rockville, MD 20850-2400. Internet: http://www.ardms.org For more information on ultrasound in medicine, contact: y American Institute of Ultrasound in MediciNE., 14750 Sweitzer LaNE., Suite 100, Laurel, MD 20707-5906. Internet: http://www.aium.org For a current list of accredited education programs in diag­ nostic medical sonography, contact: y Joint Review Committee on Education in Diagnostic Medical Sonography, 2025 Woodlane Dr., St.Paul, MN 55125-2998. Internet: http://www.jrcdms.org y Commission on Accreditation for Allied Health Education Programs, 35 East Wacker Dr., Suitel970, Chicago, IL 60601. Internet: http://www.caahep.org  Emergency Medical Technicians and Paramedics (0*NET 29-2041.00)  Significant Points •  Employment is projected to grow faster than the aver­ age as paid positions replace unpaid volunteers.  •  Emergency medical technicians and paramedics need formal training and certification, but requirements vary by State.  •  Emergency services function 24 hours a day so emer­ gency medical technicians and paramedics have ir­ regular working hours.  •  Opportunities will be best for those who have earned  Earnings Median annual earnings of diagnostic medical sonographers were $57,160 in May 2006. The middle 50 percent earned be­ tween $48,890 and $67,670 a year. The lowest 10 percent earned less than $40,960, and the highest 10 percent earned more than $77,520. Median annual earnings of diagnostic medical sonog­ raphers in May 2006 were $56,970 in offices of physicians and $56,850 in general medical and surgical hospitals.  Related Occupations Diagnostic medical sonographers operate sophisticated equip­ ment to help physicians and other health practitioners diagnose and treat patients. Workers in related occupations include car­ diovascular technologists and technicians, clinical laboratory technologists and technicians, nuclear medicine technologists, radiologic technologists and technicians, and respiratory thera­ pists.  Sources of Additional Information For information on a career as a diagnostic medical sonogra­ pher, contact: y Society of Diagnostic Medical Sonography, 2745 Dallas Pkwy., Suite 350, Plano, TX 75093-8730. Internet: http://www.sdms.org   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  advanced certifications.  Nature of the Work People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramed­ ics. Incidents as varied as automobile accidents, heart attacks, slips and falls, childbirth, and gunshot wounds all require im­ mediate medical attention. EMTs and paramedics provide this vital service as they care for and transport the sick or injured to a medical facility. In an emergency, EMTs and paramedics are typically dis­ patched by a 911 operator to the scene, where they often work with police and fire fighters. (Police and detectives and fire­ fighting occupations are discussed elsewhere in the Handbook.) Once they arrive, EMTs and paramedics assess the nature of the patient’s condition while trying to determine whether the patient has any pre-existing medical conditions. Following medical protocols and guidelines, they provide appropriate emergency care and, when necessary, transport the patient. Some paramed­ ics are trained to treat patients with minor injuries on the scene of an accident or they may treat them at their home without  Professional and Related Occupations 407  transporting them to a medical facility. Emergency treatment is carried out under the medical direction of physicians. EMTs and paramedics may use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. These workers generally work in teams. Dur­ ing the transport of a patient, one EMT or paramedic drives while the other monitors the patient’s vital signs and gives ad­ ditional care as needed. Some paramedics work as part of a helicopter’s flight crew to transport critically ill or injured pa­ tients to hospital trauma centers. At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency department staff, and may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies and check equipment. If a transported patient had a contagious disease, EMTs and para­ medics decontaminate the interior of the ambulance and report cases to the proper authorities. EMTs and paramedics also provide transportation for pa­ tients from one medical facility to another, particularly if they work for private ambulance services. Patients often need to be transferred to a hospital that specializes in their injury or illness or to a nursing home. Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. The National Registry of Emergency Medical Techni­ cians (NREMT) certifies emergency medical service providers at five levels: First Responder; EMT-Basic; EMT-Intermediate, which has two levels called 1985 and 1999; and Paramedic. Some States, however, have their own certification programs and use distinct names and titles. The EMT-Basic represents the first component of the emer­ gency medical technician system. An EMT trained at this level is prepared to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-Basic has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies. The EMT-Intermediate has more advanced training. Howev­ er, the specific tasks that those certified at this level are allowed to perform varies greatly from by State. EMT-Paramedics provide the most extensive pre-hospital care. In addition to carrying out the procedures of the other lev­ els, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment. However, like EMT-Immediate, what Paramedics are permitted to do varies from State to State. Work environment. EMTs and paramedics work both in­ doors and out, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramed­ ics may be exposed to diseases such as hepatitis-B and AIDS, as well as violence from mentally unstable patients. The work is not only physically strenuous but can be stressful, sometimes involving life-or-death situations and suffering patients. None-   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  lfgjj|  \  ns ■  —\  ........  Emergency medical technicians and paramedics often work in pairs, where one person drives the ambulance and the other monitors the patient. theless, many people find the work exciting and challenging and enjoy the opportunity to help others. EMTs and paramedics employed by fire departments work about 50 hours a week. Those employed by hospitals frequent­ ly work between 45 and 60 hours a week, and those in private ambulance services, between 45 and 50 hours. Some of these workers, especially those in police and fire departments, are on call for extended periods. Because emergency services func­ tion 24 hours a day, EMTs and paramedics have irregular work­ ing hours.  Training, Other Qualifications, and Advancement Generally, a high school diploma is required to enter a training program to become an EMT or paramedic. Workers must com­ plete a formal training and certification process. Education and training. A high school diploma is usually required to enter a formal emergency medical technician train­ ing program. Training is offered at progressive levels: EMTBasic, EMT-Intermediate, and EMT-Paramedic. At the EMT-Basic level, coursework emphasizes emergency skills, such as managing respiratory, trauma, and cardiac emer­ gencies, and patient assessment. Formal courses are often com­ bined with time in an emergency room or ambulance. The pro­ gram provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest, and emergency childbirth. Students learn how to use and maintain common emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems, and stretchers. Graduates of approved EMT-Basic training programs must pass a written and practical examination administered by the State certifying agency or the NREMT. At the EMT-Intermediate level, training requirements vary by State. The nationally defined levels (EMT-Intermediate 1985 and EMT-Intermediate 1999) typically require 30 to 350 hours of training based on scope of practice. Students learn advanced skills such the use of advanced airway devices, intravenous flu­ ids, and some medications. The most advanced level of training for this occupation is EMT-Paramedic. At this level, the caregiver receives training in anatomy and physiology as well as advanced medical skills.  408 Occupational Outlook Handbook  Most commonly, the training is conducted in community col­ leges and technical schools over 1 to 2 years and may result in an associate’s degree. Such education prepares the gradu­ ate to take the NREMT examination and become certified as a Paramedic. Extensive related coursework and clinical and field experience is required. Refresher courses and continuing edu­ cation are available for EMTs and paramedics at all levels. Licensure. All 50 States require certification for each of the EMT levels. In most States and the District of Columbia reg­ istration with the NREMT is required at some or all levels of certification. Other States administer their own certification ex­ amination or provide the option of taking either the NREMT or State examination. To maintain certification, EMTs and para­ medics must recertify, usually every 2 years. Generally, they must be working as an EMT or paramedic and meet a continu­ ing education requirement. Other qualifications. EMTs and paramedics should be emo­ tionally stable, have good dexterity, agility, and physical coor­ dination, and be able to lift and carry heavy loads. They also need good eyesight (corrective lenses may be used) with ac­ curate color vision. Advancement. Paramedics can become supervisors, opera­ tions managers, administrative directors, or executive directors of emergency services. Some EMTs and paramedics become instructors, dispatchers, or physician assistants; others move into sales or marketing of emergency medical equipment. A number of people become EMTs and paramedics to test their interest in health care before training as registered nurses, phy­ sicians, or other health workers.  Employment  prospects should be good, particularly in cities and private am­ bulance services. Employment change. Employment of emergency medical technicians and paramedics is expected to grow by 19 percent between 2006 and 2016, which is faster than the average for all occupations. Full-time paid EMTs and paramedics will be needed to replace unpaid volunteers. It is becoming increasing difficult for emergency medical services to recruit and retain unpaid volunteers because of the amount of training and the large time commitment these positions require. As a result, more paid EMTs and paramedics are needed. Furthermore, as a large segment of the population—aging members of the baby boom generation—becomes more likely to have medical emergencies, demand will increase for EMTs and paramedics. There also will still be demand for part-time, volunteer EMTs and paramedics in rural areas and smaller metropolitan areas. Job prospects. Job prospects should be favorable. Many job openings will arise from growth and from the need to replace workers who leave the occupation because of the limited poten­ tial for advancement, as well as the modest pay and benefits in private-sector jobs. Job opportunities should be best in private ambulance ser­ vices. Competition will be greater for jobs in local govern­ ment, including fire, police, and independent third-service res­ cue squad departments which tend to have better salaries and benefits. EMTs and paramedics who have advanced education and certifications, such as Paramedic level certification, should enjoy the most favorable job prospects as clients and patients demand higher levels of care before arriving at the hospital.  Earnings  EMTs and paramedics held about 201,000 jobs in 2006. Most career EMTs and paramedics work in metropolitan areas. Vol­ unteer EMTs and paramedics are more common in small cit­ ies, towns, and rural areas. These individuals volunteer for fire departments, emergency medical services, or hospitals and may respond to only a few calls per month. About 30 percent of EMTs or paramedics belong to a union. Paid EMTs and paramedics were employed in a number of industries. About 4 out of 10 worked as employees of private ambulance services. About 3 out of 10 worked in local gov­ ernment for fire departments, public ambulance services, and emergency medical services. Another 2 out of 10 worked full time in hospitals within the medical facility or responded to calls in ambulances or helicopters to transport critically ill or injured patients. The remainder worked in various industries providing emergency services.  Earnings of EMTs and paramedics depend on the employment setting and geographic location of their jobs, as well as their training and experience. Median annual earnings of EMTs and paramedics were $27,070 in May 2006. The middle 50 percent earned between $21,290 and $35,210. The lowest 10 percent earned less than $17,300, and the highest 10 percent earned more than $45,280. Median annual earnings in the industries employing the largest numbers of EMTs and paramedics in May 2006 were $23,250 in general medical and surgical hospi­ tals and $20,350 in ambulance services. Those in emergency medical services who are part of fire or police departments typically receive the same benefits as fire­ fighters or police officers. For example, many are covered by pension plans that provide retirement at half pay after 20 or 25 years of service or if the worker is disabled in the line of duty.  Job Outlook  Related Occupations  Employment for EMTs and paramedics is expected to grow faster than the average for all occupations through 2016. Job  Other workers in occupations that require quick and level-head­ ed reactions to life-or-death situations are air traffic controllers,  Projections data from the National Employment Matrix Change, Projected 2006-2016 employment, Code 2016 Number Percent 240,000 39,000 19 201,000 29-2041 Emergency medical technicians and paramedics.................. ............ NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2006  Professional and Related Occupations 409  firefighting occupations, physician assistants, police and detec­ tives, and registered nurses.  ■nv .i t  Sources of Additional Information General information about emergency medical technicians and paramedics is available from: y National Association of Emergency Medical Technicians, P.O. Box 1400, Clinton, MS 39060-1400. Internet: http://www.naemt.org > National Highway Traffic Safety Administration, EMS Division, 400 7th St.SW., NTS-14, Washington, DC 20590. Internet: http://www.ems.gov > National Registry of Emergency Medical Technicians, Rocco V. Morando Bldg., 6610 Busch Blvd., RO. Box 29233, Columbus, OH 43229. Internet: http://www.nremt.org  Licensed Practical and Licensed Vocational Nurses (0*NET 29-2061.00)  Significant Points  •  • •  Most training programs, lasting about 1 year, are of­ fered by vocational or technical schools or community or junior colleges. Overall job prospects are expected to be very good, but job outlook varies by industry. Replacement needs will be a major source of job openings, as many workers leave the occupation per­ manently.  Nature of the Work Licensed practical nurses (LPNs), or licensed vocational nurses (LVNs), care for people who are sick, injured, convalescent, or disabled under the direction of physicians and registered nurses. (The work of physicians and surgeons and of registered nurses is described elsewhere in the Handbook.) The nature of the direc­ tion and supervision required varies by State and job setting. LPNs care for patients in many ways. Often, they provide basic bedside care. Many LPNs measure and record patients’ vital signs such as height, weight, temperature, blood pressure, pulse, and respiration. They also prepare and give injections and enemas, monitor catheters, dress wounds, and give alco­ hol rubs and massages. To help keep patients comfortable, they assist with bathing, dressing, and personal hygiene, moving in bed, standing, and walking. They might also feed patients who need help eating. Experienced LPNs may supervise nursing as­ sistants and aides. As part of their work, LPNs collect samples for testing, per­ form routine laboratory tests, and record food and fluid intake and output. They clean and monitor medical equipment. Some­ times, they help physicians and registered nurses perform tests and procedures. Some LPNs help to deliver, care for, and feed infants.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Licensed practical nurses care for people who are sick, injured, convalescent, and disabled. LPNs also monitor their patients and report adverse reactions to medications or treatments. LPNs gather information from pa­ tients, including their health history and how they are currently feeling. They may use this information to complete insurance forms, pre-authorizations, and referrals, and they share informa­ tion with registered nurses and doctors to help determine the best course of care for a patient. LPNs often teach family members how to care for a relative or teach patients about good health habits. Most LPNs are generalists and work in all areas of health care. However, some work in a specialized setting, such as a nursing home, a doctor’s office, or in home health care. LPNs in nursing care facilities help to evaluate residents’ needs, develop care plans, and supervise the care provided by nursing aides. In doctors’ offices and clinics, they may be responsible for making appointments, keeping records, and performing other clerical duties. LPNs who work in home health care may prepare meals and teach family members simple nursing tasks. In some States, LPNs are permitted to administer prescribed medicines, start intravenous fluids, and provide care to ventila­ tor-dependent patients. Work environment. Most licensed practical nurses in hos­ pitals and nursing care facilities work a 40-hour week, but be­ cause patients need round-the-clock care, some work nights, weekends, and holidays. They often stand for long periods and help patients move in bed, stand, or walk. LPNs may face hazards from caustic chemicals, radiation, and infectious diseases. They are subject to back injuries when moving patients. They often must deal with the stress of heavy workloads. In addition, the patients they care for may be con­ fused, agitated, or uncooperative.  Training, Other Qualifications, and Advancement Most training programs, lasting about 1 year, are offered by vo­ cational or technical schools or community or junior colleges. LPNs must be licensed to practice. Successful completion of a practical nurse program and passing an examination are re­ quired to become licensed. Education and training. All States and the District of Co­ lumbia require LPNs to pass a licensing examination, known as the NCLEX-PN, after completing a State-approved practi­  410 Occupational Outlook Handbook  cal nursing program. A high school diploma or its equivalent usually is required for entry, although some programs accept candidates without a diploma, and some programs are part of a high school curriculum. In 2006, there were more than 1,500 State-approved train­ ing programs in practical nursing. Most training programs are available from technical and vocational schools or community and junior colleges. Other programs are available through high schools, hospitals, and colleges and universities. Most year-long practical nursing programs include both classroom study and supervised clinical practice (patient care). Classroom study covers basic nursing concepts and subjects re­ lated to patient care, including anatomy, physiology, medicalsurgical nursing, pediatrics, obstetrics, psychiatric nursing, the administration of drugs, nutrition, and first aid. Clinical practice usually is in a hospital but sometimes includes other settings. Licensure. The NCLEX-PN licensing exam is required in order to obtain licensure as an LPN. The exam is developed and administered by the National Council of State Boards of Nursing. The NCLEX-PN is a computer-based exam and var­ ies in length. The exam covers four major categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. Other qualifications. LPNs should have a caring, sympathet­ ic nature. They should be emotionally stable because working with the sick and injured can be stressful. They also need to be observant, and to have good decision-making and communica­ tion skills. As part of a health-care team, they must be able to follow orders and work under close supervision. Advancement. In some employment settings, such as nurs­ ing homes, LPNs can advance to become charge nurses who oversee the work of other LPNs and of nursing aides. Some LPNs also choose to become registered nurses through numer­ ous LPN-to-RN training programs.  Employment Licensed practical nurses held about 749,000 jobs in 2006. About 26 percent of LPNs worked in hospitals, 26 percent in nursing care facilities, and another 12 percent in offices of phy­ sicians. Others worked for home health care services; employ­ ment services; residential care facilities; community care facili­ ties for the elderly; outpatient care centers; and Federal, State, and local government agencies. About 19 percent worked part time.  Employment change. Employment of LPNs is expected to grow 14 percent between 2006 and 2016, faster than the aver­ age for all occupations, in response to the long-term care needs of an increasing elderly population and the general increase in demand for health care services. Many procedures once performed only in hospitals are being performed in physicians’ offices and in outpatient care centers such as ambulatory surgical and emergency medical centers, largely because of advances in technology. LPNs care for pa­ tients who undergo these and other procedures, so employment of LPNs is projected to decline in traditional hospitals, but is projected to grow faster than average in most settings outside of hospitals. However, some hospitals are assigning a larger share of nursing duties to LPNs, which will temper the employment decline in the industry. Employment of LPNs is expected to grow much faster than average in home health care services. Home health care agen­ cies will offer a large number of new jobs for LPNs because of an increasing number of older people with functional disabili­ ties, consumer preference for care in the home, and technologi­ cal advances that make it possible to bring increasingly complex treatments into the home. Employment of LPNs in nursing care facilities is expected to grow faster than average, and provide the most new jobs for LPNs, because of the growing number of people who are aged and disabled and in need of long-term care. In addition, LPNs in nursing care facilities will be needed to care for the increas­ ing number of patients who have been discharged from the hos­ pital but who have not recovered enough to return home. Job prospects. Replacement needs will be a major source of job openings, as many workers leave the occupation permanent­ ly. Very good job opportunities are expected. Rapid employ­ ment growth is projected in most health care industries, with the best job opportunities occurring in nursing care facilities and in home health care services. However, applicants for jobs in hospitals may face competition as the number of hospital jobs for LPNs declines.  Earnings Median annual earnings of licensed practical nurses were $36,550 in May 2006. The middle 50 percent earned between $31,080 and $43,640. The lowest 10 percent earned less than $26,380, and the highest 10 percent earned more than $50,480. Median annual earnings in the industries employing the largest numbers of licensed practical nurses in May 2006 were:  Job Outlook Employment of LPNs is projected to grow faster than average. Overall job prospects are expected to be very good, but job out­ look varies by industry. The best job opportunities will occur in nursing care facilities and home health care services, while applicants for jobs in hospitals may face competition.  Employment services.......................................................... $42,110 Nursing care facilities........................................................... 38,320 Home health care services.................................................... 37,880 General medical and surgical hospitals................................. 35,000 Offices of physicians............................................................. 32,710  Projections data from the National Employment Matrix Occupational Title Licensed practical and licensed vocational nurses................. ..........  soc  Employment,  Code  2006  29-2061  749,000  Change,  Projected employment,  2016 854,000  2006-2016 Number  105,000  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on  lion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Percent  14  Occupational Informa-  Professional and Related Occupations 411  Related Occupations LPNs work closely with people while helping them. So do emergency medical technicians and paramedics; medical assis­ tants; nursing, psychiatric, and home health aides; registered nurses; athletic trainers; social and human service assistants; pharmacy technicians; pharmacy aides; and surgical technolo­ gists.  Sources of Additional Information For information about practical nursing, contact the following organizations: >■ National Association for Practical Nurse Education and Service, Inc., P.O. Box 25647, Alexandria, VA 22313. Internet: http://www.napnes.org y National Federation of Licensed Practical Nurses, Inc., 605 Poole Dr., Garner, NC 27529. Internet: http://www.nflpn.org y National League for Nursing, 61 Broadway, New York, NY 10006. Internet: http://www.nln.org Information on the NCLEX-PN licensing exam is available from: y National Council of State Boards of Nursing, 111 East Wacker Dr., Suite 2900, Chicago, IL 60611. Internet: http://www.ncsbn.org A list of State-approved LPN programs is available from in­ dividual State boards of nursing.  Medical Records and Health Information Technicians (Q*NET 29-2071.00)  Significant Points *  Employment is expected to grow faster than average.  •  Job prospects should be very good; technicians with  formation. Technicians regularly use computer programs to tabulate and analyze data to improve patient care, better control cost, provide documentation for use in legal actions, or use in research studies. Medical records and health information technicians’ duties vary with the size of the facility where they work. In large to medium-size facilities, technicians might specialize in one aspect of health information or might supervise health infor­ mation clerks and transcriptionists while a medical records and health information administrator manages the department. (See the statement on medical and health services managers elsewhere in the Handbook.) In small facilities, a credentialed medical records and health information technician may have the opportunity to manage the department. Some medical records and health information technicians specialize in coding patients’ medical information for insur­ ance purposes. Technicians who specialize in coding are called health information coders, medical record coders, coder/ab­ stractors, or coding specialists. These technicians assign a code to each diagnosis and procedure, relying on their knowl­ edge of disease processes. Technicians then use classification systems software to assign the patient to one of several hundred “diagnosis-related groups,” or DRGs. The DRG determines the amount for which the hospital will be reimbursed if the patient is covered by Medicare or other insurance programs using the DRG system. In addition to the DRG system, coders use other coding systems, such as those required for ambulatory settings, physician offices, or long-term care. Medical records and health information technicians also may specialize in cancer registry. Cancer (or tumor) registrars maintain facility, regional, and national databases of cancer pa­ tients. Registrars review patient records and pathology reports, and assign codes for the diagnosis and treatment of different I  if ■ fi A  a strong background in medical coding will be in par­ ticularly high demand. •  Entrants usually have an associate degree.  *  This is one of the few health occupations in which there is little or no direct contact with patients.  Nature of the Work Every time a patient receives health care, a record is maintained of the observations, medical or surgical interventions, and treatment outcomes. This record includes information that the patient provides concerning his or her symptoms and medical history, the results of examinations, reports of x-rays and labo­ ratory tests, diagnoses, and treatment plans. Medical records and health information technicians organize and evaluate these records for completeness and accuracy. Technicians assemble patients’ health information, making sure that patients’ initial medical charts are complete, that all forms are completed and properly identified and authenticated, and that all necessary information is in the computer. They regularly communicate with physicians and other health care professionals to clarify diagnoses or to obtain additional in­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Medical records and health information technicians comprise one of the few health occupations that involve little or no direct contact with patients.  412 Occupational Outlook Handbook  cancers and selected benign tumors. Registrars conduct annual followups on all patients in the registry to track their treatment, survival, and recovery. Physicians and public health organiza­ tions then use this information to calculate survivor rates and success rates of various types of treatment, locate geographic areas with high incidences of certain cancers, and identify po­ tential participants for clinical drug trials. Public health offi­ cials also use cancer registry data to target areas for the alloca­ tion of resources to provide intervention and screening. Work environment. Medical records and health information technicians work in pleasant and comfortable offices. This is one of the few health-related occupations in which there is little or no direct contact with patients. Because accuracy is essen­ tial in their jobs, technicians must pay close attention to detail. Technicians who work at computer monitors for prolonged pe­ riods must guard against eyestrain and muscle pain. Medical records and health information technicians usually work a 40-hour week. Some overtime may be required. In hos­ pitals—where health information departments often are open 24 hours a day, 7 days a week—technicians may work day, eve­ ning, and night shifts.  Training, Other Qualifications, and Advancement Medical records and health information technicians entering the field usually have an associate degree from a community or junior college. Many employers favor technicians who have become Registered Health Information Technicians (RHIT). Advancement opportunities for medical record and health in­ formation technicans are typically achieved by specialization or promotion to a management position. Education and training. Medical records and health infor­ mation technicians generally obtain an associate degree from a community or junior college. Typically, community and ju­ nior colleges offer flexible course scheduling or online distance learning courses. (See the Sources of Education, Training, and Financial Aid section of the Handbook for more information re­ garding community and junior colleges.) In addition to general education, coursework includes medical terminology, anatomy and physiology, legal aspects of health information, health data standards, coding and abstraction of data, statistics, database management, quality improvement methods, and computer sci­ ence. Applicants can improve their chances of admission into a program by taking biology, math, chemistry, health, and com­ puter science courses in high school. Certification and other qualifications. Most employers pre­ fer to hire Registered Health Information Technicians (RHIT), who must pass a written examination offered by the American Health Information Management Association (AHIMA). To take the examination, a person must graduate from a 2-year associate degree program accredited by the Commission on Accreditation for Health Informatics and Information Manage­ ment Education (CAHIIM). Technicians trained in non-CAHIIM-accredited programs or trained on the job are not eligible to take the examination. In 2007, there were about 245 CAHIIM accredited programs in Health Informantics and Information Management Education. Some employers prefer candidates with experience in a health care setting. Experience is valuable in demonstrating   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  certain skills or desirable qualities. It is beneficial for health information technicians to possess good communication skills, as they often serve as a liaison between health care facilities, in­ surance companies, and other establishments. Accuracy is also essential to technicians because they must pay close attention to detail. A candidate who exhibits proficiency with computers will become more valuable as health care facilities continue to adopt electronic medical records. Certification and advancement. Experienced medical re­ cords and health information technicians usually advance in one of two ways—by specializing or by moving into a man­ agement position. Many senior technicians specialize in cod­ ing, in cancer registry, or in privacy and security. Most cod­ ing and registry skills are learned on the job. A number of schools offer certificate programs in coding or include coding as part of the associate degree program for health information technicians, although there are no formal degree programs in coding. For cancer registry, there are a few formal 2-year certificate programs approved by the National Cancer Regis­ trars Association (NCRA). Some schools and employers offer intensive 1- to 2-week training programs in either coding or cancer registry. Certification in coding is available from several organiza­ tions. Coding certification within specific medical specialty areas is available from the Board of Medical Specialty Coding and the Professional Association of Healthcare Coding Special­ ist (PAHCS). The American Academy of Professional Coders (AAPC) offers three distinct certification programs in coding. The AHIMA also offers certification for Certified Healthcare Privacy and Security because of growing concerns for the secu­ rity of electronic medical records. Certification in cancer reg­ istry is available from the NCRA. Continuing education units are typically required to renew credentials. In large medical records and health information departments, experienced technicians may advance to section supervisor, overseeing the work of the coding, correspondence, or dis­ charge sections, for example. Senior technicians with RHIT credentials may become director or assistant director of a medi­ cal records and health information department in a small facil­ ity. However, in larger institutions, the director usually is an administrator with a bachelor’s degree in medical records and health information administration. Hospitals sometimes advance promising health information clerks to jobs as medical records and health information techni­ cians, although this practice may be less common in the future. Advancement usually requires 2 to 4 years of job experience and completion of a hospital’s in-house training program.  Employment Medical records and health information technicians held about 170,000 jobs in 2006. About 2 out of 5 jobs were in hospitals. The rest were mostly in offices of physicians, nursing care fa­ cilities, outpatient care centers, and home health care services. Insurance firms that deal in health matters employ a small num­ ber of health information technicians to tabulate and analyze health information. Public health departments also employ technicians to supervise data collection from health care insti­ tutions and to assist in research.  Professional and Related Occupations 413  Projections data from the National Employment Matrix Occupational Title Medical records and health information technicians............... .........  soc Code 29-2071  Projected employment, 2016 200,000  Employment, 2006 170,000  Change, 2006-2016 Number Percent 30,000 18  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  Job Outlook  Related Occupations  Employment is expected to grow faster than average. Job pros­ pects should be very good; technicians with a strong background in medical coding will be in particularly high demand. Employment change. Employment of medical records and health information technicians is expected to increase by 18 percent through 2016—faster than the average for all occupa­ tions—because of rapid growth in the number of medical tests, treatments, and procedures that will be increasingly scrutinized by health insurance companies, regulators, courts, and consum­ ers. Also, technicians will be needed to enter patient informa­ tion into computer databases to comply with Federal legislation mandating the use of electronic medical records. New jobs are expected in offices of physicians as a result of increasing demand for detailed records, especially in large group practices. New jobs also are expected in home health care services, outpatient care centers, and nursing and residen­ tial care facilities. Although employment growth in hospitals will not keep pace with growth in other health care industries, many new jobs will, nevertheless, be created. Cancer registrars should experience job growth. As the popu­ lation continues to age, the incidence of cancer may increase. Job prospects. Job prospects should be very good. In addi­ tion to job growth, openings will result from the need to replace technicians who retire or leave the occupation permanently. Technicians with a strong background in medical coding will be in particularly high demand. Changing government regula­ tions and the growth of managed care have increased the amount of paperwork involved in filing insurance claims. Additionally, health care facilities are having some difficulty attracting quali­ fied workers, primarily because employers prefer trained and experienced technicians prepared to work in an increasingly electronic environment with the integration of electronic health records. Job opportunities may be especially good for coders employed through temporary help agencies or by professional services firms.  Medical records and health information technicians need a strong clinical background to analyze the contents of medical records. Medical secretaries and medical transcriptionists also must be knowledgeable about medical terminology, anatomy, and physiology even though they have little or no direct contact with patients.  Sources of Additional Information Information on careers in medical records and health informa­ tion technology, and a list of accredited training programs is available from: 'y American Health Information Management Association, 233 N. Michigan Ave., Suite 2150, Chicago, IL 60601-5800. Internet: http://www.ahima.org Information on training and certification for medical coders is available from: y American Academy of Professional Coders, 2480 South 3850 West, Suite B, Salt Lake City, UT 84120. Internet: http://www.aapc.com Information on cancer registrars is available from: y National Cancer Registrars Association, 1340 Braddock Place Suite 203, Alexandria, VA 22314. Internet: http://www.ncra-usa.org  Nuclear Medicine Technologists (Q*NET 29-2033.00)  Significant Points  •  Two-thirds of nuclear medicine technologists worked in hospitals.  •  Nuclear medicine technology programs range in length from 1 to 4 years and lead to a certificate, an associate degree, or a bachelor’s degree.  •  Faster-than-average job growth will arise from an increase in the number of middle-aged and elderly persons, who are the primary users of diagnostic and treatment procedures.  •  The number of job openings each year will be rela­ tively low because the occupation is small; technolo­ gists who also are trained in other diagnostic methods, such as radiologic technology or diagnostic medical sonography, will have the best prospects.  Earnings Median annual earnings of medical records and health informa­ tion technicians were $28,030 in May 2006. The middle 50 percent earned between $22,420 and $35,990. The lowest 10 percent earned less than $19,060, and the highest 10 percent earned more than $45,260. Median annual earnings in the in­ dustries employing the largest numbers of medical records and health information technicians in May 2006 were: General medical and surgical hospitals...............................$29,400 Nursing care facilities........................................................... 28,410 Outpatient care centers.......................................................... 26,680 Offices of physicians............................................................. 24,170  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  414 Occupational Outlook Handbook  Nature of the Work Diagnostic imaging embraces several procedures that aid in di­ agnosing ailments, the most familiar being the x-ray. In nuclear medicine, radionuclides—unstable atoms that emit radiation spontaneously—are used to diagnose and treat disease. Ra­ dionuclides are purified and compounded to form radiophar­ maceuticals. Nuclear medicine technologists administer radio­ pharmaceuticals to patients and then monitor the characteristics and functions of tissues or organs in which the drugs localize. Abnormal areas show higher-than-expected or lower-than-expected concentrations of radioactivity. Nuclear medicine dif­ fers from other diagnostic imaging technologies because it determines the presence of disease on the basis of metabolic changes rather than changes in organ structure. Nuclear medicine technologists operate cameras that detect and map the radioactive drug in a patient’s body to create di­ agnostic images. After explaining test procedures to patients, technologists prepare a dosage of the radiopharmaceutical and administer it by mouth, injection, inhalation, or other means. They position patients and start a gamma scintillation camera, or “scanner,” which creates images of the distribution of a ra­ diopharmaceutical as it localizes in, and emits signals from, the patient’s body. The images are produced on a computer screen or on film for a physician to interpret. When preparing radiopharmaceuticals, technologists adhere to safety standards that keep the radiation exposure as low as possible to workers and patients. Technologists keep patient re­ cords and document the amount and type of radionuclides that they receive, use, and discard. Work environment. Physical stamina is important because nuclear medicine technologists are on their feet much of the day and may have to lift or turn disabled patients. In addition, technologists must operate complicated equipment that requires mechanical ability and manual dexterity. Although the potential for radiation exposure exists in this field, it is minimized by the use of shielded syringes, gloves, and other protective devices and by adherence to strict radia­ tion safety guidelines. The amount of radiation in a nuclear medicine procedure is comparable to that received during a di­ agnostic x-ray procedure. Technologists also wear badges that  Nuclear medicine technologists operate cameras that detect and map the radioactive drugs in a patient’s body to create di­ agnostic images.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  measure radiation levels. Because of safety programs, badge measurements rarely exceed established safety levels. Nuclear medicine technologists generally work a 40-hour week, perhaps including evening or weekend hours, in depart­ ments that operate on an extended schedule. Opportunities for part-time and shift work also are available. In addition, tech­ nologists in hospitals may have on-call duty on a rotational ba­ sis, and those employed by mobile imaging services may be required to travel to several locations.  Training, Other Qualifications, and Advancement Nuclear medicine technology programs range in length from 1 to 4 years and lead to a certificate, an associate degree, or a bachelor’s degree. Many employers and an increasing num­ ber of States require certification or licensure. Aspiring nuclear medicine technologists should check the requirements of the State in which they plan to work. Education and training. Completion of a nuclear medicine technology program takes 1 to 4 years and leads to a certificate, an associate degree, or a bachelor’s degree. Generally, certifi­ cate programs are offered in hospitals, associate degree pro­ grams in community colleges, and bachelor’s degree programs in 4-year colleges and universities. Courses cover the physical sciences, biological effects of radiation exposure, radiation pro­ tection and procedures, the use of radiopharmaceuticals, imag­ ing techniques, and computer applications. One-year certificate programs are for health professionals who already possess an associate degree—especially radiologic technologists and diagnostic medical sonographers—but who wish to specialize in nuclear medicine. The programs also at­ tract medical technologists, registered nurses, and others who wish to change fields or specialize. The Joint Review Committee on Education Programs in Nuclear Medicine Technology accredits most formal training programs in nuclear medicine technology. In 2006, there were about 100 accredited programs in the continental United States and Puerto Rico. Licensure and certification. Educational requirements for nuclear medicine technologists vary from State to State, so it is important that aspiring technologists check the requirements of the State in which they plan to work. More than half of all States require certification or licensing of nuclear medi­ cine technicians. Certification is available from the American Registry of Radiologic Technologists (ARRT) and from the Nuclear Medicine Technology Certification Board (NMTCB). Although not required, some workers receive certification from both agencies. Nuclear medicine technologists must meet the minimum Federal standards on the administration of radioac­ tive drugs and the operation of radiation detection equipment. The most common way to become eligible for certification by ARRT or NMTCB is to complete a training program recog­ nized by those organizations. Other ways to become eligible are completing a bachelor’s or associate degree in biological science or related health field, such as registered nursing, or acquiring, under supervision, a certain number of hours of ex­ perience in nuclear medicine technology. ARRT and NMTCB have different requirements, but in all cases, one must pass a comprehensive exam to become certified.  Professional and Related Occupations 415  In addition to the general certification requirements, certified technicians also must complete a certain number of continuing education hours. Continuing education is required primarily because of the frequent technological and innovative changes in the field of nuclear medicine. Typically, technologists must register annually with both the ARRT and the NMTCB. Other qualifications. Nuclear medicine technologists should have excellent communication skills, be detail-oriented, and have a desire to continue learning. Technologists must effec­ tively interact with patients and their families and should be sensitive to patients’ physical and psychological needs. Nucle­ ar medicine technologists must be able to work independently as they usually have little direct supervision. Technologists also must be detailed-oriented and meticulous when performing pro­ cedures to assure that all regulations are being followed. Advancement. Technologists may advance to supervisor, then to chief technologist, and to department administrator or director. Some technologists specialize in a clinical area such as nuclear cardiology or computer analysis or leave patient care to take positions in research laboratories. Some become instruc­ tors in, or directors of, nuclear medicine technology programs, a step that usually requires a bachelor’s or master’s degree in the subject. Others leave the occupation to work as sales or training representatives for medical equipment and radiophar­ maceutical manufacturing firms or as radiation safety officers in regulatory agencies or hospitals.  Employment Nuclear medicine technologists held about 20,000 jobs in 2006. About 67 percent of all nuclear medicine technologists jobs were in hospitals—private and government. Most of the rest were in offices of physicians or in medical and diagnostic labo­ ratories, including diagnostic imaging centers.  Job Outlook Faster-than-average job growth will arise from an increase in the number of middle-aged and elderly persons, who are the primary users of diagnostic and treatment procedures. How­ ever, the number of job openings each year will be relatively low because the occupation is small. Employment change. Employment of nuclear medicine technologists is expected to increase by 15 percent from 2006 to 2016, faster than the average for all occupations. Growth will arise from technological advancement, the development of new nuclear medicine treatments, and an increase in the number of middle-aged and older persons, who are the primary users of diagnostic procedures, including nuclear medicine tests. Technological innovations may increase the diagnostic uses of nuclear medicine. New nuclear medical imaging technolo­ gies, including positron emission tomography (PET) and single photon emission computed tomography (SPECT), are expected  to be used increasingly and to contribute further to employment growth. The wider use of nuclear medical imaging to observe metabolic and biochemical changes during neurology, cardiolo­ gy, and oncology procedures also will spur demand for nuclear medicine technologists. Nonetheless, cost considerations will affect the speed with which new applications of nuclear medicine grow. Some prom­ ising nuclear medicine procedures, such as positron emission tomography, are extremely costly, and hospitals contemplating these procedures will have to consider equipment costs, reim­ bursement policies, and the number of potential users. Job prospects. In spite of fast growth in nuclear medicine, the number of openings into the occupation each year will be relatively low because of the small size of the occupation. Technologists who have additional training in other diagnostic methods, such as radiologic technology or diagnostic medical sonography, will have the best prospects.  Earnings Median annual earnings of nuclear medicine technologists were $62,300 in May 2006. The middle 50 percent earned between $53,530 and $72,410. The lowest 10 percent earned less than $46,490, and the highest 10 percent earned more than $82,310. Median annual earnings of nuclear medicine technologists in 2006 were $61,230 in general medical and surgical hospitals.  Related Occupations Nuclear medical technologists operate sophisticated equipment to help physicians and other health practitioners diagnose and treat patients. Cardiovascular technologists and technicians, clinical laboratory technologists and technicians, diagnostic medical sonographers, radiation therapists, radiologic tech­ nologists and technicians, and respiratory therapists perform similar functions.  Sources of Additional Information Additional information on a career as a nuclear medicine tech­ nologist is available from: y American Society of Radiologic Technologists, 15000 Central Ave. S.E., Albuquerque, NM 87123-3917. Internet: http://www.asrt.org y American Registry of Radiologic Technologists, 1255 Northland Dr., St.Paul, MN 55120-1155. Internet: http://www.arrt.org Society of Nuclear Medicine Technologists, 1850 Samuel Morse Dr., Reston, VA 20190-5316. Internet: http://www.snm.org For a list of accredited programs in nuclear medicine technol­ ogy, contact: y Joint Review Committee on Educational Programs in Nuclear Medicine Technology, 716 Black Point Rd„ Poison, MT 59860. Internet: http://www.jrcnmt.org  Projections data from the National Employment Matrix Occupational Title Nuclear medicine technologists................................ ..........................  soc Code 29-2033  Employment, 2006 20,000  Projected employment, 2016 23,000  Change, 2006-2016 Number Percent 2,900 15  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  416 Occupational Outlook Handbook  Information on certification is available from: V Nuclear Medicine Technology Certification Board, 2970 Clairmont Rd., Suite 935, Atlanta, GA 30329-4421. Internet: http://www.nmtcb.org  Occupational Health and Safety Specialists and Technicians (0*NET 29-9011.00, 29-9012.00)  Significant Points  •  • •  About 2 out of 5 specialists and technicians worked in Federal, State, and local government agencies that enforce rules on safety, health, and the environment. Some specialist jobs require a bachelor’s degree in occupational health, safety, or a related field. Projected average employment growth reflects a balance of continuing public demand for a safe and healthy work environment against the desire for smaller government and fewer regulations.  Nature of the Work Occupational health and safety specialists and technicians, also known as safety and health professionals or occupational health and safety inspectors, help prevent harm to workers, property, the environment, and the general public. For exam­ ple, they might design safe work spaces, inspect machines, or test air quality. In addition to making workers safer, specialists and technicians aim to increase worker productivity by reduc­ ing absenteeism and equipment downtime—and to save money by lowering insurance premiums and workers’ compensation payments, and preventing government fines. Some specialists and technicians work for governments, conducting safety in­ spections and imposing fines. Occupational health and safety specialists analyze work en­ vironments and design programs to control, eliminate, and pre­ vent disease or injury. They look for chemical, physical, radio­ logical, and biological hazards, and they work to make more equipment ergonomic—designed to promote proper body po­ sitioning, increase worker comfort, and decrease fatigue. Spe­ cialists may conduct inspections and inform an organization’s management of areas not in compliance with State and Federal laws or employer policies. They also advise management on the cost and effectiveness of safety and health programs. Some provide training on new regulations and policies or on how to recognize hazards. Sometimes, specialists develop methods to predict hazards from historical data and other information sources. They use these methods and their own knowledge and experience to evaluate current equipment, products, facilities, or processes and those planned for use in the future. For example, they might uncover patterns in injury data that show that many in­ juries are caused by a specific type of system failure, human error, or weakness in procedures. They evaluate the probability and severity of accidents and identify where controls need to be   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  implemented to reduce or eliminate risk. If a new program or practice is required, they propose it to management and moni­ tor results if it is implemented. Specialists also might con­ duct safety training for management, supervisors, and workers. Training sessions might show how to recognize hazards, for ex­ ample, or explain new regulations and production processes. Some specialists, often called loss prevention specialists, work for insurance companies, inspecting the facilities that they insure and suggesting and helping to implement improve­ ments. Occupational health and safety technicians often focus on testing air, water, machines, and other elements of the work environment. They collect data that occupational health and safety specialists then analyze. Usually working under the su­ pervision of specialists, they also help to implement and evalu­ ate safety programs. To measure hazards, such as noise or radiation, occupational health and safety technicians prepare and calibrate scientific equipment. They must properly collect and handle samples of dust, gases, vapors, and other potentially toxic materials to ensure personal safety and accurate test results. Occupational health and safety specialists also may perform this work, espe­ cially if it is complex. To ensure that machinery and equipment complies with ap­ propriate safety regulations, occupational health and safety specialists and technicians both may examine and test machin­ ery and equipment, such as lifting devices, machine guards, or scaffolding. They may check that personal protective equip­ ment, such as masks, respirators, protective eyewear, or hardhats, is being used according to regulations. They also check that hazardous materials are stored correctly. They test and identify work areas for potential accident and health hazards, such as toxic vapors, mold, mildew, and explosive gas-air mix­ tures and help implement appropriate control measures, such as adjustments to ventilation systems. Their inspection of the workplace might involve talking with workers and observing their work, as well as inspecting elements in their work envi­ ronment, such as lighting, tools, and equipment. If an injury or illness occurs, occupational health and safety specialists and technicians help investigate, studying its causes and recommending remedial action. Some occupational health and safety specialists and technicians help workers to return to work after accidents and injuries. Occupational health and safety specialists and technicians frequently communicate with management about the status of health and safety programs. They also might consult with en­ gineers or physicians. Specialists and technicians write reports, including accident reports, and enter information on Occupational Safety and Health Administration recordkeeping forms. They may pre­ pare documents used in legal proceedings and give testimony in court. Those who develop expertise in specific areas may develop occupational health and safety systems, including pol­ icies, procedures, and manuals. The responsibilities of occupational health and safety spe­ cialists and technicians vary by industry, workplace, and types of hazards affecting employees. Mine examiners, for exam­ ple, are technicians who inspect mines for proper air flow and  Professional and Related Occupations 417  health hazards such as the buildup of methane or other noxious gases. Environmental protection officers evaluate and coordi­ nate the storage and handling of hazardous waste, the cleanup of contaminated soil or water, or other activities that affect the environment. Ergonomists consider the design of industrial, office, and other equipment to maximize worker comfort, safe­ ty, and productivity. Health physicists work in places that use radiation and radioactive material, helping to protect people and the environment from hazardous radiation exposure. And industrial hygienists examine the workplace for health hazards, such as exposure to lead, asbestos, pesticides, or communica­ ble diseases. Work environment. Occupational health and safety special­ ists and technicians work in a variety of settings from offices and factories to mines. Their jobs often involve considerable fieldwork, and some require frequent travel. Occupational health and safety specialists and technicians may be exposed to many of the same strenuous, dangerous, or stressful conditions faced by industrial employees. They may find themselves in an adversarial role if an organization dis­ agrees with their recommendations. Many occupational health and safety specialists and technicians work long, and often ir­ regular, hours.  7  Occupational health and safety technicians use scientific equip­ ment to measure hazards, such as noise or radiation.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Training, Other Qualifications, and Advancement All occupational health and safety specialists and technicians are trained in the applicable laws or inspection procedures through some combination of classroom and on-the-job training. Education and training. Some employers require occupa­ tional health and safety specialists to have a bachelor’s degree in occupational health, safety, or a related field, such as engi­ neering, biology, or chemistry. For some positions, a master’s degree in industrial hygiene or a related subject is required. There also are associate degree and 1-year certificate programs, which primarily are intended for technicians. As of February 2007, the Accreditation Board for Engineer­ ing and Technology accredited 45 programs in health physics, industrial hygiene, and safety. Certification and other qualifications. Although voluntary, many employers encourage certification. Certification is avail­ able through several organizations. The Board of Certified Safety Professionals offers the Certified Safety Professional (CSP) credential. The American Board of Industrial Hygiene offers the Certified Industrial Hygienist (CIH) credential. Also, the Council on Certification of Health, Environmental, and Safety Technologists certifies people as Occupational Health and Safety Technologists (OHST), who may be called Certi­ fied Loss Control Specialists (CLCS), Construction Health and Safety Technicians (CHST), and Safety Trained Supervisors (STS). The Indoor Air Quality Association awards the Certi­ fied Indoor Environmentalist (CIE) credential. The Board of Certification in Professional Ergonomics offers the Certified Professional Ergonomist (CPE) and the Certified Ergonomics Associate (CEA) credentials. The American Board of Health Physicists awards the Certified Health Physicist (CHP) creden­ tial. Requirements for these credentials differ. Usually, they in­ clude specific education and experience, passing an examina­ tion, and completing periodic continuing education for recer­ tification. In general, people who want to enter this occupation should be responsible and like detailed work. Occupational health and safety specialists and technicians also should be able to com­ municate well. Recommended high school courses include English, mathematics, chemistry, biology, and physics. Expe­ rience as an occupational health and safety professional is also a prerequisite for many positions. Advancement. Occupational health and safety specialists and technicians who work for the Federal Government advance through their career ladder to a specified full-performance lev­ el if their work is satisfactory. For positions above this level, usually supervisory positions, advancement is competitive and based on agency needs and individual merit. Advancement op­ portunities in State and local governments and the private sec­ tor are often similar to those in the Federal Government. Specialists and technicians with broad education and experi­ ence and those who are well versed in numerous business func­ tions usually have the best advancement opportunities. One way to keep up with current professional developments is to join a professional society, such as those that offer the certifi­ cations mentioned earlier. These organizations offer journals, continuing education courses, and conferences, which offer  418 Occupational Outlook Handbook  learning and networking opportunities and can help workers and students to advance. With an advanced degree, professionals can become profes­ sors or do research. Promotion to senior specialist positions is likely to require an advanced degree and substantial experience in several areas of practice. Employment Occupational health and safety specialists and technicians held about 56,000 jobs in 2006. While the majority of jobs were spread throughout the private sector; about 2 out of 5 special­ ists worked for government agencies. Local governments em­ ployed 15 percent, the Federal Government employed 13 per­ cent, and State governments employed 12 percent. Within the Federal Government, most jobs are as Occupa­ tional Safety and Health Administration inspectors, who en­ force U.S. Department of Labor regulations and impose fines. Within the U.S. Department of Health and Human Services, the National Institute of Occupational Safety and Health hires occupational health and safety specialists to offer companies help in evaluating safety without the risk of fines. Most large government agencies also employ occupational health and safety specialists and technicians who work to protect agency employees. Most private companies either employ their own occupa­ tional health and safety workers or contract with them. Most contract work is done through consulting companies, but some specialists and technicians are self-employed. In addition to working for governments, occupational health and safety specialists and technicians were employed in man­ ufacturing firms; private general medical and surgical hospi­ tals; private colleges, universities, and professional schools; scientific and technical consulting services; research and de­ velopment in the physical, engineering, and life sciences; and electric power generation, transmission, and distribution. In­ surance companies and technical consulting services also often employed specialists, whereas employment services and test­ ing laboratories often employed technicians.  Job Outlook Average employment growth is expected; additional opportu­ nities will arise from the need to replace workers who leave the occupation. Employment change. Employment of occupational health and safety specialists and technicians is expected to increase 9 percent during the 2006-16 decade, about as fast as the average for all occupations, reflecting a balance of continuing public demand for a safe and healthy work environment against the  desire for smaller government and fewer regulations. Emer­ gency preparedness will continue to increase in importance, creating demand for these workers. More specialists will be needed to cope with technological advances in safety equip­ ment and threats, changing regulations, and increasing public expectations. In private industry, employment growth will re­ flect overall business growth and continuing self-enforcement of government and company regulations and policies. Over the past two decades, insurance and worker’s compen­ sation costs have risen and have become a financial concern for many employers and insurance companies. As a result, job growth should be good for those specializing in loss preven­ tion, especially in construction safety and in ergonomics. Job prospects. In addition to job openings from growth, job openings will arise from the need to replace workers who transfer to other occupations, retire, or leave for other reasons. An aging population paired with a decline in the number of postsecondary students studying the sciences, especially health physics, will create opportunities for those with technical skill. Employment of occupational health and safety specialists and technicians in the private sector is somewhat affected by general economic fluctuations. Federal, State, and local gov­ ernments, which employ about 2 out of 5 of all specialists and technicians, provide considerable job security; workers are less likely to be affected by changes in the economy. Earnings Median annual earnings of occupational health and safety spe­ cialists and technicians were $54,920 in May 2006. The middle 50 percent earned between $41,800 and $70,230. The lowest 10 percent earned less than $32,230, and the highest 10 percent earned more than $83,720. Median annual earnings in the in­ dustries employing the largest numbers of occupational health and safety specialists and technicians in May 2006 were: Federal Government............................................................$68,890 Management, scientific, and technical consulting services............................................. 63,130 General medical and surgical hospitals................................59,200 Local government..................................................................52,110 State government...................................................................49,690 Most occupational health and safety specialists and techni­ cians work in large private firms or for Federal, State, and lo­ cal governments, most of which generally offer benefits more generous than those offered by smaller firms.  Projections data from the National Employment Matrix Occupational Title Occupational health and safety specialists and technicians.............. Occupational health and safety specialists...................................... Occupational health and safety technicians...................................  Projected Change, employment, 2006-2016 Code 2016 Number Percent 29-9010 56,000 61,000 5,200 9 29-9011 45,000 49,000 3,700 8 29-901210,00012,0001,50015  soc  Employment, 2006  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 419  Related Occupations Occupational health and safety specialists and technicians help to ensure that laws and regulations are obeyed. Others who enforce laws and regulations include agricultural inspectors, construction and building inspectors, correctional officers, fi­ nancial examiners, fire inspectors, police and detectives, and transportation inspectors. Occupational health and safety spe­ cialists also analyze work environments and processes, topics that industrial engineers also study.  Opticians, Dispensing (0*NET 29-2081.00)  Significant Points •  or through apprenticeships lasting 2 or more years, but some employers seek graduates of postsecondary training programs in opticianry.  Sources of Additional Information Information about jobs in Federal, State, and local governments and in private industry is available from State employment ser­ vice offices. For information on a career as an industrial hygienist, includ­ ing a list of colleges and universities offering industrial hygiene and related degrees, contact: V American Industrial Hygiene Association, 2700 Prosperity Ave., Suite 250, Fairfax, VA 22031. Internet: http://www.aiha.org For information on the Certified Industrial Hygienist or Cer­ tified Associate Industrial Hygienist credential, contact: > American Board of Industrial HygieNE., 6015 West St.Joseph Hwy., Suite 102, Lansing, MI 48917. Internet: http://www.abih.org For more information on professions in safety, a list of safety and related academic programs, and the Certified Safety Profes­ sional credential, contact: y Board of Certified Safety Professionals, 208 Burwash Ave., Savoy, IL 61874. Internet: http://www.bcsp.org For information on the Occupational Health and Safety Tech­ nologist, Construction Health and Safety Technician creden­ tials, and Safety Trained Supervisors, contact: y Council on Certification of Health, Environmental, and Safety Technologists, 208 Burwash Ave., Savoy, IL 61874. Internet: http://www.cchest.org For information on a career as a health physicist, contact: y Health Physics Society, 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101. Internet: http://www.hps.org For additional career information, contact: y U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Institute of Occupational Safety and Health, Hubert H. Humphrey Bldg., 200 Independence Ave. SW., Room 715H, Washington, DC 20201. Internet: http://www.cdc.gov/niosh y U.S. Department of Labor, Occupational Safety and Health Administration, Office of Communication, 200 Constitution Ave. NW„ Washington, DC 20210. Internet: http://www.osha.gov Information on obtaining positions as occupational health and safety specialists and technicians with the Federal Govern­ ment is available from the Office of Personnel Management through USAJOBS, the Federal Government’s official employ­ ment information system. This resource for locating and apply­ ing for job opportunities can be accessed through the Internet at http://www.usajobs.opm.gov or through an interactive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not toll free, and charges may result.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Most dispensing opticians receive training on the job  •  A license to practice is required by 22 States.  •  Employment growth is projected to be average and reflect the steady demand for corrective lenses and fashionable eyeglass frames.  Nature of the Work Helping people see better and look good at the same time is the job of a dispensing optician. Dispensing opticians help se­ lect and then fit eyeglasses and contact lenses for people with eye problems, following prescriptions written by ophthalmolo­ gists or optometrists. (The work of optometrists is described elsewhere in the Handbook. See the section on physicians and surgeons for information about ophthalmologists.) Dispensing opticians recommend eyeglass frames, lenses, and lens coatings after considering the prescription and the customer’s occupa­ tion, habits, and facial features. They measure clients’ eyes, including the distance between the centers of the pupils and the distance between the ocular surface and the lens. For cus­ tomers without prescriptions, dispensing opticians may use a focimeter to record eyeglass measurements in order to duplicate their existing eyeglasses. They also may obtain a customer’s previous record to re-make eyeglasses or contact lenses, or they may verify a prescription with the examining optometrist or ophthalmologist. Dispensing opticians prepare work orders that give ophthal­ mic laboratory technicians the information they need to grind and insert lenses into a frame. (See the section on ophthalmic laboratory technicians elsewhere in the Handbook.) The work order includes prescriptions for lenses and information on their size, material, color, and style. Some dispensing opticians grind and insert lenses themselves. They may also apply tint to glasses. After the glasses are made, dispensing opticians verify that the lenses have been ground to specifications. Then they may reshape or bend the frame by hand or using pliers so that the eyeglasses fit the customer properly and comfortably. Many opticians also spend time fixing, adjusting, and refit­ ting broken frames. They instruct clients about adapting to, wearing, or caring for eyeglasses. Additionally, administrative duties have become a major part of their work, including keep­ ing records on customers’ prescriptions, work orders, and pay­ ments, and tracking inventory and sales. Some dispensing opticians, after additional education and training, specialize in fitting contacts, artificial eyes, or cos­ metic shells to cover blemished eyes. To fit contact lenses, dispensing opticians measure the shape and size of the eye, se­ lect the type of contact lens material, and prepare work orders  420 Occupational Outlook Handbook  :er  mmUlimlmi  Opticians take measurements to ensure that eyeglasses fit prop­ erly. specifying the prescription and lens size. Fitting contact lenses requires considerable skill, care, and patience. Dispensing opti­ cians observe customers’ eyes, corneas, lids, and contact lenses with specialized instruments and microscopes. During several follow-up visits, opticians teach proper insertion, removal, and care of contact lenses. Work environment. Dispensing opticians work indoors main­ ly in medical offices, optical stores, or in large department or club stores. Opticians spend a fair amount of time on their feet. If they prepare lenses, they need to take precautions against the hazards of glass cutting, chemicals, and machinery. Most dis­ pensing opticians work about 40 hours a week, although a few work longer hours. Those in retail stores may work evenings and weekends. Some work part time.  Training, Other Qualifications, and Advancement Most workers entering this occupation receive their training on the job, mainly through apprenticeship programs that may last 2 years or longer. Some employers, though, prefer to hire people who have graduated from an opticianry program. Education and training. A high school diploma is all that is required to get into this occupation, but most workers have completed at least some college courses or a degree. Classes in physics, basic anatomy, algebra, and trigonometry as well as experience with computers are particularly valuable. These prepare dispensing opticians to learn job skills, including opti­ cal mathematics, optical physics, and the use of precision mea­ suring instruments and other machinery and tools. Most applicants for optician positions do not have any back­ ground in the field and learn mainly on the job. Large em­ ployers usually offer structured apprenticeship programs; small employers provide more informal, on-the-job training. Appren­ tices receive technical training and also learn office manage­ ment and sales. Under the supervision of an experienced opti­ cian, optometrist, or ophthalmologist, apprentices work directly with patients, fitting eyeglasses and contact lenses. Formal training in the field is offered in community colleges and in a few 4-year colleges and universities. As of 2007, the Commission on Opticianry Accreditation accredited 21 associ­ ate degree programs. Graduation from an accredited program in opticianry provides a nationally recognized credential. There also are shorter programs of 1 year or less.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Licensure. Twenty-one States require dispensing opticians to be licensed. States may require individuals to pass one or more of the following for licensure: a State practical exami­ nation, a State written examination, and certification examina­ tions offered by the American Board of Opticianry (ABO) and the National Contact Lens Examiners (NCLE). To qualify for the examinations, States often require applicants to complete postsecondary training or work as apprentices for 2 to 4 years. Some States that license dispensing opticians allow graduates of opticianry programs to take the licensure exam immediately upon graduation; others require a few months to a year of experi­ ence. Continuing education is commonly required for licensure renewal. Information about specific licensing requirements is available from the State board of occupational licensing. Certification and other qualifications. Any optician can ap­ ply to the ABO and the NCLE for certification of their skills, whether or not their State requires it. Certification signifies to customers and employers that an optician has a certain level of expertise. All applicants age 18 or older who have a high school diploma or equivalent are eligible for the exam, but some State licensing boards have additional eligibility requirements. Certification must be renewed every 3 years through continuing education. The State of Texas offers voluntary registration for the occupation. Dispensing opticians deal directly with the public, so they should be tactful, pleasant, and communicate well. Manual dexterity and the ability to do precision work are essential. Advancement. Many experienced dispensing opticians open their own optical stores. Others become managers of optical stores or sales representatives for wholesalers or manufacturers of eyeglasses or lenses.  Employment Dispensing opticians held about 66,000 jobs in 2006. About one-third of dispensing opticians worked in offices of optom­ etrists. Nearly one-third worked in health and personal care stores, including optical goods stores. Many of these stores of­ fer one-stop shopping. Customers may have their eyes exam­ ined, choose frames, and have glasses made on the spot. Some opticians work in optical departments of department stores or other general merchandise stores, such as warehouse clubs and superstores. Eleven percent worked in offices of physi­ cians, primarily ophthalmologists, who sell glasses directly to patients. Two percent were self-employed and ran their own unincorporated businesses.  Job Outlook Employment of dispensing opticians is expected to grow about as fast as average for all occupations through 2016, as the popu­ lation ages and demand for corrective lenses increases. Good job prospects are expected, but the occupation will remain rela­ tively small. Employment change. Employment in this occupation is ex­ pected to rise 9 percent over the 2006-16 decade. Middle age is a time when many individuals use corrective lenses for the first time, and elderly persons generally require more vision care than others. As the share of the population in these older age groups increases, more opticians will be needed to provide service to them. In addition, awareness is increasing of the im­ portance of regular eye exams across all age groups. A small,  Professional and Related Occupations 421  Projections data from the National Employment Matrix Occupational Title Opticians, dispensing.................................... ...............................  soc  Code 29-2081  Projected employment, 2016 72,000  Employment, 2006 66,000  Change, 2006-2016 Number Percent 5,700 9  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  but growing number of States require children as young as 5 to get eye exams, which is expected to increase the need for eye care services in those States. Fashion also influences demand. Frames come in a growing variety of styles, colors, and sizes, encouraging people to buy more than one pair. Moderating the need for optician services is the increasing use of laser surgery to correct vision problems. Although the surgery remains relatively more expensive than eyewear, pa­ tients who successfully undergo this surgery may not require glasses or contact lenses for several years. Also, new technol­ ogy is allowing people with minimal training to make the mea­ surements needed to fit glasses and may allow dispensing opti­ cians to work faster, limiting the need for more workers. There also is proposed legislation that, if passed, may require contact lens manufacturers to make lenses available to nonoptical retail outlets, which may allow them to be sold over the Internet, re­ ducing the need for opticians to provide contact lens services. Job prospects. Job prospects for entering the profession should be good as there is a regular need to replace those who leave the occupation or retire. Nevertheless, the number of job openings will be limited because the occupation is small. Also, dispensing opticians are vulnerable to changes in the business cycle because eyewear purchases often can be deferred for a time. Job prospects will be best for those who have taken for­ mal opticianry classes and those who master new technology, including new refraction systems, framing materials, and edg­ ing techniques.  Earnings Median annual earnings of dispensing opticians were $30,300 in May 2006. The middle 50 percent earned between $23,560 and $38,950. The lowest 10 percent earned less than $19,290, and the highest 10 percent earned more than $47,630. Median annual earnings in the industries employing the largest numbers of dispensing opticians in May 2006 were: Offices of physicians........................................................... $32,770 Health and personal care stores............................................. 31,850 Offices of health practitioner................................................ 29,200 Offices of optometrists.......................................................... 29,190 Benefits for opticians are generally determined by the indus­ tries in which they are employed. In general, those who work part-time or in small retail shops generally have fewer benefits than those who may work for large optical chains or depart­ ment stores. Self-employed opticians must provide their own benefits.  Related Occupations Other workers who deal with customers and perform delicate work include jewelers and precious stone and metal workers,   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  orthotists and prosthetists, and precision instrument and equip­ ment repairers. Ophthalmic laboratory technicians also per­ form many of the tasks that opticians perform. And because many opticians work in the retail industry, retail salesworkers also perform some of the same duties.  Sources of Additional Information To learn about voluntary certification for opticians who fit eye­ glasses, as well as a list of State licensing boards for opticians, contact: y American Board of Opticianry, 6506 Loisdale Rd„ Suite 209, Springfield, VA 22150. Internet: http://www.abo.org For information on voluntary certification for dispensing op­ ticians who fit contact lenses, contact: y National Contact Lens Examiners, 6506 Loisdale Rd., Suite 209, Springfield, VA 22150. Internet: http://www.abo-ncle.org  Pharmacy Technicians (0*NET 29-2052.00)  Significant Points •  • •  Job opportunities are expected to be good, especially for those with certification or previous work experi­ ence. Many technicians work evenings, weekends, and holi­ days. About 71 percent of jobs were in retail pharmacies, grocery stores, department stores, or mass retailers.  Nature of the Work Pharmacy technicians help licensed pharmacists provide medi­ cation and other health care products to patients. Technicians usually perform routine tasks to help prepare prescribed medi­ cation, such as counting tablets and labeling bottles. They also perform administrative duties, such as answering phones, stock­ ing shelves, and operating cash registers. Technicians refer any questions regarding prescriptions, drug information, or health matters to a pharmacist. (See the statement on pharmacists elsewhere in the Handbook.) Pharmacy technicians who work in retail or mail-order phar­ macies have varying responsibilities, depending on State rules and regulations. Technicians receive written prescriptions or requests for prescription refills from patients. They also may receive prescriptions sent electronically from the doctor’s of­ fice. They must verify that information on the prescription is complete and accurate. To prepare the prescription, technicians  422 Occupational Outlook Handbook  must retrieve, count, pour, weigh, measure, and sometimes mix the medication. Then, they prepare the prescription labels, se­ lect the type of prescription container, and affix the prescription and auxiliary labels to the container. Once the prescription is filled, technicians price and file the prescription, which must be checked by a pharmacist before it is given to the patient. Technicians may establish and maintain patient profiles, pre­ pare insurance claim forms, and stock and take inventory of prescription and over-the-counter medications. In hospitals, nursing homes, and assisted-living facilities, technicians have added responsibilities, including reading pa­ tients’ charts and preparing the appropriate medication. After the pharmacist checks the prescription for accuracy, the phar­ macy technician may deliver it to the patient. The technician then copies the information about the prescribed medication onto the patient’s profile. Technicians also may assemble a 24hour supply of medicine for every patient. They package and label each dose separately. The packages are then placed in the medicine cabinets of patients until the supervising pharmacist checks them for accuracy, and only then is the medication given to the patients. Pharmacy aides work closely with pharmacy technicians. They often are clerks or cashiers who primarily answer tele­ phones, handle money, stock shelves, and perform other clerical duties. (See the statement on pharmacy aides elsewhere in the Handbook.) Pharmacy technicians usually perform more com­ plex tasks than pharmacy aides, although in some States their duties and job titles may overlap. Work environment. Pharmacy technicians work in clean, or­ ganized, well-lighted, and well-ventilated areas. Most of their workday is spent on their feet. They may be required to lift heavy boxes or to use stepladders to retrieve supplies from high shelves. Technicians work the same hours that pharmacists work. These may include evenings, nights, weekends, and holidays, particularly in facilities that are open 24 hours a day such as hospitals and some retail pharmacies. As their seniority in­ creases, technicians often acquire increased control over the hours they work. There are many opportunities for part-time work in both retail and hospital settings.  ■ vs  ^ '  Pharmacy technicians prepare prescription medications for pa­ tients.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Training, Other Qualifications, and Advancement Most pharmacy technicians are trained on-the-job, but employ­ ers favor applicants who have formal training, certification, or previous experience. Strong customer service skills also are important. Pharmacy technicians may become supervisors, may move into specialty positions or into sales, or may become pharmacists. Education and training. Although most pharmacy techni­ cians receive informal on-the-job training, employers favor those who have completed formal training and certification. However, there are currently few State and no Federal require­ ments for formal training or certification of pharmacy tech­ nicians. Employers who have insufficient resources to give on-the-job training often seek formally educated pharmacy technicians. Formal education programs and certification em­ phasize the technician’s interest in and dedication to the work. In addition to the military, some hospitals, proprietary schools, vocational or technical colleges, and community colleges offer formal education programs. Formal pharmacy technician education programs require classroom and laboratory work in a variety of areas, including medical and pharmaceutical terminology, pharmaceutical cal­ culations, pharmacy recordkeeping, pharmaceutical techniques, and pharmacy law and ethics. Technicians also are required to learn medication names, actions, uses, and doses. Many train­ ing programs include internships, in which students gain handson experience in actual pharmacies. After completion, students receive a diploma, a certificate, or an associate’s degree, de­ pending on the program. Prospective pharmacy technicians with experience working as an aide in a community pharmacy or volunteering in a hospital may have an advantage. Employers also prefer applicants with experience managing inventories, counting tablets, measuring dosages, and using computers. In addition, a background in chemistry, English, and health education may be beneficial. Certification and other qualifications. Two organizations, the Pharmacy Technician Certification Board and the Institute for the Certification of Pharmacy Technicians, administer na­ tional certification examinations. Certification is voluntary in most States, but is required by some States and employers. Some technicians are hired without formal training, but under the condition that they obtain certification within a specified period of time. To be eligible for either exam, candidates must have a high school diploma or GED, no felony convictions of any kind within 5 years of applying, and no drug or pharmacy related felony convictions at any point. Employers, often phar­ macists, know that individuals who pass the exam have a stan­ dardized body of knowledge and skills. Many employers also will reimburse the costs of the exam. Under both programs, technicians must be recertified every 2 years. Recertification requires 20 hours of continuing educa­ tion within the 2-year certification period. At least 1 hour must be in pharmacy law. Continuing education hours can be earned from several different sources, including colleges, pharmacy as­ sociations, and pharmacy technician training programs. Up to 10 hours of continuing education can be earned on the job under the direct supervision and instruction of a pharmacist.  Professional and Related Occupations 423  Strong customer service and teamwork skills are needed be­ cause pharmacy technicians interact with patients, coworkers, and health care professionals. Mathematics, spelling, and read­ ing skills also are important. Successful pharmacy technicians are alert, observant, organized, dedicated, and responsible. They should be willing and able to take directions, but be able to work independently without constant instruction. They must be precise; details are sometimes a matter of life and death. Candidates interested in becoming pharmacy technicians can­ not have prior records of drug or substance abuse. Advancement. In large pharmacies and health-systems, phar­ macy technicians with significant training, experience and cer­ tification can be promoted to supervisory positions, mentoring and training pharmacy technicians with less experience. Some may advance into specialty positions such as chemo therapy technician and nuclear pharmacy technician. Others move into sales. With a substantial amount of formal training, some phar­ macy technicians go on to become pharmacists.  Employment Pharmacy technicians held about 285,000 jobs in 2006. About 71 percent of jobs were in retail pharmacies, either indepen­ dently owned or part of a drugstore chain, grocery store, depart­ ment store, or mass retailer. About 18 percent of jobs were in hospitals and a small proportion was in mail-order and Internet pharmacies, offices of physicians, pharmaceutical wholesalers, and the Federal Government.  Job Outlook Employment is expected to increase much faster than the av­ erage through 2016, and job opportunities are expected to be good. Employment change. Employment of pharmacy techni­ cians is expected to increase by 32 percent from 2006 to 2016, which is much faster than the average for all occupations. The increased number of middle-aged and elderly people—who use more prescription drugs than younger people—will spur demand for technicians throughout the projection period. In addition, as scientific advances bring treatments for an increas­ ing number of conditions, more pharmacy technicians will be needed to fill a growing number of prescriptions. As cost-conscious insurers begin to use pharmacies as pa­ tient-care centers, pharmacy technicians will assume responsi­ bility for some of the more routine tasks previously performed by pharmacists. In addition, they will adopt some of the admin­ istrative duties that were previously performed by pharmacy aides, such as answering phones and stocking shelves. Reducing the need for pharmacy technicians to some degree, however, will be the growing use of drug dispensing machines. These machines increase productivity by completing some of the pharmacy technician’s duties, namely counting pills and  placing them into prescription containers. These machines are only used for the most common medications, however, and their effect on employment should be minimal. Almost all States have legislated the maximum number of technicians who can safely work under a pharmacist at one time. Changes in these laws could directly affect employment. Job prospects. Good job opportunities are expected for full­ time and part-time work, especially for technicians with formal training or previous experience. Job openings for pharmacy technicians will result from employment growth, and from the need to replace workers who transfer to other occupations or leave the labor force.  Earnings Median hourly earnings of wage-and-salary pharmacy techni­ cians in May 2006 were $12.32. The middle 50 percent earned between $10.10 and $14.92. The lowest 10 percent earned less than $8.56, and the highest 10 percent earned more than $17.65. Median hourly earnings in the industries employing the largest numbers of pharmacy technicians in May 2006 were: General medical and surgical hospitals................................ $13.86 Grocery stores......................................................................... 12.78 Pharmacies and drug stores.....................................................11.50 Certified technicians may earn more. Shift differentials for working evenings or weekends also can increase earnings. Some technicians belong to unions representing hospital or gro­ cery store workers.  Related Occupations This occupation is most closely related to pharmacists and pharmacy aides. Workers in other medical support occupations include dental assistants, medical transcriptionists, medical re­ cords and health information technicians, occupational therapist assistants and aides, and physical therapist assistants and aides.  Sources of Additional Information For information on pharmacy technician certification programs, contact: y Pharmacy Technician Certification Board, 2215 Constitution Ave. NW„ Washington DC 20037-2985. Internet: http://www.ptcb.org y Institute for the Certification of Pharmacy Technicians, 2536 S. Old Hwy 94, Suite 214, St.Charles, MO 63303. Internet: http://www.nationaltechexam.org For a list of accredited pharmacy technician training pro­ grams, contact: y American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Internet: http://www.ashp.org  Projections data from the National Employment Matrix Occupational Title Pharmacy technicians... ....................................................................  soc  Employment,  Code  2006  29-2052  285,000  Projected employment,  2016 376,000  Change,  2006-2016 Number  91,000  Percent  32  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  424 Occupational Outlook Handbook  For pharmacy technician career information, contact:  y National Pharmacy Technician Association, P.O. Box 683148, Houston, TX 77268. Internet: http://www.pharmacytechnician.org  Radiologic Technologists and Technicians (0*NET 29-2034.00, 29-2034.01, 29-2034.02)  Significant Points •  Employment is projected to grow faster than aver­ age, and job opportunities are expected to be favor­ able.  •  Formal training programs in radiography are offered in hospitals, colleges and universities, and less fre­ quently at vocational-technical institutes; range in length from 1 to 4 years; and lead to a certificate, an associate degree, or a bachelor’s degree.  •  Although hospitals will remain the primary employ­ er, a number of new jobs will be found in physicians’ offices and diagnostic imaging centers.  Nature of the Work Radiologic technologists take x-rays and administer nonra­ dioactive materials into patients’ bloodstreams for diagnostic purposes. Radiologic technologists also referred to as radiographers, produce x-ray films (radiographs) of parts of the human body for use in diagnosing medical problems. They prepare patients for radiologic examinations by explaining the procedure, re­ moving jewelry and other articles through which x-rays can­ not pass, and positioning patients so that the parts of the body can be appropriately radiographed. To prevent unnecessary exposure to radiation, these workers surround the exposed area with radiation protection devices, such as lead shields, or limit the size of the x-ray beam. Radiographers position radiographic equipment at the correct angle and height over the appropriate area of a patient’s body. Using instruments similar to a measuring tape, they may measure the thickness of the section to be radiographed and set controls on the x-ray machine to produce radiographs of the appropriate density, detail, and contrast. They place the x-ray film under the part of the patient’s body to be examined and make the exposure. They then remove the film and develop it. Radiologic technologists must follow physicians’ orders precisely and conform to regulations concerning the use of radiation to protect themselves, their patients, and their co­ workers from unnecessary exposure. In addition to preparing patients and operating equipment, radiologic technologists keep patient records and adjust and maintain equipment. They also may prepare work schedules, evaluate purchases of equipment, or manage a radiology de­ partment.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Experienced radiographers may perform more complex im­ aging procedures. When performing fluoroscopies, for exam­ ple, radiographers prepare a solution of contrast medium for the patient to drink, allowing the radiologist (a physician who interprets radiographs) to see soft tissues in the body. Some radiographers specialize in computed tomography (CT), and are sometimes referred to as CT technologists. CT scans produce a substantial amount of cross-sectional x-rays of an area of the body. From those cross-sectional x-rays a three-dimensional image is made. The CT uses ionizing ra­ diation; therefore, it requires the same precautionary measures that radiographers use with other x-rays. Radiographers also can specialize in Magnetic Resonance Imaging as an MR technologist. MR, like CT, produces mul­ tiple cross-sectional images to create a 3-dimensional image. Unlike CT, MR uses non-ionizing radio frequency to generate image contrast. Another common specialty for radiographers specialize in is mammography. Mammographers use low dose x-ray sys­ tems to produce images of the breast. In addition to radiologic technologists, others who conduct diagnostic imaging procedures include cardiovascular tech­ nologists and technicians, diagnostic medical sonographers, and nuclear medicine technologists. (Each is discussed else­ where in the Handbook.) Work environment. Physical stamina is important in this occupation because technologists are on their feet for long periods and may lift or turn disabled patients. Technologists work at diagnostic machines but also may perform some pro­ cedures at patients’ bedsides. Some travel to patients in large vans equipped with sophisticated diagnostic equipment. Although radiation hazards exist in this occupation, they are minimized by the use of lead aprons, gloves, and other shield­ ing devices, as well as by instruments monitoring exposure  rJ  yf  -v ■ f §  «  Radiographers position equipment at the correct angle and height over the appropriate area of a patient’s body.  Professional and Related Occupations 425  to radiation. Technologists wear badges measuring radiation levels in the radiation area, and detailed records are kept on their cumulative lifetime dose. Most full-time radiologic technologists work about 40 hours a week. They may, however, have evening, weekend, or oncall hours. Opportunities for part-time and shift work also are available.  Training, Other Qualifications, and Advancement Preparation for this profession is offered in hospitals, colleges and universities, and less frequently at vocational-technical institutes. Hospitals employ most radiologic technologists. Employers prefer to hire technologists with formal training. Education and training. Formal training programs in ra­ diography range in length from 1 to 4 years and lead to a cer­ tificate, an associate degree, or a bachelor’s degree. Two-year associate degree programs are most prevalent. Some 1-year certificate programs are available for experi­ enced radiographers or individuals from other health occu­ pations, such as medical technologists and registered nurses, who want to change fields. A bachelor’s or master’s degree in one of the radiologic technologies is desirable for supervisory, administrative, or teaching positions. The Joint Review Committee on Education in Radiologic Technology accredits most formal training programs for the field. The committee accredited more than 600 radiography programs in 2007. Admission to radiography programs re­ quire, at a minimum, a high school diploma or the equivalent. High school courses in mathematics, physics, chemistry, and biology are helpful. The programs provide both classroom and clinical instruction in anatomy and physiology, patient care procedures, radiation physics, radiation protection, prin­ ciples of imaging, medical terminology, positioning of pa­ tients, medical ethics, radiobiology, and pathology. Licensure. Federal legislation protects the public from the hazards of unnecessary exposure to medical and dental radiation by ensuring that operators of radiologic equipment are properly trained. Under this legislation, the Federal Gov­ ernment sets voluntary standards that the States may use for accrediting training programs and licensing individuals who engage in medical or dental radiography. In 2007, 40 states required licensure for practicing radiologic technologists and technicians. Certification and other qualifications. The American Registry of Radiologic Technologists (ARRT) offers volun­ tary certification for radiologic technologists. In addition, 35 States use ARRT-administered exams for State licensing pur­ poses. To be eligible for certification, technologists generally must graduate from an accredited program and pass an exami­ nation. Many employers prefer to hire certified radiographers.  To be recertified, radiographers must complete 24 hours of continuing education every 2 years. Radiologic technologists should be sensitive to patients’ physical and psychological needs. They must pay attention to detail, follow instructions, and work as part of a team. In ad­ dition, operating complicated equipment requires mechanical ability and manual dexterity. Advancement. With experience and additional training, staff technologists may become specialists, performing CT scanning, MR, and angiography, a procedure during which blood vessels are x-rayed to find clots. Technologists also may advance, with additional education and certification, to become a radiologist assistant. Experienced technologists also may be promoted to super­ visor, chief radiologic technologist, and, ultimately, depart­ ment administrator or director. Depending on the institution, courses or a master’s degree in business or health administra­ tion may be necessary for the director’s position. Some technologists progress by specializing in the occu­ pation to become instructors or directors in radiologic tech­ nology programs; others take jobs as sales representatives or instructors with equipment manufacturers.  Employment Radiologic technologists held about 196,000 jobs in 2006. More than 60 percent of all jobs were in hospitals. Most other jobs were in offices of physicians; medical and diagnostic laboratories, including diagnostic imaging centers; and out­ patient care centers.  Job Outlook Employment is projected to grow faster than average, and job opportunities are expected to be favorable. Employment change. Employment of radiologic technolo­ gists is expected to increase by about 15 percent from 2006 to 2016, faster than the average for all occupations. As the popu­ lation grows and ages, there will be an increasing demand for diagnostic imaging. Although health care providers are en­ thusiastic about the clinical benefits of new technologies, the extent to which they are adopted depends largely on cost and reimbursement considerations. As technology advances many imaging modalities are becoming less expensive and their adoption is becoming more widespread. For example, digital imaging technology can improve the quality of the images and the efficiency of the procedure, but it remains slightly more expensive than analog imaging, a procedure during which the image is put directly on film. Despite this, digital imaging is becoming more widespread in many imaging facilities be­ cause of the advantages it provides over analog. Although hospitals will remain the principal employer of radiologic technologists, a number of new jobs will be found  Projections data from the National Employment Matrix Occupational Title Radiologic technologists and technicians...........................................  soc  Code 29-2034  Employment, 2006 196,000  Projected employment, 2016 226,000  Change, 2006-2016 Number Percent 30,000 15  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  426 Occupational Outlook Handbook  in offices of physicians and diagnostic imaging centers. Health facilities such as these are expected to grow through 2016, because of the shift toward outpatient care, encouraged by third-party payers and made possible by technological ad­ vances that permit more procedures to be performed outside the hospital. Job prospects. In addition to job growth, job openings also will arise from the need to replace technologists who leave the occupation. Radiologic technologists are willing to relocate and who also are experienced in more than one diagnostic im­ aging procedure—such as CT, MR, and mammography—will have the best employment opportunities as employers seek to control costs by using multi-credentialed employees. CT is becoming a frontline diagnosis tool. Instead of taking x-rays to decide whether a CT is needed, as was the practice before, it is often the first choice for imaging because of its accuracy. MR also is increasing in frequency of use. Tech­ nologists with credentialing in either of these specialties will be very marketable to employers.  Earnings Median annual earnings of radiologic technologists were $48,170 in May 2006. The middle 50 percent earned between $39,840 and $57,940. The lowest 10 percent earned less than $32,750, and the highest 10 percent earned more than $68,920. Median annual earnings in the industries employing the larg­ est numbers of radiologic technologists in 2006 were: Medical and diagnostis laboratories..................................$51,280 General medical and surgical hospitals............................... 48,830 Offices of physicians............................................................45,500  Related Occupations Radiologic technologists operate sophisticated equipment to help physicians, dentists, and other health practitioners diag­ nose and treat patients. Workers in related occupations in­ clude cardiovascular technologists and technicians, clinical laboratory technologists and technicians, diagnostic medical sonographers, nuclear medicine technologists, radiation ther­ apists, and respiratory therapists.  Sources of Additional Information For information on careers in radiologic technology, contact: >• American Society of Radiologic Technologists, 15000 Central Ave. SE., Albuquerque, NM 87123-3917. Internet: http://www.asrt.org For the current list of accredited education programs in ra­ diography, write to: y Joint Review Committee on Education in Radiologic Technology, 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606-3182. Internet: http://www.jrcert.org For certification information, contact: y American Registry of Radiologic Technologists, 1255 Northland Dr., St.Paul, MN 55120-1155. Internet: http://www.arrt.org  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Surgical Technologists (0*NET 29-2055.00)  Significant Points  •  Employment is expected to grow much faster than  •  average. Job opportunities will be best for technologists who are certified.  •  Training programs last 9 to 24 months and lead to a certificate, diploma, or associate degree.  •  Hospitals will continue to be the primary employer, although much faster employment growth is expect­ ed in other health care industries.  Nature of the Work Surgical technologists, also called scrubs and surgical or oper­ ating room technicians, assist in surgical operations under the supervision of surgeons, registered nurses, or other surgical personnel. Surgical technologists are members of operating room teams, which most commonly include surgeons, anes­ thesiologists, and circulating nurses. Before an operation, surgical technologists help prepare the operating room by setting up surgical instruments and equip­ ment, sterile drapes, and sterile solutions. They assemble both sterile and nonsterile equipment, as well as check and adjust it to ensure it is working properly. Technologists also get pa­ tients ready for surgery by washing, shaving, and disinfecting incision sites. They transport patients to the operating room, help position them on the operating table, and cover them with sterile surgical drapes. Technologists also observe patients’ vital signs, check charts, and help the surgical team put on sterile gowns and gloves. During surgery, technologists pass instruments and other sterile supplies to surgeons and surgeon assistants. They may hold retractors, cut sutures, and help count sponges, needles, supplies, and instruments. Surgical technologists help pre­ pare, care for, and dispose of specimens taken for laboratory analysis and help apply dressings. Some operate sterilizers, lights, or suction machines, and help operate diagnostic equip­ ment. After an operation, surgical technologists may help transfer patients to the recovery room and clean and restock the oper­ ating room. Certified surgical technologists with additional specialized education or training also may act in the role of the surgical first assistant or circulator. The surgical first assistant, as de­ fined by the American College of Surgeons (ACS,) provides aid in exposure, hemostasis (controlling blood flow and stop­ ping or preventing hemorrhage), and other technical functions under the surgeon’s direction that help the surgeon carry out a safe operation. A circulating technologist is the “unsterile” member of the surgical team who interviews the patient before surgery; prepares the patient; helps with anesthesia; obtains  Professional and Related Occupations 427  Surgical technologists assemble, check, and adjust both sterile and nonsterile equipment. and opens packages for the “sterile” people to remove the ster­ ile contents during the procedure; keeps a written account of the surgical procedure; and answers the surgeon’s questions about the patient during the surgery. Work environment. Surgical technologists work in clean, well-lighted, cool environments. They must stand for long pe­ riods and remain alert during operations. At times, they may be exposed to communicable diseases and unpleasant sights, odors, and materials. Most surgical technologists work a regular 40-hour week, although they may be on call or work nights, weekends, and holidays on a rotating basis.  Training, Other Qualifications, and Advancement Training programs last 9 to 24 months and lead to a certificate, diploma, or associate degree. Professional certification can help in getting jobs and promotions. Education and training. Surgical technologists receive their training in formal programs offered by community and junior colleges, vocational schools, universities, hospitals, and the military. In 2006, the Commission on Accreditation of Al­ lied Health Education Programs (CAAHEP) recognized more than 400 accredited training programs. Programs last from 9 to 24 months and lead to a certificate, diploma, or associate degree. High school graduation normally is required for ad­ mission. Recommended high school courses include health, biology, chemistry, and mathematics. Programs provide classroom education and supervised clini­ cal experience. Students take courses in anatomy, physiology, microbiology, pharmacology, professional ethics, and medical terminology. Other topics covered include the care and safety of patients during surgery, sterile techniques, and surgical pro­ cedures. Students also learn to sterilize instruments; prevent  and control infection; and handle special drugs, solutions, supplies, and equipment. Certification and other qualifications. Most employers pre­ fer to hire certified technologists. Technologists may obtain voluntary professional certification from the Liaison Council on Certification for the Surgical Technologist by graduating from a CAAHEP-accredited program and passing a national certification examination. They may then use the Certified Surgical Technologist (CST) designation. Continuing edu­ cation or reexamination is required to maintain certification, which must be renewed every 4 years. Certification also may be obtained from the National Center for Competency Testing (NCCT). To qualify to take the exam, candidates follow one of three paths: complete an accredited training program; undergo a 2-year hospital on-the-job train­ ing program; or acquire 7 years of experience working in the field. After passing the exam, individuals may use the desig­ nation Tech in Surgery-Certified, TS-C (NCCT). This certifi­ cation must be renewed every 5 years through either continu­ ing education or reexamination. Surgical technologists need manual dexterity to handle in­ struments quickly. They also must be conscientious, orderly, and emotionally stable to handle the demands of the operat­ ing room environment. Technologists must respond quickly and must be familiar with operating procedures in order to have instruments ready for surgeons without having to be told. They are expected to keep abreast of new developments in the field. Advancement. Technologists advance by specializing in a particular area of surgery, such as neurosurgery or open heart surgery. They also may work as circulating technologists. With additional training, some technologists advance to first assistant. Some surgical technologists manage central sup­ ply departments in hospitals, or take positions with insurance companies, sterile supply services, and operating equipment firms.  Employment Surgical technologists held about 86,000 jobs in 2006. About 70 percent of jobs for surgical technologists were in hospitals, mainly in operating and delivery rooms. Other jobs were in offices of physicians or dentists who perform outpatient sur­ gery and in outpatient care centers, including ambulatory sur­ gical centers. A few technologists, known as private scrubs, are employed directly by surgeons who have special surgical teams, like those for liver transplants.  Job Outlook Employment of surgical technologists is expected to grow much faster than the average for all occupations. Job oppor­ tunities will be best for technologists who are certified.  Projections data from the National Employment Matrix Occupational Title Surgical technologists............................................. .............................  soc Code 29-2055  Employment, 2006 86,000  Projected employment, 2016 107,000  Change, 2006-2016 Number Percent 21,000 24  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  428 Occupational Outlook Handbook  Employment change. Employment of surgical technolo­ gists is expected to grow 24 percent between 2006 and 2016, much faster than the average for all occupations, as the volume of surgeries increases. The number of surgical procedures is expected to rise as the population grows and ages. Older people, including the baby boom generation, who generally require more surgical procedures, will account for a larger portion of the general population. In addition, technological advances, such as fiber optics and laser technology, will per­ mit an increasing number of new surgical procedures to be performed and also will allow surgical technologists to assist with a greater number of procedures. Hospitals will continue to be the primary employer of surgi­ cal technologists, although much faster employment growth is expected in offices of physicians and in outpatient care cen­ ters, including ambulatory surgical centers. Job prospects. Job opportunities will be best for technolo­ gists who are certified.  Earnings Median annual earnings of wage-and-salary surgical tech­ nologists were $36,080 in May 2006. The middle 50 percent earned between $30,300 and $43,560. The lowest 10 percent earned less than $25,490, and the highest 10 percent earned more than $51,140. Median annual earnings in the indus­ tries employing the largest numbers of surgical technologists were: Offices of physicians..........................................................$37,300 Outpatient care centers.........................................................37,280 General medical and surgical hospitals............................... 35,840 Offices of dentists.................................................................34,160 Benefits provided by most employers include paid vacation and sick leave, health, medical, vision, dental insurance and life insurance, and retirement program. A few employers also provide tuition reimbursement and child care benefits.  Related Occupations Other health occupations requiring approximately 1 year of training after high school include dental assistants, licensed practical and licensed vocational nurses, clinical laboratory technologists and technicians, and medical assistants.  Sources of Additional Information For additional information on a career as a surgical technolo­ gist and a list of CAAHEP-accredited programs, contact: y Association of Surgical Technologists, 6 West Dry Creek Circle, Suite 200, Littleton, CO 80120. Internet: http://www.ast.org For information on becoming a Certified Surgical Technolo­ gist, contact: V Liaison Council on Certification for the Surgical Technologist, 6 West Dry Creek Circle, Suite 100, Littleton, CO 80120. Internet: http://www.lcc-st.org For information on becoming a Tech in Surgery-Certified, contact: y National Center for Competency Testing, 7007 College Blvd., Suite 705, Overland Park, KS 66211.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Veterinary Technologists and Technicians (0*NET 29-2056.00)  Significant Points  •  Animal lovers get satisfaction from this occupation, but aspects of the work can be unpleasant, physically and emotionally demanding, and sometimes dangerous.  •  Entrants generally complete a 2-year or 4-year veteri­ nary technology program and must pass a State exami­ nation. Employment is expected to grow much faster than av­  • •  erage. Overall job opportunities should be excellent; howev­ er, keen competition is expected for jobs in zoos and aquariums.  Nature of the Work Owners of pets and other animals today expect state-of-the-art veterinary care. To provide this service, veterinarians use the skills of veterinary technologists and technicians, who perform many of the same duties for a veterinarian that a nurse would for a physician, including routine laboratory and clinical procedures. Although specific job duties vary by employer, there often is lit­ tle difference between the tasks carried out by technicians and by technologists, despite some differences in formal education and training. As a result, most workers in this occupation are called technicians. Veterinary technologists and technicians typically conduct clin­ ical work in a private practice under the supervision of a licensed veterinarian. They often perform various medical tests and treat and diagnose medical conditions and diseases in animals. For example, they may perform laboratory tests such as urinalysis and blood counts, assist with dental prophylaxis, prepare tissue samples, take blood samples, or assist veterinarians in a variety of tests and analyses in which they often use various items of medical equipment, such as test tubes and diagnostic equipment. While most of these duties are performed in a laboratory set­ ting, many are not. For example, some veterinary technicians obtain and record patients’ case histories, expose and develop x-rays and radiographs, and provide specialized nursing care. In addition, experienced veterinary technicians may discuss a pet’s condition with its owners and train new clinic personnel. Veteri­ nary technologists and technicians assisting small-animal prac­ titioners usually care for companion animals, such as cats and dogs, but can perform a variety of duties with mice, rats, sheep, pigs, cattle, monkeys, birds, fish, and frogs. Very few veterinary technologists work in mixed animal practices where they care for both small companion animals and larger, nondomestic animals. Besides working in private clinics and animal hospitals, vet­ erinary technologists and technicians may work in research fa­ cilities, where they administer medications orally or topically, prepare samples for laboratory examinations, and record infor-  Professional and Related Occupations 429  ■ ■■■ ;•  Many veterinary technologists and technicians assist veterinar­ ians in routine laboratory and clinical procedures. mation on an animal’s genealogy, diet, weight, medications, food intake, and clinical signs of pain and distress. Some may steril­ ize laboratory and surgical equipment and provide routine post­ operative care. At research facilities, veterinary technologists typically work under the guidance of veterinarians or physicians. Some veterinary technologists vaccinate newly admitted animals and occasionally may have to euthanize seriously ill, severely injured, or unwanted animals. While the goal of most veterinary technologists and techni­ cians is to promote animal health, some contribute to human health as well. Veterinary technologists occasionally assist vet­ erinarians in implementing research projects as they work with other scientists in medical-related fields such as gene therapy and cloning. Some find opportunities in biomedical research, wildlife medicine, the military, livestock management, or phar­ maceutical sales. Work environment. People who love animals get satisfaction from working with and helping them. However, some of the work may be unpleasant, physically and emotionally demanding, and sometimes dangerous. At times, veterinary technicians must clean cages and lift, hold, or restrain animals, risking exposure to bites or scratches. These workers must take precautions when treating animals with germicides or insecticides. The work set­ ting can be noisy. Veterinary technologists and technicians who witness abused animals or who euthanize unwanted, aged, or hopelessly injured animals may experience emotional stress. Those working for humane societies and animal shelters often deal with the public, some of whom might react with hostility to any implication that the owners are neglecting or abusing their pets. Such workers must maintain a calm and professional demeanor while they en­ force the laws regarding animal care. In some animal hospitals, research facilities, and animal shel­ ters, a veterinary technician is on duty 24 hours a day, which means that some may work night shifts. Most full-time veteri­ nary technologists and technicians work about 40 hours a week, although some work 50 or more hours a week.  Training, Other Qualifications, and Advancement There are primarily two levels of education and training for entry to this occupation: a 2-year program for veterinary technicians and a 4-year program for veterinary technologists.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Education and training. Most entry-level veterinary techni­ cians have a 2-year associate degree from an American Veterinary Medical Association (AVMA)-accredited community college program in veterinary technology in which courses are taught in clinical and laboratory settings using live animals. About 16 colleges offer veterinary technology programs that are longer and that culminate in a 4-year bachelor’s degree in veterinary tech­ nology. These 4-year colleges, in addition to some vocational schools, also offer 2-year programs in laboratory animal science. Several schools offer distance learning. In 2006, 131 veterinary technology programs in 44 States were accredited by the American Veterinary Medical Associa­ tion (AVMA). Graduation from an AVMA-accredited veterinary technology program allows students to take the credentialing exam in any State in the country. Persons interested in careers as veterinary technologists and technicians should take as many high school science, biology, and math courses as possible. Science courses taken beyond high school, in an associate or bachelor’s degree program, should emphasize practical skills in a clinical or laboratory setting. Technologists and technicians usually begin work as trainees in routine positions under the direct supervision of a veterinarian. Entry-level workers whose training or educational background encompasses extensive hands-on experience with a variety of laboratory equipment, including diagnostic and medical equip­ ment, usually require a shorter period of on-the-job training. Licensure and certification. Each State regulates veterinary technicians and technologists differently; however, all States re­ quire them to pass a credentialing exam following coursework. Passing the State exam assures the public that the technician or technologist has sufficient knowledge to work in a veterinary clinic or hospital. Candidates are tested for competency through an examination that includes oral, written, and practical portions and that is regulated by the State Board of Veterinary Examiners or the appropriate State agency. Depending on the State, candi­ dates may become registered, licensed, or certified. Most States, however, use the National Veterinary Technician (NVT) exam. Prospects usually can have their passing scores transferred from one State to another, so long as both States use the same exam. Employers recommend American Association for Laboratory Animal Science (AALAS) certification for those seeking em­ ployment in a research facility. AALAS offers certification for three levels of technician competence, with a focus on three prin­ cipal areas—animal husbandry, facility management, and animal health and welfare. Those who wish to become certified must satisfy a combination of education and experience requirements prior to taking the AALAS examination. Work experience must be directly related to the maintenance, health, and well-being of laboratory animals and must be gained in a laboratory animal fa­ cility as defined by AALAS. Candidates who meet the necessary criteria can begin pursuing the desired certification on the basis of their qualifications. The lowest level of certification is As­ sistant Laboratory Animal Technician (ALAT), the second level is Laboratory Animal Technician (LAT), and the highest level of certification is Laboratory Animal Technologist (LATG). The AALAS examination consists of multiple-choice questions and is longer and more difficult for higher levels of certification, rang­  430 Occupational Outlook Handbook  ing from 2 hours and 120 multiple choice questions for the ALAT to 3 hours and 180 multiple choice questions for the LATG. Other qualifications. As veterinary technologists and techni­ cians often deal with pet owners, communication skills are very important. In addition, technologists and technicians should be able to work well with others, because teamwork with veterinar­ ians is common. Organizational ability and the ability to pay attention to detail also are important. Advancement. As they gain experience, technologists and technicians take on more responsibility and carry out more as­ signments under only general veterinary supervision. Some eventually may become supervisors.  Employment Veterinary technologists and technicians held about 71,000 jobs in 2006. About 91 percent worked in veterinary services. The remainder worked in boarding kennels, animal shelters, stables, grooming salons, zoos, State and private educational institutions, and local, State, and Federal agencies. Job Outlook Excellent job opportunities will stem from the need to replace veterinary technologists and technicians who leave the occupa­ tion and from the limited output of qualified veterinary techni­ cians from 2-year programs, which are not expected to meet the demand over the 2006-16 period. Employment is expected to grow much faster than average. Employment change. Employment of veterinary technologists and technicians is expected to grow 41 percent over the 2006-16 projection period, which is much faster than the average for all occupations. Pet owners are becoming more affluent and more willing to pay for advanced veterinary care because many of them consider their pet to be part of the family. This growing af­ fluence and view of pets will continue to increase the demand for veterinary care. The vast majority of veterinary technicians work at private clinical practice under veterinarians. As the number of veterinarians grows to meet the demand for veterinary care, so will the number of veterinary technicians needed to assist them. The number of pet owners who take advantage of veterinary services for their pets—currently about 6 in 10—is expected to grow over the projection period, increasing employment oppor­ tunities. The availability of advanced veterinary services, such as preventive dental care and surgical procedures, also will provide opportunities for workers specializing in those areas as they will be needed to assist licensed veterinarians. The rapidly growing number of cats kept as companion pets is expected to boost the demand for feline medicine and services. Further demand for these workers will stem from the desire to replace veterinary as­ sistants with more highly skilled technicians and technologists in animal clinics and hospitals, shelters, boarding kennels, and humane societies.  Biomedical facilities, diagnostic laboratories, wildlife facili­ ties, humane societies, animal control facilities, drug or food manufacturing companies, and food safety inspection facilities will provide additional jobs for veterinary technologists and technicians. However, keen competition is expected for veteri­ nary technologist and technician jobs in zoos and aquariums, due to expected slow growth in facility capacity, low turnover among workers, the limited number of positions, and the fact that the work in zoos and aquariums attracts many candidates. Job prospects. Excellent job opportunities are expected be­ cause of the relatively few veterinary technology graduates each year. The number of 2-year programs has recently grown to 131, but due to small class sizes, fewer than 3,000 graduates are anticipated each year, which is not expected to meet demand. Additionally, many veterinary technicians remain in the field for only 7-8 years, so the need to replace workers who leave the oc­ cupation each year also will produce many job opportunities. Employment of veterinary technicians and technologists is relatively stable during periods of economic recession. Layoffs are less likely to occur among veterinary technologists and tech­ nicians than in some other occupations because animals will con­ tinue to require medical care.  Earnings Median hourly earnings of veterinary technologists and techni­ cians were $12.88 in May 2006. The middle 50 percent earned between $10.44 and $15.77. The bottom 10 percent earned less than $8.79, and the top 10 percent earned more than $18.68.  Related Occupations Others who work extensively with animals include animal care and service workers, and veterinary assistants and laboratory ani­ mal caretakers. Like veterinary technologists and technicians, they must have patience and feel comfortable with animals. However, the level of training required for these occupations is less than that needed by veterinary technologists and technicians. Veterinarians, who need much more formal education, also work extensively with animals, preventing, diagnosing, and treating their diseases, disorders, and injuries.  Sources of Additional Information For information on certification as a laboratory animal technician or technologist, contact: y American Association for Laboratory Animal Science, 9190 Crestwyn Hills Dr., Memphis, TN 38125. Internet: http://www.aalas.org For information on careers in veterinary medicine and a listing of AVMA-accredited veterinary technology programs, contact: y American Veterinary Medical Association, 1931 N. Meacham Rd„ Suite 100, Schaumburg, IL 60173-4360. Internet: http://www.avma.org  Projections data from the National Employment Matrix Occupational Title Veterinary technologists and technicians............................................  SOC Code 29-2056  Employment, 2006 71,000  Projected employment, 2016 100,000  Change, 2006-2016 Number Percent 29,000 41  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Service Occupations Healthcare Support Occupations Dental Assistants (0*NET 31-9091.00)  Significant Points •  Job prospects should be excellent.  •  Dentists are expected to hire more assistants to per­ form routine tasks so that they may devote their own time to more complex procedures.  •  Many assistants learn their skills on the job, although an increasing number are trained in dental-assisting programs; most programs take 1 year or less to com­ plete.  Nature of the Work Dental assistants work closely with, and under the supervision of, dentists. (See the statement on dentists elsewhere in the Handbook.) Assistants perform a variety of patient care, office, and laboratory duties. Dental assistants should not be confused with dental hy­ gienists, who are licensed to perform different clinical tasks. (See the statement on dental hygienists elsewhere in the Hand­ book.) Dental assistants sterilize and disinfect instruments and equipment, prepare and lay out the instruments and materials required to treat each patient, and obtain patients’ dental re­ cords. Assistants make patients as comfortable as possible in the dental chair and prepare them for treatment. During dental procedures, assistants work alongside the dentist to provide as­ sistance. They hand instruments and materials to dentists and keep patients’ mouths dry and clear by using suction or other devices. They also instruct patients on postoperative and gen­ eral oral health care. Dental assistants may prepare materials for impressions and restorations, take dental x-rays, and process x-ray film as di­ rected by a dentist. They also may remove sutures, apply topi­ cal anesthetics to gums or cavity-preventive agents to teeth, remove excess cement used in the filling process, and place rubber dams on the teeth to isolate them for individual treat­ ment. Some States are expanding dental assistants’ duties to include tasks such as coronal polishing and restorative dentistry functions for those assistants that meet specific training and ex­ perience requirements. Dental assistants with laboratory duties make casts of the teeth and mouth from impressions, clean and polish removable appliances, and make temporary crowns. Those with office du­ ties schedule and confirm appointments, receive patients, keep  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  treatment records, send bills, receive payments, and order den­ tal supplies and materials. Work environment. Dental assistants work in a well-lighted, clean environment. Their work area usually is near the den­ tal chair so that they can arrange instruments, materials, and medication and hand them to the dentist when needed. Den­ tal assistants must wear gloves, masks, eyewear, and protective clothing to protect themselves and their patients from infectious diseases. Assistants also follow safety procedures to minimize the risks associated with the use of x-ray machines. About half of dental assistants have a 35- to 40-hour work­ week. Most of the rest work part-time or have variable sched­ ules. Depending on the hours of the dental office where they work, assistants may have to work on Saturdays or evenings. Some dental assistants hold multiple jobs by working at dental offices that are open on different days or scheduling their work at a second office around the hours they work at their primary office.  Training, Other Qualifications, and Advancement Many assistants learn their skills on the job, although an in­ creasing number are trained in dental-assisting programs of­ fered by community and junior colleges, trade schools, techni­ cal institutes, or the Armed Forces. Education and training. High school students interested in a career as a dental assistant should take courses in biology, chemistry, health, and office practices. For those wishing to pursue further education, the Commission on Dental Accredita­ tion within the American Dental Association (ADA) approved 269 dental-assisting training programs in 2006. Programs in­ clude classroom, laboratory, and preclinical instruction in den­ tal-assisting skills and related theory. In addition, students gain practical experience in dental schools, clinics, or dental offices. Most programs take 1 year or less to complete and lead to a cer­ tificate or diploma. Two-year programs offered in community  : --£■  .. ... -  k ' ■  Dental assistants prepare and lay out the instruments and ma­ terials required to treat each patient. 431  432 Occupational Outlook Handbook  and junior colleges lead to an associate degree. All programs re­ quire a high school diploma or its equivalent, and some require science or computer-related courses for admission. A number of private vocational schools offer 4- to 6-month courses in den­ tal assisting, but the Commission on Dental Accreditation does not accredit these programs. A large number of dental assistants learn through on-the-job training. In these situations, the employing dentist or other den­ tal assistants in the dental office teach the new assistant dental terminology, the names of the instruments, how to perform daily duties, how to interact with patients, and other things necessary to help keep the dental office running smoothly. While some things can be picked up easily, it may be a few months before new dental assistants are completely knowledgeable about their duties and comfortable doing all of their tasks without assis­ tance. A period of on-the-job training is often required even for those that have completed a dental-assisting program or have some previous experience. Different dentists may have their own styles of doing things that need to be learned before an assistant can be comfortable working with them. Office-spe­ cific information, such as where files are kept, will need to be learned at each new job. Also, as dental technology changes, dental assistants need to stay familiar with the tools and proce­ dures that they will be using or helping dentists to use. On-thejob training is often sufficient to keep assistants up-to-date on these matters. Licensure. Most States regulate the duties that dental as­ sistants are allowed to perform. Some States require licensure or registration, which may include passing a written or practi­ cal examination. There are a variety of schools offering cours­ es—approximately 10 to 12 months in length—that meet their State’s requirements. Other States require dental assistants to complete State-approved education courses of 4 to 12 hours in length. Some States offer registration of other dental assisting credentials with little or no education required. Some States re­ quire continuing education to maintain licensure or registration. A few States allow dental assistants to perform any function delegated to them by the dentist. Individual States have adopted different standards for den­ tal assistants who perform certain advanced duties. In some States, for example, dental assistants who perform radiological procedures must complete additional training. Completion of the Radiation Health and Safety examination offered by Dental Assisting National Board (DANB) meets the standards in more than 30 States. Some States require completion of a State-ap­ proved course in radiology as well. Certification and other qualifications. Certification is avail­ able through the Dental Assisting National Board (DANB) and is recognized or required in more than 30 States. Certification is an acknowledgment of an assistant’s qualifications and pro­  fessional competence and may be an asset when one is seeking employment. Candidates may qualify to take the DANB cer­ tification examination by graduating from an ADA-accredited dental assisting education program or by having 2 years of full­ time, or 4 years of part-time, experience as a dental assistant. In addition, applicants must have current certification in cardio­ pulmonary resuscitation. For annual recertification, individuals must earn continuing education credits. Other organizations offer registration, most often at the State level. Dental assistants must be a second pair of hands for a dentist; therefore, dentists look for people who are reliable, work well with others, and have good manual dexterity. Advancement. Without further education, advancement op­ portunities are limited. Some dental assistants become office managers, dental-assisting instructors, dental product sales representatives, or insurance claims processors for dental insur­ ance companies. Others go back to school to become dental hy­ gienists. For many, this entry-level occupation provides basic training and experience and serves as a steppingstone to more highly skilled and higher paying jobs.  Employment Dental assistants held about 280,000 jobs in 2006. Almost all jobs for dental assistants were in offices of dentists. A small number of jobs were in the Federal, State, and local govern­ ments or in offices of physicians. About 35 percent of dental assistants worked part time, sometimes in more than one dental office.  Job Outlook Employment is expected to increase much faster than average; job prospects are expected to be excellent. Employment change. Employment is expected to grow 29 percent from 2006 to 2016, which is much faster than the aver­ age for all occupations. In fact, dental assistants are expected to be among the fastest growing occupations over the 2006-16 projection period. Population growth, greater retention of natural teeth by middle-aged and older people, and an increased focus on pre­ ventative dental care for younger generations will fuel demand for dental services. Older dentists, who have been less likely to employ assistants or have employed fewer, are leaving the occupation and will be replaced by recent graduates, who are more likely to use one or more assistants. In addition, as den­ tists’ workloads increase, they are expected to hire more assis­ tants to perform routine tasks, so that they may devote their own time to more complex procedures. Job prospects. Job prospects for dental assistants should be excellent. In addition to job openings due to employment growth, numerous job openings will arise out of the need to replace assistants who transfer to other occupations, retire, or  Projections data from the National Employment Matrix Occupational Title Dental assistants...................................................... .............................  soc Code 31-9091  Employment, 2006 280,000  Projected employment, 2016 362,000  Change, 2006-16 Number Percent 82,000 29  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Occupational Informa­  Service Occupations 433  leave for other reasons. Many opportunities for entry-level po­ sitions offer on-the-job training, but some dentists prefer to hire experienced assistants or those who have completed a dentalassisting program.  , j :  J  I  Earnings  ■'K-i  Median hourly earnings of dental assistants were $14.53 in May 2006. The middle 50 percent earned between $11.94 and $17.44 an hour. The lowest 10 percent earned less than $9.87, and the highest 10 percent earned more than $20.69 an hour. Benefits vary substantially by practice setting and may be con­ tingent upon full-time employment. According to the American Dental Association, 87 percent of dentists offer reimbursement for continuing education courses taken by their assistants.  Related Occupations Other workers supporting health practitioners include dental hygienists, medical assistants, surgical technologists, pharmacy aides, pharmacy technicians, occupational therapist assistants and aides, and physical therapist assistants and aides.  Sources of Additional Information Information about career opportunities and accredited dental assistant programs is available from: y Commission on Dental Accreditation, American Dental Association, 211 East Chicago Ave., Suite 1814, Chicago, IL 60611. Internet: http://www.ada.org For information on becoming a Certified Dental Assistant and a list of State boards of dentistry, contact: y Dental Assisting National Board, Inc., 676 North Saint Clair St., Suite 1880, Chicago, IL 60611. Internet: http://www.danb.org For more information on a career as a dental assistant and general information about continuing education, contact: y American Dental Assistants Association, 35 East Wacker Dr., Suite 1730, Chicago, IL 60601. Internet: http://www.dentalassistant.org For more information about continuing education courses, contact: y National Association of Dental Assistants, 900 South Washington St., Suite G-13, Falls Church, VA 22046.  Massage Therapists (0*NET 31-9011.00)  Significant Points •  Employment is expected to grow faster than average over the 2006-16 period as more people learn about the benefits of massage therapy.  •  Many States require formal training and national cer­ tification in order to practice massage therapy.  •  This occupation includes a large percentage of part­ time and self-employed workers.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Massage therapists improve circulation by rubbing or applying pressure to muscles.  Nature of the Work The medical benefits of “friction” were first documented in Western culture by the Greek physician Hippocrates around 400 BC. Today, massage therapy is being used as a means of treating painful ailments, decompressing tired and overworked muscles, reducing stress, rehabilitating sports injuries, and pro­ moting general health. This is done by manipulating the soft tissue muscles of the body in order to improve circulation and remove waste products from the muscles. Clients may seek massage for medical benefit or for relax­ ation purposes, and there is a wide range of massage treatment available to meet these distinct needs. Massage therapy that aims to improve physical health typically differs in duration and technique from massage that is intended to simply relax or reju­ venate clients. The training background of those who perform the two types of massage therapy differs as well. Massage therapists can specialize in over 80 different types of massage, called modalities. Swedish massage, deep tissue massage, reflexology, acupressure, sports massage, and neu­ romuscular massage are just a few of the many approaches to massage therapy. Most massage therapists specialize in several modalities, which require different techniques. Some use exag­ gerated strokes ranging the length of a body part, while oth­ ers use quick, percussion-like strokes with a cupped or closed hand. A massage can be as long as 2 hours or as short as 5 or 10 minutes. Usually, the type of massage given depends on the client’s needs and the client’s physical condition. For example, therapists may use special techniques for elderly clients that they would not use for athletes, and they would use approaches for clients with injuries that would not be appropriate for clients seeking relaxation. There are also some forms of massage that are given solely to one type of client, for example prenatal mas­ sage and infant massage. Massage therapists work by appointment. Before beginning a massage therapy session, therapists conduct an informal inter­ view with the client to find out about the person’s medical his­ tory and desired results from the massage. This gives therapists a chance to discuss which techniques could be beneficial to the client and which could be harmful. Because massage therapists tend to specialize in only a few areas of massage, customers will often be referred to or seek a therapist with a certain type of  434 Occupational Outlook Handbook  massage in mind. Based on the person’s goals, ailments, medi­ cal history, and stress- or pain-related problem areas, a massage therapist will conclude whether a massage would be harmful, and if not, move forward with the session. While giving the massage, therapists alter their approach or concentrate on any areas of particular discomfort as necessary. Many modalities of massage therapy use massage oils, lo­ tions, or creams to massage and rub the client’s muscles. Most massage therapists, particularly those who are self-employed, supply their own table or chair, sheets, pillows, and body lo­ tions or oils. Most modalities of massage require clients to be covered in a sheet or blanket, and require clients to be undressed or to wear loose-fitting clothing. The therapist only exposes the body part being massaged. Some types of massage are done without oils or lotions and are performed with the client fullyclothed. Massage therapists must develop a rapport with their clients if repeat customers are to be secured. Because those who seek a therapist tend to make regular visits, developing a loyal clien­ tele is an important part of becoming successful. Work environment. Massage therapists work in an array of settings both private and public: private offices, studios, hos­ pitals, nursing homes, fitness centers, sports medicine facili­ ties, airports, and shopping malls, for example. Some massage therapists also travel to clients’ homes or offices to provide a massage. It is not uncommon for full-time massage therapists to divide their time among several different settings, depending on the clients and locations scheduled. Most massage therapists give massages in dimly lit settings. Using candles and/or incense is not uncommon. Ambient or other calm, soothing music is often played. The dim lighting, smells, and background noise are meant to put clients at ease. On the other hand, when visiting a client’s office, a massage therapist may not have those amenities. The working condi­ tions depend heavily on a therapist’s location and what the cli­ ent wants. Because massage is physically demanding, massage thera­ pists can succumb to injury if the proper technique is not used. Repetitive motion problems and fatigue from standing for ex­ tended periods of time are most common. This risk can be lim­ ited by use of good technique, proper spacing between sessions, exercise, and in many cases by the therapists themselves receiv­ ing a massage on a regular basis. Because of the physical nature of the work and time needed in between sessions, massage therapists typically give massag­ es less than 40 hours per week. Most therapists who work 15 to 30 hours per week consider themselves to be full-time work­ ers, because when time for travel, equipment set-up, and busi­ ness functions, such as billing, are added, a massage therapist’s hours per week may very well be more than 40 hours. About 42 percent of all massage therapists worked part time and 20 percent had variable schedules in 2006.  Training, Other Qualifications, and Advancement In 2007,38 States and the District of Columbia had laws regulat­ ing massage therapy in some way. Most of the boards govern­ ing massage therapy in these States require practicing massage therapists to complete a formal education program and pass a   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  national certification examination or a State exam. It is best to check information on licensing, certification, and accreditation on a State-by-State basis. Education and training. Training standards and requirements for massage therapists vary greatly by State and locality. There are roughly 1,500 massage therapy postsecondary schools, col­ lege programs, and training programs throughout the country. Massage therapy programs generally cover subjects such as anatomy; physiology, the study of organs and tissues; kinesiol­ ogy, the study of motion and body mechanics; business; ethics; as well as hands-on practice of massage techniques. Training programs may concentrate on certain modalities of massage. Several programs also provide alumni services such as post­ graduate job placement and continuing educational services. Both full- and part-time programs are available. These programs vary in accreditation. Massage therapy training programs are generally approved by a State board, and may also be accredited by an independent accrediting agency. In States that regulate massage therapy, graduation from an ap­ proved school or training program is usually required in order to practice. Some State regulations require that therapists keep up on their knowledge and technique through continuing educa­ tion. Licensure. After completion of a training program, many massage therapists opt to take the National Certification Exam­ ination for Therapeutic Massage and Bodywork (NCETMB.) Many States require that therapists pass this test in order to practice massage therapy. The exam is administered by the Na­ tional Certification Board for Therapeutic Massage and Body­ work (NCBTMB), which has several eligibility requirements. In States that require massage therapy program approval, a can­ didate must graduate from a State-approved training institute or submit a portfolio of training experience for NCBTMB review to qualify for the test. In locations that do not require accred­ ited training programs, this is unnecessary. When a therapist passes the NCETMB, he or she can use the recognized national credential: Nationally Certified in Thera­ peutic Massage and Bodywork (NCTMB). The credential must be renewed every 4 years. In order to remain certified, a thera­ pist must perform at least 200 hours of therapeutic massage and complete continuing education requirements during this time. In 2005, the NCBTMB introduced a new national certification test and corresponding professional credential. The new test covers the same topics as the traditional national certification exam, but covers fewer modalities of massage therapy. Recog­ nition of this new national certification varies by State. Recently, a second multi-State examination program has be­ gun to take shape. The Federation of State Massage Therapy Boards offers a licensure program that is also accepted by many States. Massage therapy licensure boards decide which certifications and tests to accept on a State-by-State basis. Therefore, those wishing to practice massage therapy should look into legal re­ quirements for the State and locality in which they intend to practice. Other qualifications. Both strong communication skills and a friendly, empathetic personality are extremely helpful quali­ ties for fostering a trusting relationship with clients and in turn,  Service Occupations 435  expanding one’s client base. Massage can be a delicate issue for some clients and because of this, making clients feel comfortable is one of the most important abilities for massage therapists. Advancement. Membership in a professional massage thera­ py association may help therapists network and in turn, find new clients. Some of these associations require that members gradu­ ate from a nationally credentialed training program, have a State license, or be nationally certified by the NCBTMB. Because of the nature of massage therapy, opportunities for advancement are limited. However, with increased experience and an expanding client base, there are opportunities for thera­ pists to increase client fees and, therefore, income. In addition, those who are well organized and have an entrepreneurial spirit may go into business for themselves. Self-employed massage therapists with a large client base have the highest earnings.  Employment Massage therapists held about 118,000 jobs in 2006. About 64 percent were self-employed. There are many more people who practice massage therapy as a secondary source of income. As a result, some industry sources estimate that more than 200,000 people practice massage therapy in some capacity. Of those self-employed, most owned their own business, and the rest worked as independent contractors. Others found em­ ployment in salons and spas; the offices of physicians and chi­ ropractors; fitness and recreational sports centers; and hotels. While massage therapists can find jobs throughout the country, employment is concentrated in metropolitan areas, as well as re­ sort and destination locales.  selves as employee-friendly, providing professional in-office, seated massages for employees is becoming a popular on-the-job benefit. Older citizens in nursing homes or assisted living facilities are also finding benefits from massage, such as increased energy lev­ els and reduced health problems. Demand for massage therapy should grow among older age groups because they increasingly enjoy longer, more active lives and persons age 55 and older are projected to be the most rapidly growing segment of the U.S. population over the next decade. However, demand for massage therapy is presently greatest among young adults, and they are likely to continue to enjoy the benefits of massage therapy as they age. Job prospects. In States that regulate massage therapy, those who complete formal training programs and pass the national certification exam are likely to have very good opportunities. However, new massage therapists should expect to work only part-time in spas, hotels, hospitals, physical therapy centers, and other businesses until they can build a client base of their own. Because referrals are a very important source of work for mas­ sage therapists, networking will increase the number of job op­ portunities. Joining a State or local chapter of a professional as­ sociation can also help build strong contacts and further increase the likelihood of steady work. Female massage therapists will continue to enjoy slightly bet­ ter job prospects, as some clients—both male and female—are uncomfortable with male physical contact. In 2006, 84 percent of all massage therapists were female.  Job Outlook  Earnings  Employment growth for massage therapists is expected to be faster than average for all occupations with very good job pros­ pects, particularly for those seeking part-time work. Employment change. Employment for massage therapists is expected to increase 20 percent from 2006 to 2016, faster than average for all occupations. Employment will grow as more people learn about the benefits of massage therapy. Increased interest in alternative medicine and holistic heal­ ing will translate into new openings for those skilled in massage therapy. Healthcare providers and medical insurance companies are beginning to recognize massage therapy as a legitimate treat­ ment and preventative measure for several types of injuries and illnesses. The health care industry is using massage therapy more often as a supplement to conventional medical techniques for ail­ ments such as muscle problems, some sicknesses and diseases, and stress-related health problems. Massage therapy’s growing acceptance as a medical tool, particularly by the medical pro­ vider and insurance industries, will have the greatest impact on new job growth for massage therapists. Massage is an increasingly popular technique for relaxation and reduction of stress. As workplaces try to distinguish them­  Median wage and salary hourly earnings of massage therapists, including gratuities, were $16.06 in May 2006. The middle 50 percent earned between $10.98 and $24.22. The lowest 10 per­ cent earned less than $7.48, and the highest 10 percent earned more than $33.83. Generally, massage therapists earn 15 to 20 percent of their income as gratuities. For those who work in a hospital or other clinical setting, however, tipping is not com­ mon. As is typical for most workers who are self-employed and work part-time, few benefits are provided.  Related Occupations Other workers associated with the healthcare industry who pro­ vide therapy to clients include athletic trainers, physical thera­ pists, physical therapist assistants and aides, chiropractors, and workers in other occupations that use touch to aid healing or re­ lieve stress.  Sources of Additional Information General information on becoming a massage therapist is avail­ able from State regulatory boards.  Projections data from the National Employment Matrix Occupational Title Massage therapists................................................... .............................  soc Code 31-9011  Employment, 2006 118,000  Projected employment, 2016 142.000  Change, 2006-16 Number Percent 24.000 20  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  436 Occupational Outlook Handbook  For more information on becoming a massage therapist, con­ tact: X Associated Bodywork & Massage Professionals, 1271 Sugarbush Dr., Evergreen, CO 80439. Intemet:http://www.massagetherapy.com/careers/index.php y American Massage Therapy Association, 500 Davis St., Suite 900, Evanston, IL 60201. Internet: http://www.amtamassage.org For a directory of schools providing accredited massage ther­ apy training programs, contact: y Commission on Massage Therapy Accreditation, 1007 Church St., Suite 302, Evanston, IL 60201. Internet: http://www.comta.org y Accrediting Commission of Career Schools and Colleges of Technology, 2101 Wilson Blvd., Suite 302, Arlington, VA 22201. Internet: http://www.accsct.org Information on national testing and national certification is available from: y National Certification Board for Therapeutic Massage and Bodywork, 1901 S. Meyers Rd., Suite 240, Oakbrook Terrace, IL 60181. Internet: http://www.ncbtmb.com y Federation of State Massage Therapy Boards, 7111 W 151 st Street, Suite 356, Overland Park, Kansas 66223. Internet: http://www.fsmtb.org  Medical Assistants (0*NET 31-9092.00)  Significant Points  •  About 62 percent of medical assistants work in offices of physicians.  •  Some medical assistants are trained on the job, but many complete 1-year or 2-year programs.  •  Employment is projected to grow much faster than average, ranking medical assistants among the fastest growing occupations over the 2006-16 decade.  •  Job prospects should be excellent.  Nature of the Work Medical assistants perform administrative and clinical tasks to keep the offices of physicians, podiatrists, chiropractors, and other health practitioners running smoothly. They should not be confused with physician assistants, who examine, diagnose, and treat patients under the direct supervision of a physician. (Physician assistants are discussed elsewhere in the Hand­ book.) The duties of medical assistants vary from office to office, de­ pending on the location and size of the practice and the practi­ tioner’s specialty. In small practices, medical assistants usually do many different kinds of tasks, handling both administrative and clinical duties and reporting directly to an office manager, physician, or other health practitioner. Those in large practices tend to specialize in a particular area, under the supervision of department administrators.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Medical assistants who perform administrative tasks have many duties. They update and file patients’ medical records, fill out insurance forms, and arrange for hospital admissions and laboratory services. They also perform tasks less specific to medical settings, such as answering telephones, greeting pa­ tients, handling correspondence, scheduling appointments, and handling billing and bookkeeping. For clinical medical assistants, duties vary according to what is allowed by State law. Some common tasks include taking medical histories and recording vital signs, explaining treat­ ment procedures to patients, preparing patients for examina­ tions, and assisting physicians during examinations. Medical assistants collect and prepare laboratory specimens and some­ times perform basic laboratory tests on the premises, dispose of contaminated supplies, and sterilize medical instruments. They might instruct patients about medications and special diets, prepare and administer medications as directed by a physician, authorize drug refills as directed, telephone prescriptions to a pharmacy, draw blood, prepare patients for x-rays, take electro­ cardiograms, remove sutures, and change dressings. Medical assistants also may arrange examining room in­ struments and equipment, purchase and maintain supplies and equipment, and keep waiting and examining rooms neat and clean. Ophthalmic medical assistants, optometric assistants, and podiatric medical assistants are examples of specialized as­ sistants who have additional duties. Ophthalmic medical as­ sistants help ophthalmologists provide eye care. They conduct diagnostic tests, measure and record vision, and test eye muscle function. They also show patients how to insert, remove, and care for contact lenses, and they apply eye dressings. Under the direction of the physician, ophthalmic medical assistants may administer eye medications. They also maintain optical and surgical instruments and may assist the ophthalmologist in sur­ gery. Optometric assistants also help provide eye care, working with optometrists. They provide chair-side assistance, instruct patients about contact lens use and care, conduct preliminary tests on patients, and otherwise provide assistance while work­ ing directly with an optometrist. Podiatric medical assistants make castings of feet, expose and develop x-rays, and assist podiatrists in surgery.  in  Medical assistants who perform clinical tasks often record vital signs ofpatients.  Service Occupations 437  Work environment. Medical assistants work in well-lighted, clean environments. They constantly interact with other people and may have to handle several responsibilities at once. Most full-time medical assistants work a regular 40-hour week. How­ ever, many medical assistants work part time, evenings, or weekends.  Training, Other Qualifications, and Advancement Some medical assistants are trained on the job, but many com­ plete 1-year or 2-year programs. Education and training. Postsecondary medical assisting programs are offered in vocational-technical high schools, post­ secondary vocational schools, and community and junior colleg­ es. Programs usually last either 1 year and result in a certificate or diploma, or 2 years and result in an associate degree. Courses cover anatomy, physiology, and medical terminology, as well as typing, transcription, recordkeeping, accounting, and insurance processing. Students leam laboratory techniques, clinical and diagnostic procedures, pharmaceutical principles, the adminis­ tration of medications, and first aid. They study office practices, patient relations, medical law, and ethics. There are various or­ ganizations that accredit medical assisting programs. Accred­ ited programs often include an internship that provides practical experience in physicians’ offices, hospitals, or other health care facilities. Formal training in medical assisting, while generally pre­ ferred, is not always required. Some medical assistants are trained on the job, although this practice is less common than in the past. Applicants usually need a high school diploma or the equivalent. Recommended high school courses include math­ ematics, health, biology, typing, bookkeeping, computers, and office skills. Volunteer experience in the health care field also is helpful. Medical assistants who are trained on the job usu­ ally spend their first few months attending training sessions and working closely with more experienced workers. Some States allow medical assistants to perform more ad­ vanced procedures, such as giving injections, after passing a test or taking a course. Certification and other qualifications. Employers prefer to hire experienced workers or those who are certified. Although not required, certification indicates that a medical assistant meets certain standards of competence. There are various asso­ ciations—some listed in the sources of information below—that award certification credentials to medical assistants, and the cer­ tification process varies. It also is possible to become certified in a specialty, such as podiatry, optometry, or ophthalmology. Medical assistants deal with the public; therefore, they must be neat and well groomed and have a courteous, pleasant man­ ner and they must be able to put patients at ease and explain physicians’ instructions. They must respect the confidential na­  ture of medical information. Clinical duties require a reasonable level of manual dexterity and visual acuity. Advancement. Medical assistants may advance to other oc­ cupations through experience or additional training. For ex­ ample, some may go on to teach medical assisting, and others pursue additional education to become nurses or other health care workers. Administrative medical assistants may advance to office manager, or qualify for a variety of administrative support occupations.  Employment Medical assistants held about 417,000 jobs in 2006. About 62 percent worked in offices of physicians; 12 percent worked in public and private hospitals, including inpatient and outpatient facilities; and 11 percent worked in offices of other health prac­ titioners, such as chiropractors, optometrists, and podiatrists. Most of the remainder worked in other health care industries such as outpatient care centers and nursing and residential care facilities.  Job Outlook Employment is projected to grow much faster than average, ranking medical assistants among the fastest growing occupa­ tions over the 2006-16 decade. Job opportunities should be ex­ cellent, particularly for those with formal training or experience, and certification. Employment change. Employment of medical assistants is expected to grow 35 percent from 2006 to 2016, much faster than the average for all occupations. As the health care industry expands because of technological advances in medicine and the growth and aging of the population, there will be an increased need for all health care workers. Increasing use of medical as­ sistants in the rapidly growing health care industry will further stimulate job growth. Helping to drive job growth is the increasing number of group practices, clinics, and other health care facilities that need a high proportion of support personnel, particularly medical assistants who can handle both administrative and clinical duties. In addi­ tion, medical assistants work primarily in outpatient settings, a rapidly growing sector of the health care industry. Job prospects. Job seekers who want to work as a medical assistant should find excellent job prospects. Medical assistants are projected to account for a very large number of new jobs, and many other opportunities will come from the need to replace workers leaving the occupation. Those with formal training or experience—particularly those with certification—should have the best job opportunities.  Earnings The earnings of medical assistants vary, depending on their ex­ perience, skill level, and location. Median annual earnings of  Projections data from the National Employment Matrix Occupational Title Medical assistants.................................................... .............................  soc Code 31-9092  Employment, 2006 417,000  Projected employment, 2016 565.000  Change, 2006-16 Number Percent 148,000 35  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  438 Occupational Outlook Handbook  wage-and-salary medical assistants were $26,290 in May 2006. The middle 50 percent earned between $21,970 and $31,210. The lowest 10 percent earned less than $18,860, and the highest 10 percent earned more than $36,840. Median annual earnings in the industries employing the largest numbers of medical as­ sistants in May 2006 were: General medical and surgical hospitals............................... $27,340 Outpatient care centers.......................................................... 26,840 Offices of physicians............................................................. 26,620 Offices of chiropractors......................................................... 22,940 Offices of optometrists.......................................................... 22,850  Related Occupations Medical assistants perform work similar to the tasks completed by other workers in medical support occupations. Administra­ tive medical assistants do work similar to that of medical secre­ taries, medical transcriptionists, and medical records and health information technicians. Clinical medical assistants perform du­ ties similar to those of dental assistants; dental hygienists; occu­ pational therapist assistants and aides; pharmacy aides; licensed practical and licensed vocational nurses; surgical technologists; physical therapist assistants and aides; and nursing, psychiatric, and home health aides.  Sources of Additional Information Information about career opportunities and certification for med­ ical assistants is available from: y American Association of Medical Assistants, 20 North Wacker Dr., Suite 1575, Chicago, IL 60606. Internet: http://www.aama-ntl.org y American Medical Technologists, 10700 West Higgins Rd., Suite 150, Rosemont, IL 60018. Internet: http://www.amtl.com y National Healthcareer Association, 7 Ridgedale Ave., Suite 203, Cedar Knolls, NJ 07927. Information about career opportunities, training programs, and certification for ophthalmic medical personnel is available from: y Joint Commission on Allied Health Personnel in Ophthalmology, 2025 Woodlane Dr., St.Paul, MN 55125. Internet: http ://www.jcahpo.org/newsite/index.htm Information about career opportunities, training programs and certification for optometric assistants is available from: y American Optometric Association, 243 N. Lindbergh Blvd., St.Louis, MO 63141. Internet: http://www.aoa.org Information about certification for podiatric assistants is avail­ able from: y American Society of Podiatric Medical Assistants, 2124 South Austin Blvd., Cicero, IL 60804. Internet: http://www.aspma.org For lists of accredited educational programs in medical assist­ ing, contact: y Accrediting Bureau of Health Education Schools, 7777 Leesburg Pike, Suite 314 N, Falls Church, VA 22043. Internet: http://www.abhes.org y Commission on Accreditation of Allied Health Education Programs, 1361 Park St., Clearwater, FL 33756. Internet: http://www.caahep.org   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Medical Transcriptionists (0*NET 31-9094.00)  Significant Points  •  Job opportunities will be good.  •  Employers prefer medical transcriptionists who have completed a postsecondary training program.  •  Many medical transcriptionists telecommute from home-based offices.  •  About 41 percent worked in hospitals, and another 29 percent worked in offices of physicians.  Nature of the Work Medical transcriptionists listen to dictated recordings made by physicians and other health care professionals and transcribe them into medical reports, correspondence, and other adminis­ trative material. They generally listen to recordings on a head­ set, using a foot pedal to pause the recording when necessary, and key the text into a personal computer or word processor, editing as necessary for grammar and clarity. The documents they produce include discharge summaries, medical history and physical examination reports, operative reports, consultation reports, autopsy reports, diagnostic imaging studies, progress notes, and referral letters. Medical transcriptionists return tran­ scribed documents to the physicians or other health care pro­ fessionals who dictated them for review and signature or cor­ rection. These documents eventually become part of patients’ permanent files. To understand and accurately transcribe dictated reports, medical transcriptionists must understand medical terminology, anatomy and physiology, diagnostic procedures, pharmacology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms. To help identify terms appropriately, transcriptionists refer to stan­ dard medical reference materials—both printed and electronic; some of these are available over the Internet. Medical tran­ scriptionists must comply with specific standards that apply to the style of medical records and to the legal and ethical require­ ments for keeping patient information confidential. Experienced transcriptionists spot mistakes or inconsisten­ cies in a medical report and check to correct the information. Their ability to understand and correctly transcribe patient as­ sessments and treatments reduces the chance of patients receiv­ ing ineffective or even harmful treatments and ensures highquality patient care. Currently, most health care providers transmit dictation to medical transcriptionists using either digital or analog dictat­ ing equipment. The Internet has grown to be a popular mode for transmitting documentation. Many transcriptionists receive dictation over the Internet and are able to quickly return tran­ scribed documents to clients for approval. Another increasing­ ly popular method uses speech recognition technology, which electronically translates sound into text and creates drafts of reports. Transcriptionists then format the reports; edit them for  Service Occupations 439  mistakes in translation, punctuation, or grammar; and check for consistency and any wording that doesn’t make sense medical­ ly. Transcriptionists working in specialties, such as radiology or pathology, with standardized terminology are more likely to use speech recognition technology. However, speech recogni­ tion technology will become more widespread in all specialties as the technology becomes more sophisticated, that is, better able to recognize and more accurately transcribe diverse modes of speech. Medical transcriptionists who work in physicians’ offices may have other office duties, such as receiving patients, scheduling appointments, answering the telephone, and handling incoming and outgoing mail. Medical secretaries, discussed in the state­ ment on secretaries and administrative assistants elsewhere in the Handbook, also may transcribe as part of their jobs. Work environment. The majority of these workers are em­ ployed in comfortable settings, such as hospitals, physicians’ offices, transcription service offices, clinics, laboratories, medi­ cal libraries, government medical facilities, or their own homes. Many medical transcriptionists telecommute from home-based offices. Workers usually sit in the same position for long periods. They can suffer wrist, back, neck, or eye problems due to strain and risk repetitive motion injuries such as carpal tunnel syn-  ^2:  Medical transcriptionists listen to recordings on a headset, key the text into a personal computer or word processor, and edit for grammar and clarity.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  drome. The constant pressure to be accurate and productive also can be stressful. Many medical transcriptionists work a standard 40-hour week. Self-employed medical transcriptionists are more likely to work irregular hours—including part time, evenings, week­ ends, or on call at any time.  Training, Other Qualifications, and Advancement Postsecondary training in medical transcription is preferred by employers; writing and computer skills also are important. Education and training. Employers prefer to hire transcrip­ tionists who have completed postsecondary training in medical transcription offered by many vocational schools, community colleges, and distance-learning programs. Completion of a 2-year associate degree or 1-year certificate program—including coursework in anatomy, medical termi­ nology, legal issues relating to health care documentation, and English grammar and punctuation—is highly recommended, but not always required. Many of these programs include su­ pervised on-the-job experience. Some transcriptionists, espe­ cially those already familiar with medical terminology from previous experience as a nurse or medical secretary, become proficient through refresher courses and training. Formal accreditation is not required for medical transcription programs. However, the Approval Committee for Certificate Programs (AACP)—established by the Association for Health­ care Documentation Integrity (AHDI) and the American Health Information Management Association—offers voluntary ac­ creditation for medical transcription programs. Although vol­ untary, completion of an ACCP approved program may be re­ quired for transcriptionists seeking certification. Certification and other qualifications. The AHDI awards two voluntary designations, the Registered Medical Transcriptionist (RMT) and the Certified Medical Transcriptionist (CMT). Medical transcriptionists who are recent graduates of medical transcription educational programs, or have fewer than 2 years experience in acute care, may become a registered RMT. The RMT credential is awarded upon successfully pass­ ing the AHDI level 1 registered medical transcription exam. The CMT designation requires at least 2 years of acute care ex­ perience working in multiple specialty surgery areas using dif­ ferent format, report, and dictation types. Candidates also must earn a passing score on a certification examination. Because medicine is constantly evolving, medical transcriptionists are encouraged to update their skills regularly. RMTs and CMTs must earn continuing education credits every 3 years to be re­ certified. As in many other fields, certification is recognized as a sign of competence. Graduates of an ACCP approved program who earn the RMT credential are eligible to participate in the Registered Appren­ ticeship Program sponsored by the Medical Transcription In­ dustry Association through the U.S. Department of Labor. The Registered Apprenticeship program offers structured on-the-job learning and related technical instruction for qualified medical transcriptionists entering the profession. In addition to understanding medical terminology, transcrip­ tionists must have good English grammar and punctuation skills and proficiency with personal computers and word processing  440 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Medical transcriptionists....................................... ....................  soc  Employment,  Code  31-9094  2006 98,000  Projected employment,  2016 112,000  Change,  2006-16  Number  Percent  13,000  14  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. _______________________________________________  software. Normal hearing acuity and good listening skills also are necessary. Employers usually require applicants to take pre-employment tests. Advancement. With experience, medical transcriptionists can advance to supervisory positions, home-based work, edit­ ing, consulting, or teaching. Some become owners of medical transcription businesses. With additional education or training, some become medical records and health information techni­ cians, medical coders, or medical records and health informa­ tion administrators.  Employment Medical transcriptionists held about 98,000 jobs in 20006. About 41 percent worked in hospitals and another 29 percent worked in offices of physicians. Others worked for business support services; medical and diagnostic laboratories; outpa­ tient care centers; and offices of physical, occupational, and speech therapists, and audiologists.  Job Outlook Employment of medical transcriptionists is projected to grow faster than the average; job opportunities should be good, espe­ cially for those who are certified. Employment change. Employment of medical transcription­ ists is projected to grow 14 percent from 2006 to 2016, fast­ er than the average for all occupations. Demand for medical transcription services will be spurred by a growing and aging population. Older age groups receive proportionately greater numbers of medical tests, treatments, and procedures that re­ quire documentation. A high level of demand for transcription services also will be sustained by the continued need for elec­ tronic documentation that can be shared easily among provid­ ers, third-party payers, regulators, consumers, and health infor­ mation systems. Growing numbers of medical transcriptionists will be needed to amend patients’ records, edit documents from speech recognition systems, and identify discrepancies in medi­ cal reports. Contracting out transcription work overseas and advance­ ments in speech recognition technology are not expected to sig­ nificantly reduce the need for well-trained medical transcrip­ tionists. Outsourcing transcription work abroad—to countries such as India, Pakistan, Philippines, and the Caribbean—has grown more popular as transmitting confidential health infor­ mation over the Internet has become more secure; however, the demand for overseas transcription services is expected only to supplement the demand for well-trained domestic medical tran­ scriptionists. In addition, reports transcribed by overseas medi­ cal transcription services usually require editing for accuracy by domestic medical transcriptionists before they meet U.S. quality standards.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Speech-recognition technology allows physicians and other health professionals to dictate medical reports to a computer that immediately creates an electronic document. In spite of the advances in this technology, the software has been slow to grasp and analyze the human voice and the English language, and the medical vernacular with all its diversity. As a result, there will continue to be a need for skilled medical transcriptionists to identify and appropriately edit the inevitable errors created by speech recognition systems, and to create a final document. Job prospects. Job opportunities will be good, especially for those who are certified. Hospitals will continue to employ a large percentage of medical transcriptionists, but job growth there will not be as fast as in other industries. An increasing demand for standardized records should result in rapid employ­ ment growth in physicians’ offices, especially in large group practices.  Earnings Wage-and-salary medical transcriptionists had median hourly earnings of $ 14.40 in May 2006. The middle 50 percent earned between $12.17 and $17.06. The lowest 10 percent earned less than $10.22, and the highest 10 percent earned more than $20.15. Median hourly earnings in the industries employing the largest numbers of medical transcriptionists were: Medical and diagnostic laboratories..................................... $15.68 General medical and surgical hospitals................................... 14.62 Business support services........................................................14.34 Outpatient care centers.............................................................14.31 Offices of physicians................................................................14.00 Compensation methods for medical transcriptionists vary. Some are paid based on the number of hours they work or on the number of lines they transcribe. Others receive a base pay per hour with incentives for extra production. Employees of transcription services and independent contractors almost al­ ways receive production-based pay. Independent contractors earn more than do transcriptionists who work for others, but independent contractors have higher expenses than their corpo­ rate counterparts, receive no benefits, and may face higher risk of termination than do wage-and-salary transcriptionists.  Related Occupations Workers in other occupations also type, record information, and process paperwork. Among these are court reporters; human resources assistants, except payroll and timekeeping; reception­ ists and information clerks; and secretaries and administrative assistants. Other workers who provide medical support include medical assistants and medical records and health information technicians.  Service Occupations 441  Sources of Additional Information For information on a career as a medical transcriptionist, con­ tact: y Association for Healthcare Documentation Integrity, 4230 Kieman Ave., Suite 130, Modesto, CA 95356. Internet: http://www.ahdionline.org State employment service offices can provide information about job openings for medical transcriptionists.  Nursing, Psychiatric, and Home Health Aides (0*NET 31-1011.00, 31-1012.00, 31-1013.00)  Significant Points  •  Numerous job openings and excellent job opportuni­ ties are expected.  •  Most jobs are in nursing and residential care facilities, hospitals, and home health care services. This occupation is characterized by modest entry re­ quirements, low pay, high physical and emotional de­ mands, and limited advancement opportunities.  •  Nature of the Work Nursing and psychiatric aides help care for physically or men­ tally ill, injured, disabled, or infirm individuals in hospitals, nursing care facilities, and mental health settings. Home health aides have duties that are similar, but they work in patients’ homes or residential care facilities. Nursing aides and home health aides are among the occupations commonly referred to as direct care workers, due to their role in working with patients who need long-term care. The specific care they give depends on their specialty. Nursing aides—also known as nurse aides, nursing assistants, certified nursing assistants, geriatric aides, unlicensed assistive personnel, orderlies, or hospital attendants—provide hands-on care and perform routine tasks under the supervision of nursing and medical staff. Specific tasks vary, with aides handling many aspects of a patient’s care. They often help patients to eat, dress, and bathe. They also answer calls for help, deliver messages, serve meals, make beds, and tidy up rooms. Aides sometimes are responsible for taking a patient’s temperature, pulse rate, respiration rate, or blood pressure. They also may help provide care to patients by helping them get into and out of bed and walk, escorting them to operating and examining rooms, or pro­ viding skin care. Some aides help other medical staff by setting up equipment, storing and moving supplies, and assisting with some procedures. Aides also observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff. Nurse aides employed in nursing care facilities often are the principal caregivers, having far more contact with residents than do other members of the staff. Because some residents may stay in a nursing care facility for months or even years, aides   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  develop ongoing relationships with them and interact with them in a positive, caring way. Home health aides help elderly, convalescent, or disabled per­ sons live in their own homes instead of health care facilities. Under the direction of nursing or medical staff, they provide health-related services, such as administering oral medications. (Personal and home care aides, who provide mainly housekeep­ ing and routine personal care services, are discussed elsewhere in the Handbook.) Like nursing aides, home health aides may check patients’ pulse rate, temperature, and respiration rate; help with simple prescribed exercises; and help patients to get in and out of bed, bathe, dress, and groom. Occasionally, they change nonsterile dressings, give massages and provide skin care, or assist with braces and artificial limbs. Experienced home health aides, with training, also may assist with medical equipment such as ventilators, which help patients breathe. Most home health aides work with elderly or disabled per­ sons who need more extensive care than family or friends can provide. Some help discharged hospital patients who have rela­ tively short-term needs. In home health agencies, a registered nurse, physical thera­ pist, or social worker usually assigns specific duties to and su­ pervises home health aides, who keep records of the services they perform and record each patient’s condition and progress. The aides report changes in a patient’s condition to the supervi­ sor or case manager. Psychiatric aides, also known as mental health assistants or psychiatric nursing assistants, care for mentally impaired or emotionally disturbed individuals. They work under a team that may include psychiatrists, psychologists, psychiatric nurses, so­ cial workers, and therapists. In addition to helping patients to dress, bathe, groom themselves, and eat, psychiatric aides so­ cialize with them and lead them in educational and recreational activities. Psychiatric aides may play card games or other games with patients, watch television with them, or participate in group activities, such as playing sports or going on field trips. They observe patients and report any physical or behavioral signs that might be important for the professional staff to know. They ac­ company patients to and from therapy and treatment. Because they have such close contact with patients, psychiatric aides can have a great deal of influence on their outlook and treatment. Work environment. Work as an aide can be physically de­ manding. Aides spend many hours standing and walking, and they often face heavy workloads. Aides must guard against back injury because they may have to move patients into and out of bed or help them to stand or walk. It is important for aides to be trained in and to follow the proper procedures for lifting and moving patients. Aides also may face hazards from minor infec­ tions and major diseases, such as hepatitis, but can avoid infec­ tions by following proper procedures. Aides also perform tasks that some may consider unpleasant, such as emptying bedpans and changing soiled bed linens. The patients they care for may be disoriented, irritable, or uncoop­ erative. Psychiatric aides must be prepared to care for patients whose illness may cause violent behavior. Although their work can be emotionally demanding, many aides gain satisfaction from assisting those in need. Home health aides may go to the same patient’s home for months or even years. However, most aides work with a num­  442 Occupational Outlook Handbook  ber of different patients, each job lasting a few hours, days, or weeks. Home health aides often visit multiple patients on the same day. Home health aides generally work alone, with periodic visits from their supervisor. They receive detailed instructions ex­ plaining when to visit patients and what services to perform. Aides are individually responsible for getting to patients’ homes, and they may spend a good portion of the working day traveling from one patient to another. Because mechanical lifting devices available in institutional settings are not as frequently available in patients’ homes, home health aides must take extra care to avoid injuries resulting from overexertion when they assist pa­ tients. Most full-time aides work about 40 hours per week, but be­ cause patients need care 24 hours a day, some aides work eve­ nings, nights, weekends, and holidays. In 2006, 23 percent of aides worked part time compared with 15 percent of all work­ ers.  Training, Other Qualifications, and Advancement In many cases, a high school diploma or equivalent is neces­ sary for a job as a nursing or psychiatric aide. However, a high school diploma generally is not required for jobs as home health aides. Specific qualifications vary by occupation, State laws, and work setting. Advancement opportunities are limited. Education and training. Nursing and psychiatric aide train­ ing is offered in high schools, vocational-technical centers, some nursing care facilities, and some community colleges. Courses cover body mechanics, nutrition, anatomy and physiology, in­ fection control, communication skills, and resident rights. Per­ sonal care skills, such as how to help patients to bathe, eat, and groom themselves, also are taught. Hospitals may require pre­ vious experience as a nursing aide or home health aide. Some States also require psychiatric aides to complete a formal train­ ing program. However, most psychiatric aides learn their skills on the job from experienced workers. Home health aides are generally not required to have a high school diploma. They usually are trained on the job by reg­ istered nurses, licensed practical nurses, or experienced aides. Also, clients may prefer that tasks are done a certain way, and make those suggestions to the home health aide. A competency evaluation may be required to ensure the aide can perform the required tasks. Some employers provide classroom instruction for newly hired aides, while others rely exclusively on informal on-the-job instruction by a licensed nurse or an experienced aide. Such training may last from several days to a few months. Aides also may attend lectures, workshops, and in-service training. Licensure and certification. The Federal Government has guidelines for home health aides whose employers receive re­ imbursement from Medicare. Federal law requires home health aides to pass a competency test covering a wide range of areas. A home health aide may receive training before taking the com­ petency test. In addition, the National Association for Home Care and Hospice offers voluntary certification for home health aides. Some States also require aides to be licensed. Similar Federal requirements exist for nurse aides who work in nursing care facilities. These aides must complete a mini­ mum of 75 hours of state-approved training and pass a compe­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  tency evaluation. Aides who complete the program are known as certified nurse assistants (CNAs) and are placed on the State registry of nurse aides. Other qualifications. Aides must be in good health. A physi­ cal examination, including State-regulated tests such as those for tuberculosis, may be required. A criminal background check also is usually required for employment. Applicants should be tactful, patient, understanding, emo­ tionally stable, and dependable and should have a desire to help people. They also should be able to work as part of a team, have good communication skills, and be willing to perform repetitive, routine tasks. Home health aides should be honest and discreet because they work in private homes. They also will need access to a car or public transportation to reach patients’ homes. Advancement. Opportunities for advancement within these occupations are limited. Aides generally need additional for­ mal training or education to enter other health occupations. The most common health care occupations for former aides are li­ censed practical nurse, registered nurse, and medical assistant. For some individuals, these occupations serve as entry-level jobs. For example, some high school and college students gain experience working in these occupations while attending school. In addition, experience as an aide can help individuals decide whether to pursue a career in health care.  Employment Nursing, psychiatric, and home health aides held about 2.3 mil­ lion jobs in 2006. Nursing aides held the most jobs—approxi­ mately 1.4 million. Home health aides held roughly 787,000 jobs, and psychiatric aides held about 62,000 jobs. About 52 percent of nursing aides worked in nursing and residential care facilities and another 29 percent worked in hospitals. Home health aides were mainly employed by home health care ser­ vices, nursing and residential care facilities and social assistance agencies. About 47 percent of all psychiatric aides worked in  jHji  r 4  ttefc T ' i  Aides help care for physically or mentally ill, injured, disabled, or infirm individuals in a variety of settings.  Service Occupations 443  Projections data from the National Employment Matrix Occupational Title Nursing, psychiatric, and home health aides..................... ............... Home health aides............................................................. ............... Nursing aides, orderlies, and attendants......................... ............... Psychiatric aides................................................................. ...............  soc  Code  Employment, 2006  31-1000 31-1011 31-1012 31-1013  2,296,000 787,000 1,447,000 62,000  Projected employment, 2016 2,944,000 1,171,000 1,711,000 62,000  Change, 2006-16 Number Percent 647,000 28 384,000 49 264,000 18  0  0  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  hospitals, primarily in psychiatric and substance abuse hospitals, although some also worked in the psychiatric units of general medical and surgical hospitals. Others were employed in State government agencies; residential mental retardation, mental health, and substance abuse facilities; and nursing and residen­ tial care facilities.  Job Outlook Excellent job opportunities for nursing, psychiatric, and home health aides will arise from a combination of rapid employment growth and the need to replace the many workers who leave the occupation each year. Employment change. Overall employment of nursing, psy­ chiatric, and home health aides is projected to grow 28 percent between 2006 and 2016, much faster than the average for all occupations. However, growth will vary for the individual oc­ cupations. Home health aides are expected to gain jobs faster than other aides as a result of growing demand for home services from an aging population and efforts to contain costs by moving patients out of hospitals and nursing care facilities as quickly as possible. Consumer preference for care in the home and im­ provements in medical technologies for in-home treatment also will contribute to much-faster-than-average employment growth for home health aides. Nursing aide employment will not grow as fast as home health aide employment, largely because nursing aides are concentrated in relatively slower-growing industries. Employment of nursing aides is expected to grow faster than the average for all occupa­ tions through 2016, in response to the long-term care needs of an increasing elderly population. Financial pressures on hospitals to discharge patients as soon as possible should boost admis­ sions to nursing care facilities. As a result, job openings will be more numerous in nursing and residential care facilities than in hospitals. Modem medical technology also will drive demand for nursing aides because as the technology saves and extends more lives, it increases the need for long-term care provided by aides. Little or no change is expected in employment of psychiatric aides—the smallest of the three occupations. Most psychiatric aides currently work in hospitals, but the industries most likely to see growth will be residential facilities for people with de­ velopmental disabilities, mental illness, and substance abuse problems. There is a long-term trend toward treating psychi­ atric patients outside of hospitals because it is more cost effec­ tive and allows patients to live more independent lives. Demand for psychiatric aides in residential facilities will rise in response to the increase in the number of older persons, many of whom will require mental health services. Growing demand for these workers also rests on an increasing number of mentally disabled   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  adults who were formerly cared for by their elderly parents and who will continue to need care. Job growth also could be af­ fected by changes in government funding of programs for the mentally ill. Job prospects. High replacement needs for nursing, psychi­ atric, and home health aides reflect modest entry requirements, low pay, high physical and emotional demands, and limited op­ portunities for advancement within the occupation. For these same reasons, the number of people looking to enter the occupa­ tion will be limited. Many aides leave the occupation to attend training programs for other health care occupations. Therefore, people who are interested in, and suited for, this work should have excellent job opportunities.  Earnings Median hourly earnings of nursing aides, orderlies, and atten­ dants were $10.67 in May 2006. The middle 50 percent earned between $9.09 and $12.80 an hour. The lowest 10 percent earned less than $7.78, and the highest 10 percent earned more than $14.99 an hour. Median hourly earnings in the industries employing the largest numbers of nursing aides, orderlies, and attendants in May 2006 were: Local government.................................................................$12.15 Employment services.............................................................. 11.47 General medical and surgical hospitals...................................11.06 Nursing care facilities............................................................. 10.37 Community care facilities for the elderly...............................10.07 Nursing and psychiatric aides in hospitals generally receive at least 1 week of paid vacation after 1 year of service. Paid holidays and sick leave, hospital and medical benefits, extra pay for late-shift work, and pension plans also are available to many hospital employees and to some nursing care facility employ­ ees. Median hourly earnings of home health aides were $9.34 in May 2006. The middle 50 percent earned between $7.99 and $10.90 an hour. The lowest 10 percent earned less than $7.06, and the highest 10 percent earned more than $13.00 an hour. Median hourly earnings in the industries employing the largest numbers of home health aides in May 2006 were: Nursing care facilities.............................................................$9.76 Residential mental retardation facilities................................... 9.34 Services for the elderly and persons with disabilities.........................................................9.26 Home health care services........................................................9.14 Community care facilities for the elderly.................................8.87  444 Occupational Outlook Handbook  Home health aides receive slight pay increases with experi­ ence and added responsibility. Usually, they are paid only for the time worked in the home, not for travel time between jobs, and must pay for their travel costs from their earnings. Most employers hire only on-call hourly workers and provide no benefits. Median hourly earnings of psychiatric aides were $11.49 in May 2006. The middle 50 percent earned between $9.20 and $14.46 an hour. The lowest lOpercent earned less than $7.75, and the highest 10 percent earned more than $17.32 an hour. Median hourly earnings in the industries employing the larg­ est numbers of psychiatric aides in May 2006 were:  Occupational Therapist Assistants and Aides (0*NET 31-2011.00, 31-2012.00) Significant Points  •  • State government......................................................... $13.27 General medical and surgical hospitals.............................. 12.31 Psychiatric and substance abuse hospitals......................... 11.76 Residential mental health and substance abuse facilities........ 9.65 Residential mental retardation facilities...............................8.80 Related Occupations Nursing, psychiatric, and home health aides help people who need routine care or treatment. So do child care workers, li­ censed practical and licensed vocational nurses, medical as­ sistants, occupational therapist assistants and aides, personal and home care aides, physical therapist assistants and aides, radiation therapists, and registered nurses. Social and human service assistants, who sometimes work with mental health patients, do work similar to that of psychiatric aides. Sources of Additional Information Information about employment opportunities may be obtained from local hospitals, nursing care facilities, home health care agencies, psychiatric facilities, State boards of nursing, and local offices of the State employment service. Information on licensing requirements for nursing and home health aides, and lists of State-approved nursing aide programs are available from State departments of public health, departments of occupational licensing, boards of nurs­ ing, and home care associations. For more information on training and requirements for home health aides, contact: y National Association for Home Care and Hospice, 228 7th St.SE., Washington, DC 20003. Internet: http://www.nahc.org For more information on the home health care industry, contact: V Visiting Nurse Associations of America, 8403 Colesville Rd., Suite 1550, Silver Spring, MD 20910-6374. Internet: http://www.vnaa.org For more information on the health care workforce, con­ tact: y The Center for the Health Professions, 3333 California St., San Francisco, CA 94118. Internet: http://www.futurehealth.ucsf.edu   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  •  Occupational therapist assistants generally must com­ plete an associate degree or a certificate program; in contrast, occupational therapist aides usually receive most of their training on the job. Employment is projected to grow much faster than the average as demand for occupational therapy services rises and as occupational therapists increasingly use assistants and aides. Job prospects should be very good for occupational therapist assistants; job seekers holding only a high school diploma might face keen competition for oc­ cupational therapist aide jobs.  Nature of the Work Occupational therapist assistants and aides work under the direction of occupational therapists to provide rehabilitative services to persons with mental, physical, emotional, or de­ velopmental impairments. The ultimate goal is to improve clients’ quality of life and ability to perform daily activi­ ties. For example, occupational therapist assistants help in­ jured workers re-enter the labor force by teaching them how to compensate for lost motor skills or help individuals with learning disabilities increase their independence. Occupational therapist assistants, commonly known as oc­ cupational therapy assistants, help clients with rehabilitative activities and exercises outlined in a treatment plan developed in collaboration with an occupational therapist. Activities range from teaching the proper method of moving from a bed into a wheelchair to the best way to stretch and limber the muscles of the hand. Assistants monitor an individual’s ac­ tivities to make sure that they are performed correctly and to provide encouragement. They also record their client’s progress for the occupational therapist. If the treatment is not having the intended effect, or the client is not improving as expected, the therapist may alter the treatment program in hopes of obtaining better results. In addition, occupational therapist assistants document the billing of the client’s health insurance provider. Occupational therapist aides typically prepare materials and assemble equipment used during treatment. They are re­ sponsible for a range of clerical tasks, including scheduling appointments, answering the telephone, restocking or order­ ing depleted supplies, and filling out insurance forms or other paperwork. Aides are not licensed, so the law does not al­ low them to perform as wide a range of tasks as occupational therapist assistants. Work environment. Occupational therapist assistants and aides need to have a moderate degree of strength because of  Service Occupations 445  .  ll A  *  Applicants to occupational therapist assistant programs can improve their chances of admission by taking high school courses in biology and health and by performing volunteer work in nursing care facilities, occupational or physical thera­ pists’ offices, or other health care settings. Occupational therapist aides usually receive most of their training on the job. Qualified applicants must have a high school diploma, strong interpersonal skills, and a desire to help people in need. Applicants may increase their chances of get­ ting a job by volunteering their services, thus displaying initia­ tive and aptitude to the employer. Licensure. In most States, occupational therapist assistants are regulated and must pass a national certification examination after they graduate. Those who pass the test are awarded the title “Certified Occupational Therapy Assistant.” Other qualifications. Assistants and aides must be respon­ sible, patient, and willing to take directions and work as part of a team. Furthermore, they should be caring and want to help people who are not able to help themselves. Advancement. Occupational therapist assistants may ad­ vance into administration positions. They might organize all the assistants in a large occupational therapy department or act as the director for a specific department such as sports medi­ cine. Some assistants go on to teach classes in accredited oc­ cupational therapist assistant academic programs or lead health risk reduction classes for the elderly.  Employment Occupational therapist assistants and aides provide rehabili­ tative services to persons with mental, physical, emotional, or developmental impairments. the physical exertion required to assist patients. For example, assistants and aides may need to lift patients. Constant kneel­ ing, stooping, and standing for long periods also are part of the job. The hours and days that occupational therapist assistants and aides work vary by facility and with whether they are full- or part time. For example, many outpatient therapy offices and clinics have evening and weekend hours to coincide with pa­ tients’ schedules.  Training, Other Qualifications, and Advancement An associate degree or a certificate from an accredited commu­ nity college or technical school is generally required to qualify for occupational therapist assistant jobs. In contrast, occupa­ tional therapist aides usually receive most of their training on the job. Education and training. There were 126 accredited occu­ pational therapist assistant programs in 2007. The first year of study typically involves an introduction to health care, basic medical terminology, anatomy, and physiology. In the second year, courses are more rigorous and usually include occupa­ tional therapist courses in areas such as mental health, adult physical disabilities, gerontology, and pediatrics. Students also must complete 16 weeks of supervised fieldwork in a clinic or community setting.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Occupational therapist assistants and aides held about 33,000 jobs in 2006. Occupational therapist assistants held about 25,000 jobs, and occupational therapist aides held approxi­ mately 8,000. About 29 percent of jobs for assistants and aides were in hospitals, 23 percent were in offices of occupational therapists, and 21 percent were in nursing and residential care facilities. The rest were primarily in community care facilities for the elderly, home health care services, individual and family services, and State government agencies.  Job Outlook Employment is expected to grow much faster than average as demand for occupational therapy services rises and as occupa­ tional therapists increasingly use assistants and aides. Job pros­ pects should be very good for occupational therapist assistants. Job seekers holding only a high school diploma might face keen competition for occupational therapist aide jobs. Employment change. Employment of occupational therapist assistants and aides is expected to grow 25 percent from 2006 to 2016, much faster than the average for all occupations. In the short ran, the impact of proposed Federal legislation impos­ ing limits on reimbursement for therapy services may adversely affect the job market for occupational therapist assistants and aides. Over the long run, however, demand for occupational therapist assistants and aides will continue to rise because of the increasing number of individuals with disabilities or limited function. The growing elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic ser­ vices. These patients often need additional assistance in their treatment, making the roles of assistants and aides vital. Also,  446 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Occupational therapist assistants and aides Occupational therapist assistants............ Occupational therapist aides...................  soc  Code  31-2010 31-2011 31-2012  Projected employment,  Employment,  2006  2016 41,000 31,000 10,000  33,000 25,000 8,200  Change,  2006-16 Number  Percent  8,200 6,400 1,800  25 25 22  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  the large baby-boom generation is entering the prime age for heart attacks and strokes, further increasing the demand for cardiac and physical rehabilitation. In addition, future medical developments should permit an increased percentage of trauma victims to survive, creating added demand for therapy services. An increase of sensory disorders in children will also spur de­ mand for occupational therapy services. Occupational therapists are expected to increasingly utilize assistants and aides to reduce the cost of occupational therapy services. Once a patient is evaluated and a treatment plan is designed by the therapist, the occupational therapist assistant can provide many aspects of treatment, as prescribed by the therapist. Job prospects. Opportunities for individuals interested in becoming occupational therapist assistants are expected to be very good. In addition to employment growth, job openings will result from the need to replace occupational therapist as­ sistants and aides who leave the occupation permanently over the 2006-16 period. Occupational therapist assistants and aides with prior experience working in an occupational therapy office or other health care setting will have the best job opportunities. However, individuals with only a high school diploma may face keen competition for occupational therapist aide jobs.  Related Occupations Occupational therapist assistants and aides work under the su­ pervision and direction of occupational therapists. Other work­ ers in the health care field who work under similar supervision include dental assistants; medical assistants; nursing, psychi­ atric, and home health aides; personal and home care aides; pharmacy aides; pharmacy technicians; and physical therapist assistants and aides.  Sources of Additional Information For information on a career as an occupational therapist assis­ tant or aide, and a list of accredited programs, contact: y American Occupational Therapy Association, 4720 Montgomery Lane, Bethesda, MD 20824-1220. Internet: http://www.aota.org  Pharmacy Aides (C)*NET 31-9095.00)  Significant Points  •  Job opportunities are expected to be good for full-time and part-time work, especially for those with related work experience.  •  Many pharmacy aides work evenings, weekends, and holidays. About 82 percent work in retail pharmacies, grocery stores, department stores, or mass retailers.  Earnings Median annual earnings of occupational therapist assistants were $42,060 in May 2006. The middle 50 percent earned between $34,130 and $50,230. The lowest 10 percent earned less than $26,050, and the highest 10 percent earned more than $58,270. Median annual earnings in the industries employing the largest numbers of occupational therapist assistants in May 2006 were: Offices of physical, occupational and speech therapists, and audiologists................................................................ $45,130 Nursing care facilities........................................................... 43,280 General medical and surgical hospitals.................................40,060 Median annual earnings of occupational therapist aides were $25,020 in May 2006. The middle 50 percent earned between $20,460 and $32,160. The lowest 10 percent earned less than $17,060, and the highest 10 percent earned more than $44,130. Median annual earnings in the industries employing the largest numbers of occupational therapist aides in May 2006 were: Offices of physical, occupational and speech therapists, and audiologists................................................................ $26,960 General medical and surgical hospitals................................. 26,360 Nursing care facilities........................................................... 25,520   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  •  Nature of the Work Pharmacy aides perform administrative duties in pharmacies. Aides often are clerks or cashiers who primarily answer tele­ phones, handle money, stock shelves, and perform other clerical duties. They work closely with pharmacy technicians. Phar­ macy technicians usually perform more complex tasks than do aides, although in some States the duties and titles of the jobs overlap. (See the statement on pharmacy technicians elsewhere in the Handbook.) Aides refer any questions regarding prescrip­ tions, drug information, or health matters to a pharmacist. (See the statement on pharmacists elsewhere in the Handbook.) Pharmacy aides may establish and maintain patient profiles, prepare insurance claim forms, and stock and take inventory of prescription and over-the-counter medications. Accurate re­ cordkeeping is necessary to help avert dangerous drug interac­ tions. In addition, because many people have medical insurance to help pay for prescriptions, it is essential that pharmacy aides  Service Occupations 447  correspond efficiently and correctly with third-party insurance providers to obtain payment. Pharmacy aides also maintain in­ ventory and inform the supervisor of stock needs so that the pharmacy does not run out of vital medications that customers need. Some aides also help with the maintenance of equipment and supplies. Work environment. Pharmacy aides work in clean, orga­ nized, well-lighted, and well-ventilated areas. Most of their workday is spent on their feet. They may be required to lift heavy boxes or to use stepladders to retrieve supplies from high shelves. Aides work the same hours that pharmacists do. These in­ clude evenings, nights, weekends, and some holidays, particu­ larly in facilities that are open 24 hours a day such as hospitals and some retail pharmacies.  Training, Other Qualifications, and Advancement Most pharmacy aides are trained on the job. Employers prefer applicants with previous experience and strong customer ser­ vice skills. Many pharmacy aides go on to become pharmacy technicians. Education and training. Most pharmacy aides receive in­ formal on-the-job training, but employers favor those with at least a high school diploma. Prospective pharmacy aides with experience working as cashiers may have an advantage when applying for jobs. Employers also prefer applicants with expe­ rience managing inventories and using computers. Pharmacy aides begin their training by observing a more ex­ perienced worker. After they become familiar with the store’s equipment, policies, and procedures, they begin to work on their own. Once they become experienced, aides are not likely to receive additional training, except when new equipment is introduced or when policies or procedures change. Other qualifications. Strong customer service and commu­ nication skills are essential, as pharmacy aides frequently inter­ act with patients, fellow employees, and other health-care pro­ fessionals. Aides entering the field also need strong spelling, reading, and mathematics skills. Successful pharmacy aides are organized, dedicated, friendly, and responsible. They should be willing and able to take directions. Candidates interested in becoming pharmacy aides cannot have prior records of drug or substance abuse. Advancement. With experience or certification, many phar­ macy aides go on to become pharmacy technicians. Some become pharmacists after completing a substantial amount of formal training.  • * '  ‘Fin'riir  . ■—■— ------------  rftr  Pharmacy aides perform administrative duties in pharmacies, such as answering phones and stocking shelves. stores, or mass retailers. About 7 percent of aides worked in hospitals.  Job Outlook Employment of pharmacy aides is expected to decline rapidly from 2006 to 2016. Job prospects, however, should be good. Employment change. Employment of pharmacy aides is expected to decline rapidly, decreasing by 11 percent over the 2006 to 2016 period. Demand for pharmacy aides will fall as pharmacy technicians become increasingly responsible for answering phones, stocking shelves, operating cash registers, and performing other administrative tasks. In addition, with in­ creased training, many pharmacy aides will become pharmacy technicians, which will result in further declines in pharmacy aide jobs. Job prospects. Despite declining employment, job opportu­ nities for full-time and part-time work are expected to be good. The frequent need to replace workers who leave the occupation will create opportunities for interested applicants. Aides with related work experience in pharmacies, or as cashiers or stock clerks in other retail settings, should have the best opportuni­ ties.  Earnings Median hourly earnings of wage-and-salary pharmacy aides were $9.35 in May 2006. The middle 50 percent earned be­ tween $7.89 and $11.58; the lowest 10 percent earned less than $6.92, and the highest 10 percent earned more than $14.64. Median hourly earnings in the industries employing the largest numbers of pharmacy aides in May 2006 were:  Employment Pharmacy aides held about 50,000 jobs in 2006. About 82 per­ cent worked in retail pharmacies, most of which were in drug stores but some of which were in grocery stores, department  General medical and surgical hospitals................................ $11.53 Grocery stores...........................................................................9.87 Pharmacies and drug stores.......................................................8.97  Projections data from the National Employment Matrix Occupational Title Pharmacy aides........................................................... .............................  soc Code 31-9095  Employment, 2006 50,000  Projected employment, 2016 45,000  Change, 2006-16 Number Percent __ -5,600 -11  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  448 Occupational Outlook Handbook  Related Occupations The work of pharmacy aides is closely related to that of phar­ macy technicians, cashiers, and stock clerks and order fillers.  Sources of Additional Information For information on employment opportunities, contact local employers or local offices of the State employment service.  Physical Therapist Assistants and Aides (0*NET 31-2021.00, 31-2022.00)  Significant Points  • •  •  •  Employment is projected to increase much faster than average. Assistants should have very good job prospects; on the other hand, aides may face keen competition from the large pool of qualified applicants. Aides usually learn skills on the job, while assistants generally have an associate degree; some States re­ quire licensing for assistants. About 71 percent of jobs were in offices of physical therapists or in hospitals.  Nature of the Work Physical therapist assistants and aides help physical therapists to provide treatment that improves patient mobility, relieves pain, and prevents or lessens physical disabilities of patients. A physical therapist might ask an assistant to help patients exer­ cise or leam to use crutches, for example, or an aide to gather and prepare therapy equipment. Patients include accident vic­ tims and individuals with disabling conditions such as lowerback pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy. Physical therapist assistants perform a variety of tasks. Un­ der the direction and supervision of physical therapists, they provide part of a patient’s treatment. This might involve exer­ cises, massages, electrical stimulation, paraffin baths, hot and cold packs, traction, and ultrasound. Physical therapist assis­ tants record the patient’s responses to treatment and report the outcome of each treatment to the physical therapist. Physical therapist aides help make therapy sessions produc­ tive, under the direct supervision of a physical therapist or phys­ ical therapist assistant. They usually are responsible for keep­ ing the treatment area clean and organized and for preparing for each patient’s therapy. When patients need assistance moving to or from a treatment area, aides push them in a wheelchair or provide them with a shoulder to lean on. Because they are not licensed, aides do not perform the clinical tasks of a physical therapist assistant in States where licensure is required. The duties of aides include some clerical tasks, such as or­ dering depleted supplies, answering the phone, and filling out insurance forms and other paperwork. The extent to which an  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  aide or an assistant performs clerical tasks depends on the size and location of the facility. Work environment. Physical therapist assistants and aides need a moderate degree of strength because of the physical exertion required in assisting patients with their treatment. In some cases, assistants and aides need to lift patients. Frequent kneeling, stooping, and standing for long periods also are part of the job. The hours and days that physical therapist assistants and aides work vary with the facility. About 23 percent of all physical therapist assistants and aides work part time. Many outpatient physical therapy offices and clinics have evening and weekend hours, to coincide with patients’ personal schedules.  Training, Other Qualifications, and Advancement Most physical therapist aides are trained on the job, but most physical therapist assistants earn an associate degree from an accredited physical therapist assistant program. Some States require licensing for physical therapist assistants. Education and training. Employers typically require physi­ cal therapist aides to have a high school diploma. They are trained on the job, and most employers provide clinical on-thejob training. In many States, physical therapist assistants are required by law to hold at least an associate degree. According to the Amer­ ican Physical Therapy Association, there were 233 accredited physical therapist assistant programs in the United States as of 2006. Accredited programs usually last 2 years, or 4 semesters, and culminate in an associate degree. Programs are divided into academic study and hands-on clinical experience. Academic course work includes algebra, anatomy and physiology, biology, chemistry, and psychology. Clinical work includes certifications in CPR and other first aid and field experience in treatment centers. Both educators and prospective employers view clinical experience as essential to ensuring that students understand the responsibilities of a phys­ ical therapist assistant. Licensure. Licensing is not required to practice as a physi­ cal therapist aide. However, some States require licensure or registration in order to work as a physical therapist assistant.  m m %  Physical therapist assistants have very good job prospects, but physical therapist aides should experience keen competition for jobs.  Service Occupations 449  Projections data from the National Employment Matrix Occupational Title Physical therapist assistants and aides Physical therapist assistants........... Physical therapist aides....................  soc  Employment,  Code  2006  31-2020 31-2021 31-2022  107,000 60,000 46,000  Projected employment, 2016 137,000 80,000 58,000  Change, 2006-16 Number Percent 31,000 29 20,000 32 11,000 24  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  States that require licensure stipulate specific educational and examination criteria. Additional requirements may include certification in cardiopulmonary resuscitation (CPR) and other first aid and a minimum number of hours of clinical experience. Complete information on regulations can be obtained from State licensing boards. Other qualifications. Physical therapist assistants and aides should be well-organized, detail oriented, and caring. They usually have strong interpersonal skills and a desire to help people in need. Advancement. Some physical therapist aides advance to be­ come therapist assistants after gaining experience and, often, additional education. Sometimes, this education is required by law. Some physical therapist assistants advance by specializing in a clinical area. They gain expertise in treating a certain type of patient, such as geriatric or pediatric, or a type of ailment, such as sports injuries. Many physical therapist assistants advance to administration positions. These positions might include or­ ganizing all the assistants in a large physical therapy organiza­ tion or acting as the director for a specific department such as sports medicine. Other assistants go on to teach in an accred­ ited physical therapist assistant academic program, lead health risk reduction classes for the elderly, or organize community activities related to fitness and risk reduction.  Employment Physical therapist assistants and aides held about 107,000 jobs in 2006. Physical therapist assistants held about 60,000 jobs; physical therapist aides, approximately 46,000. Both work with physical therapists in a variety of settings. About 71 percent of jobs were in offices of physical therapists or in hospitals. Oth­ ers worked primarily in nursing care facilities, offices of physi­ cians, home health care services, and outpatient care centers.  Job Outlook Employment is expected to grow much faster than average because of increasing consumer demand for physical therapy services. Job prospects for physical therapist assistants are ex­ pected to be very good. Aides should experience keen competi­ tion for jobs. Employment change. Employment of physical therapist as­ sistants and aides is expected to grow by 29 percent over the 2006-16 decade, much faster than the average for all occupa­ tions. The impact of Federal limits on Medicare and Medic­ aid reimbursement for therapy services may adversely affect the short-term job outlook for physical therapist assistants and aides. However, long-term demand for physical therapist assis­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  tants and aides will continue to rise, as the number of individu­ als with disabilities or limited function grows. The increasing number of people who need therapy reflects, in part, the increasing elderly population. The elderly popu­ lation is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. These patients often need additional assistance in their treatment, making the roles of assistants and aides vital. In addition, the large babyboom generation is entering the prime age for heart attacks and strokes, further increasing the demand for cardiac and physical rehabilitation. Moreover, future medical developments should permit an increased percentage of trauma victims to survive, creating added demand for therapy services. Physical therapists are expected to increasingly use assistants to reduce the cost of physical therapy services. Once a patient is evaluated and a treatment plan is designed by the physical therapist, the physical therapist assistant can provide many parts of the treatment, as approved by the therapist. Job prospects. Opportunities for individuals interested in becoming physical therapist assistants are expected to be very good. Physical therapist aides may face keen competition from the large pool of qualified individuals. In addition to employ­ ment growth, job openings will result from the need to replace workers who leave the occupation permanently. Physical ther­ apist assistants and aides with prior experience working in a physical therapy office or other health care setting will have the best job opportunities.  Earnings Median annual earnings of physical therapist assistants were $41,360 in May 2006. The middle 50 percent earned between $33,840 and $49,010. The lowest 10 percent earned less than $26,190, and the highest 10 percent earned more than $57,220. Median annual earnings in the industries employing the largest numbers of physical therapist assistants in May 2006 were: Home health care services..................................................$46,390 Nursing care facilities...........................................................44,460 Offices of physical, occupational and speech therapists, and audiologists................................................40,780 General medical and surgical hospitals................................ 40,670 Offices of physicians.............................................................39,290 Median annual earnings of physical therapist aides were $22,060 in May 2006. The middle 50 percent earned between $18,550 and $26,860. The lowest 10 percent earned less than $15,850, and the highest 10 percent earned more than $32,600. Median annual earnings in the industries employing the largest numbers of physical therapist aides in May 2006 were:  450 Occupational Outlook Handbook  Nursing care facilities......................................................... $24,170 Offices of physicians............................................................. 22,680 General medical and surgical hospitals................................. 22,680 Offices of physical, occupational and speech therapists, and audiologists................................................ 21,230  tants; medical assistants; occupational therapist assistants and aides; pharmacy aides; pharmacy technicians; nursing, psychi­ atric, and home health aides; personal and home care aides; and social and human service assistants.  Sources of Additional Information Related Occupations Physical therapist assistants and aides work under the supervi­ sion of physical therapists. Other workers in the health care field who work under similar supervision include dental assis­  Career information on physical therapist assistants and a list of schools offering accredited programs can be obtained from: y The American Physical Therapy Association, 1111 North Fairfax St., Alexandria, VA 22314-1488. Internet: http://www.apta.org  Protective Service Occupations Correctional Officers (Q*NET 33-1011.00, 33-3011.00, 33-3012.00)  Significant Points  •  The work can be stressful and hazardous.  •  Most correctional officers are employed in State and local government prisons and jails. Job opportunities are expected to be excellent.  •  Nature of the Work Correctional officers, also known as detention officers, are re­ sponsible for overseeing individuals who have been arrested and are awaiting trial or who have been convicted of a crime and sentenced to serve time in a jail, reformatory, or peniten­ tiary. The jail population changes constantly as some are released, some are convicted and transferred to prison, and new offend­ ers are arrested and enter the system. Correctional officers in local jails admit and process about 12 million people a year, with about 700,000 offenders in jail at any given time. Cor­ rectional officers in State and Federal prisons watch over the approximately 1.5 million offenders who are incarcerated there at any given time. Correctional officers maintain security and inmate account­ ability to prevent disturbances, assaults, and escapes. Officers have no law enforcement responsibilities outside the institution where they work. ( For more information on related occupa­ tions, see the statements on police and detectives and on proba­ tion officers and correctional treatment specialists, elsewhere in the Handbook.) Regardless of the setting, correctional officers maintain or­ der within the institution and enforce rules and regulations. To help ensure that inmates are orderly and obey rules, correctional officers monitor the activities and supervise the work assign­ ments of inmates. Sometimes, officers must search inmates and their living quarters for contraband like weapons or drugs, settle disputes between inmates, and enforce discipline. Correctional officers periodically inspect the facilities, checking cells and   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  other areas of the institution for unsanitary conditions, con­ traband, fire hazards, and any evidence of infractions of rules. In addition, they routinely inspect locks, window bars, grilles, doors, and gates for signs of tampering. Finally, officers inspect mail and visitors for prohibited items. Correctional officers report orally and in writing on inmate conduct and on the quality and quantity of work done by in­ mates. Officers also report security breaches, disturbances, violations of rules, and any unusual occurrences. They usually keep a daily log or record of their activities. Correctional of­ ficers cannot show favoritism and must report any inmate who violates the rules. If a crime is committed within their institu­ tion or an inmate escapes, they help the responsible law en­ forcement authorities investigate or search for the escapee. In jail and prison facilities with direct supervision of cellblocks, officers work unarmed. They are equipped with communica­ tions devices so that they can summon help if necessary. These officers often work in a cellblock alone, or with another officer, among the 50 to 100 inmates who reside there. The officers enforce regulations primarily through their interpersonal com­ munication skills and through the use of progressive sanctions, such as the removal of some privileges. In the highest security facilities, where the most dangerous inmates are housed, correctional officers often monitor the activities of prisoners from a centralized control center with closed-circuit television cameras and a computer tracking sys­ tem. In such an environment, the inmates may not see anyone but officers for days or weeks at a time and may leave their cells only for showers, solitary exercise time, or visitors. Depending on the offenders’ security classification within the institution, correctional officers may have to restrain inmates in handcuffs and leg irons to safely escort them to and from cells and other areas and to see authorized visitors. Officers also escort prison­ ers between the institution and courtrooms, medical facilities, and other destinations outside the institution. Bailiffs, also known as marshals or court officers, are law enforcement officers who maintain safety and order in court­ rooms. Their duties, which vary by location, include enforcing courtroom rules, assisting judges, guarding juries from outside contact, delivering court documents, and providing general se­ curity for courthouses.  Service Occupations 451  Work environment. Working in a correctional institution can be stressful and hazardous. Every year, correctional officers are injured in confrontations with inmates. Correctional officers may work indoors or outdoors. Some correctional institutions are well lighted, temperature controlled, and ventilated, but oth­ ers are old, overcrowded, hot, and noisy. Although both jails and prisons can be dangerous places to work, prison popula­ tions are more stable than jail populations, and correctional of­ ficers in prisons know the security and custodial requirements of the prisoners with whom they are dealing. Correctional officers usually work an 8-hour day, 5 days a week, on rotating shifts. Because prison and jail security must be provided around the clock, officers work all hours of the day and night, weekends, and holidays. In addition, officers may be required to work paid overtime.  Training, Other Qualifications, and Advancement Correctional officers learn most of what they need to know for their work through on-the-job training. Qualifications vary by agency, but all agencies require a high school diploma or equiv­ alent, and some also require some college education or full-time work experience. Education and training. A high school diploma or gradua­ tion equivalency degree is required by all employers. The Fed­ eral Bureau of Prisons requires entry-level correctional officers to have at least a bachelor’s degree; 3 years of full-time experi­ ence in a field providing counseling, assistance, or supervision to individuals; or a combination of the two. Some State and local corrections agencies require some college credits, but law enforcement or military experience may be substituted to fulfill this requirement. Federal, State, and some local departments of corrections provide training for correctional officers based on guidelines established by the American Correctional Association and the American Jail Association. Some States have regional training academies that are available to local agencies. At the conclu-  r~rr—  it?--*!  m W  sion of formal instruction, all State and local correctional agen­ cies provide on-the-job training, including training on legal restrictions and interpersonal relations. Many systems require firearms proficiency and self-defense skills. Officer trainees typically receive several weeks or months of training in an ac­ tual job setting under the supervision of an experienced offi­ cer. However, on-the-job training varies widely from agency to agency. Academy trainees generally receive instruction in a number of subjects, including institutional policies, regulations, and operations, as well as custody and security procedures. New Federal correctional officers must undergo 200 hours of formal training within the first year of employment. They also must complete 120 hours of specialized training at the U.S. Federal Bureau of Prisons residential training center at Glynco, GA, within 60 days of their appointment. Experienced officers re­ ceive annual in-service training to keep abreast of new develop­ ments and procedures. Some correctional officers are members of prison tactical re­ sponse teams, which are trained to respond to disturbances, ri­ ots, hostage situations, forced cell moves, and other potentially dangerous confrontations. Team members practice disarming prisoners wielding weapons, protecting themselves and inmates against the effects of chemical agents, and other tactics. Other qualifications. All institutions require correctional officers to be at least 18 to 21 years of age, be a U.S. citizen or permanent resident, and have no felony convictions. Some require previous experience in law enforcement or the military, but college credits can be substituted to fulfill this requirement. Others require demonstration of job stability, usually by accu­ mulating 2 years of work experience, which need not be related to corrections or law enforcement. Correctional officers must be in good health. Candidates for employment generally are required to meet formal standards of physical fitness, eyesight, and hearing. In addition, many ju­ risdictions use standard tests to determine applicant suitability to work in a correctional environment. Good judgment and the ability to think and act quickly are indispensable. Applicants are typically screened for drug abuse, subject to background checks, and required to pass a written examination. Advancement. Qualified officers may advance to the posi­ tion of correctional sergeant. Correctional sergeants supervise correctional officers and usually are responsible for maintain­ ing security and directing the activities of other officers dur­ ing an assigned shift or in an assigned area. Ambitious and qualified correctional officers can be promoted to supervisory or administrative positions all the way up to warden. Promo­ tion prospects may be enhanced by attending college. Officers sometimes transfer to related jobs, such as probation officer, parole officer, and correctional treatment specialist.  Employment  Job opportunities for correctional officers should be excellent.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Correctional officers held about 500,000 jobs in 2006. About 3 of every 5 jobs were in State correctional institutions such as prisons, prison camps, and youth correctional facilities. About 18,000 jobs for correctional officers were in Federal correction­ al institutions, and about 16,000 jobs were in privately owned and managed prisons.  452 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Correctional officers......................................................... First-line supervisors/managers of correctional officers........... .... Bailiffs, correctional officers, and jailers................................... .... Bailiffs.................................................................................... .... Correctional officers and jailers.......................................... ....  soc Code  Employment, 2006  33-1011 33-3010 33-3011 33-3012  500,000 40,000 460,000 19,000 442,000  Projected employment, 2016 582,000 45,000 537,000 21,000 516,000  Change, 2006-16 Number Percent 82,000 16 5,000 13 77,000 17 2,100 11 75,000 17  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  Most of the remaining jobs were in city and county jails or in other institutions run by local governments. Some 300 of these jails, all of them in urban areas, are large, housing over 1,000 inmates. Most correctional officers employed in jails, however, work in institutions located in rural areas with smaller inmate populations. Other correctional officers oversee individuals being held by the U.S. Immigration and Naturalization Service pending re­ lease or deportation or work for correctional institutions that are run by private, for-profit organizations.  Job Outlook Employment growth is expected to be faster than the average for all occupations, and job opportunities are expected to be excellent. Employment change. Employment of correctional officers is expected to grow 16 percent between 2006 and 2016, faster than the average for all occupations. Increasing demand for correctional officers will stem from population growth and ris­ ing rates of incarceration. Mandatory sentencing guidelines calling for longer sentences and reduced parole for inmates are a primary reason for historically increasing incarceration rates. Some States are reconsidering mandatory sentencing guidelines because of budgetary constraints, court decisions, and doubts about their effectiveness. Additionally, the Supreme Court re­ cently ruled to make Federal sentencing guidelines voluntary, rather than mandatory, for judges. It is unclear how many States will change their sentencing policies and how long it will be before any changes affect the prison population. Neverthe­ less, these developments could moderate future increases in the prison population and cause employment of correctional offi­ cers to grow more slowly than they have in the past. Some employment opportunities also will arise in the private sector, as public authorities contract with private companies to provide and staff corrections facilities. Both State and Federal corrections agencies are increasingly using private prisons. Job prospects. Job opportunities for correctional officers are expected to be excellent. The need to replace correctional offi­ cers who transfer to other occupations, retire, or leave the labor force, coupled with rising employment demand, will generate thousands of job openings each year. In the past, some local and State corrections agencies have experienced difficulty in attracting and keeping qualified applicants, largely because of low salaries, shift work, and the concentration of jobs in rural locations. This situation is expected to continue. Layoffs of correctional officers are rare because of increasing offender populations.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Earnings Median annual earnings of correctional officers and jailers were $35,760 in May 2006. The middle 50 percent earned between $28,320 and $46,500. The lowest 10 percent earned less than $23,600, and the highest 10 percent earned more than $58,580. Median annual earnings in the public sector were $47,750 in the Federal Government, $36,140 in State government, and $34,820 in local government. In the facilities support services industry, where the relatively small number of officers employed by pri­ vately operated prisons is classified, median annual earnings were $25,050. Median annual earnings of first-line supervisors/managers of correctional officers were $52,580 in May 2006. The middle 50 percent earned between $38,920 and $67,820. The lowest 10 percent earned less than $33,270, and the highest 10 per­ cent earned more than $81,230. Median annual earnings were $51,500 in State government and $52,940 in local government. Median annual earnings of bailiffs were $34,210 in May 2006. The middle 50 percent earned between $25,130 and $48,010. The lowest 10 percent earned less than $18,390, and the highest 10 percent earned more than $58,270. Median an­ nual earnings were $30,510 in local government. According to the Federal Bureau of Prisons, the starting sala­ ry for Federal correctional officers was $28,862 a year in 2007. Starting Federal salaries were slightly higher in areas where prevailing local pay levels were higher. In addition to typical benefits, correctional officers employed in the public sector usually are provided with uniforms or a clothing allowance to purchase their own uniforms. Civil ser­ vice systems or merit boards cover officers employed by the Federal Government and most State governments. Their retire­ ment coverage entitles correctional officers to retire at age 50 after 20 years of service or at any age with 25 years of service.  Related Occupations A number of options are available to those interested in careers in protective services and security. Security guards and gaming surveillance officers protect people and property against theft, vandalism, illegal entry, and fire. Police and detectives main­ tain law and order, prevent crime, and arrest offenders. Proba­ tion officers and correctional treatment specialists monitor and counsel offenders and evaluate their progress in becoming pro­ ductive members of society.  Sources of Additional Information Further information about correctional officers is available from:  Service Occupations 453  y American Correctional Association, 206 N. Washington St., Suite 200, Alexandria, VA 22314. Internet: http://www.aca.org ^American Jail Association, 1135 Professional Ct., Hagerstown, MD 21740. Internet: http ://www.corrections.com/aj a Information on entrance requirements, training, and career opportunities for correctional officers at the Federal level may be obtained from the Federal Bureau of Prisons. Internet: http://www.bop.gov Information on obtaining a position as a correctional offi­ cer with the Federal Government is available from the Office of Personnel Management through USAJOBS, the Federal Government’s official employment information system. This resource for locating and applying for job opportunities can be accessed through the Internet at http://www.usajobs.opm.gov or through an interactive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not tollfree, and charges may result.  Fire Fighting Occupations (0*NET 33-1021.00, 33-1021.01, 33-1021.02, 33-2011.00, 33-2011.01, 33-2011.02, 33-2021.00, 33-2021.01,33-2021.02, 33-2022.00)  Significant Points  •  Fire fighting involves hazardous conditions and long, irregular hours. • About 9 out of 10 fire fighting workers were employed by local governments. • Applicants for city fire fighting jobs generally must pass written, physical, and medical examinations. • Although employment is expected to grow faster than the average, keen competition for jobs is expected be­ cause this occupation attracts many qualified candi­ dates. Nature of the Work Every year, fires and other emergencies take thousands of lives and destroy property worth billions of dollars. Fire fighters help protect the public against these dangers by responding to fires and a variety of other emergencies. In addition to putting out fires, they are frequently the first emergency personnel at the scene of a traffic accident or medical emergency and may be called upon to treat injuries or perform other vital functions. During duty hours, fire fighters must be prepared to respond immediately to a fire or others emergency. Fighting fires is dan­ gerous and complex, therefore requires organization and team­ work. At every emergency scene, fire fighters perform specific duties assigned by a superior officer. At fires, they connect hose lines to hydrants and operate a pump to send water to high-pres­ sure hoses. Some carry hoses, climb ladders, and enter burning buildings—using systematic and careful procedures—to put out fires. At times, they may need to use tools, like an ax, to make   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  their way through doors, walls, and debris sometimes with the aid of information about a building’s floor plan. Some find and rescue occupants who are unable to safely leave the building without assistance. They also provide emergency medical at­ tention, ventilate smoke-filled areas, and attempt to salvage the contents of buildings. Fire fighters’ duties may change several times while the company is in action. Sometimes they remain at the site of a disaster for days at a time, rescuing trapped sur­ vivors, and assisting with medical treatment. Fire fighters work in a variety of settings, including metro­ politan areas, rural areas with grasslands and forests, airports, chemical plants and other industrial sites. They have also as­ sumed a range of responsibilities, including emergency medical services. In fact, most calls to which fire fighters respond in­ volve medical emergencies. In addition, some fire fighters work in hazardous materials units that are specially trained for the control, prevention, and cleanup of hazardous materials, such as oil spills or accidents involving the transport of chemicals. (For more information, see the Handbook section on hazardous material removal workers.) Workers specializing forest fires utilize different methods and equipment than other fire fighters. In national forests and parks, forest fire inspectors and prevention specialists spot fires from watchtowers and report the fires to headquarters by telephone or radio. Forest rangers also patrol to ensure that travelers and campers comply with fire regulations. When fires break out, crews of fire fighters are brought in to suppress the blaze with heavy equipment and water hoses. Fighting forest fires, like fighting urban fires, is rigorous work. One of the most effec­ tive means of fighting a forest fire is creating fire lines—cut­ ting down trees and digging out grass and all other combustible vegetation in the path of the fire—to deprive it of fuel. Elite fire fighters called smoke jumpers parachute from airplanes to reach otherwise inaccessible areas. This tactic, however, can be extremely hazardous.When they aren’t responding to fires and other emergencies, fire fighters clean and maintain equipment, study fire science and fire fighting techniques, conduct practice drills and fire inspections, and participate in physical fitness activities. They also prepare written reports on fire incidents and review fire science literature to stay informed about tech­ nological developments and changing administrative practices and policies. Most fire departments have a fire prevention division, usually headed by a fire marshal and staffed by fire inspectors. Workers in this division conduct inspections of structures to prevent fires by ensuring compliance with fire codes. These inspectors also work with developers and planners to check and approve plans for new buildings and inspect buildings under construction. Some fire fighters become fire investigators, who determine the causes of fires. They collect evidence, interview witnesses, and prepare reports on fires in cases where the cause may be arson or criminal negligence. They often are asked to testify in court. In some cities, these investigators work in police depart­ ments, and some are employed by insurance companies. Work environment. Fire fighters spend much of their time at fire stations, which are usually similar to dormitories. When an alarm sounds, fire fighters respond, regardless of the weather or hour. Fire fighting involves the risk of death or injury from  454 Occupational Outlook Handbook  floors caving in, walls toppling, traffic accidents, and exposure to flames and smoke. Fire fighters also may come into contact with poisonous, flammable, or explosive gases and chemicals and radioactive materials, which may have immediate or long­ term effects on their health. For these reasons, they must wear protective gear that can be very heavy and hot. Work hours of fire fighters are longer and more varied than the hours of most other workers. Many fire fighters work more than 50 hours a week, and sometimes they may work longer. In some agencies, fire fighters are on duty for 24 hours, then off for 48 hours, and receive an extra day off at intervals. In others, they work a day shift of 10 hours for 3 or 4 days, a night shift of 14 hours for 3 or 4 nights, have 3 or 4 days off, and then repeat the cycle. In addition, fire fighters often work extra hours at fires and other emergencies and are regularly assigned to work on holidays. Fire lieutenants and fire captains often work the same hours as the fire fighters they supervise.  Training, Other Qualifications, and Advancement Applicants for fire fighting jobs are usually required to have at least a high school diploma, but candidates with some edu­ cation after high school are increasingly preferred. Most mu­ nicipal jobs require passing written and physical tests. All fire fighters receive extensive training after being hired. Education and training. Most fire fighters have a high school diploma, however, the completion of community college courses, or in some cases, an associate degree, in fire science may improve an applicant’s chances for a job. A number of colleges and universities offer courses leading to 2- or 4-year degrees in fire engineering or fire science. In recent years, an increasing proportion of new fire fighters have had some educa­ tion after high school. As a rule, entry-level workers in large fire departments are trained for several weeks at the department’s training center or academy. Through classroom instruction and practical training, the recruits study fire fighting techniques, fire prevention, haz­ ardous materials control, local building codes, and emergency medical procedures, including first aid and cardiopulmonary resuscitation (CPR). They also learn how to use axes, chain saws, fire extinguishers, ladders, and other fire fighting and res­ cue equipment. After successfully completing this training, the recruits are assigned to a fire company, where they undergo a period of probation. Many fire departments have accredited apprenticeship pro­ grams lasting up to 4 years. These programs combine formal instruction with on-the-job training under the supervision of experienced fire fighters. Almost all departments require fire fighters to be certified as emergency medical technicians. (For more information, see the section of the Handbook on emergency medical technicians and paramedics.) Although most fire departments require the low­ est level of certification, Emergency Medical Technician-Basic (EMT-Basic), larger departments in major metropolitan areas increasingly require paramedic certification. Some depart­ ments include this training in the fire academy, whereas others prefer that recruits earn EMT certification on their own but will give them up to 1 year to do it.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Fire fighters respond to emergencies, such as car accidents and fires. In addition to participating in training programs conducted by local fire departments, some fire fighters attend training ses­ sions sponsored by the U.S. National Fire Academy. These training sessions cover topics such as executive development, anti-arson techniques, disaster preparedness, hazardous materi­ als control, and public fire safety and education. Some States also have either voluntary or mandatory fire fighter training and certification programs. Many fire departments offer fire fight­ ers incentives such as tuition reimbursement or higher pay for completing advanced training. Other qualifications. Applicants for municipal fire fighting jobs usually must pass a written exam; tests of strength, physi­ cal stamina, coordination, and agility; and a medical examina­ tion that includes a drug screening. Workers may be monitored on a random basis for drug use after accepting employment. Examinations are generally open to people who are at least 18 years of age and have a high school education or its equivalent. Those who receive the highest scores in all phases of testing have the best chances of being hired. Among the personal qualities fire fighters need are mental alertness, self-discipline, courage, mechanical aptitude, endur­ ance, strength, and a sense of public service. Initiative and good judgment also are extremely important because fire fight­ ers make quick decisions in emergencies. Members of a crew live and work closely together under conditions of stress and danger for extended periods, so they must be dependable and able to get along well with others. Leadership qualities are nec­ essary for officers, who must establish and maintain discipline and efficiency, as well as direct the activities of the fire fighters in their companies. Advancement. Most experienced fire fighters continue studying to improve their job performance and prepare for pro­ motion examinations. To progress to higher level positions, they acquire expertise in advanced fire fighting equipment and techniques, building construction, emergency medical technol­ ogy, writing, public speaking, management and budgeting pro­ cedures, and public relations. Opportunities for promotion depend upon the results of writ­ ten examinations, as well as job performance, interviews, and  Service Occupations 455  Projections data from the National Employment Matrix Occupational Title Fire fighting occupations....................................................................... First-line supervisors/managers of fire fighting and prevention workers............................................................................................ Fire fighting and prevention workers.............................................. Fire fighters.................................................................................... Fire inspectors................................................................................ Fire inspectors and investigators............................................. Forest fire inspectors and prevention specialists...................  SOC Code  Employment, 2006  —  361,000  33-1021 33-2000 33-2011 33-2020 33-2021 33-2022  52,000 308,000 293,000 16,000 14,000 1,800  Projected employment, 2016 404,000 58,000 345,000 328,000 17,000 15,000 1,900  Change, 2006-16 Number Percent 43,000 12 6,000 37,000 35,000 1,600 1,500 0  11 12 12 10 11 2  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  seniority. Hands-on tests that simulate real-world job situa­ tions are also used by some fire departments. Usually, fire fighters are first promoted to engineer, then lieutenant, captain, battalion chief, assistant chief, deputy chief, and, finally, chief. For promotion to positions higher than battalion chief, many fire departments now require a bachelor’s degree, preferably in fire science, public admin­ istration, or a related field. An associate degree is required for executive fire officer certification from the National Fire Academy.  Employment In 2006, total paid employment in firefighting occupations was about 361,000. Fire fighters held about 293,000 jobs, first-line supervisors/managers of fire fighting and preven­ tion workers held about 52,000, and fire inspectors and in­ vestigators held about 14,000 jobs. These employment fig­ ures include only paid career fire fighters—they do not cover volunteer fire fighters, who perform the same duties and may constitute the majority of fire fighters in a residential area. According to the U.S. Fire Administration, about 71 percent of fire companies were staffed entirely by volunteer fire fight­ ers in 2005. About 9 out of 10 fire fighting workers were employed by local government. Some large cities have thousands of career fire fighters, while many small towns have only a few. Most of the remainder worked in fire departments on Federal and State installations, including airports. Private fire fighting companies employ a small number of fire fighters. In response to the expanding role of fire fighters, some mu­ nicipalities have combined fire prevention, public fire edu­ cation, safety, and emergency medical services into a single organization commonly referred to as a public safety organi­ zation. Some local and regional fire departments are being consolidated into countywide establishments to reduce ad­ ministrative staffs, cut costs, and establish consistent training standards and work procedures.  Job Outlook Although employment is expected to grow as fast as the aver­ age for all jobs, candidates for these positions are expected to face keen competition as these positions are highly attractive and sought after.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Employment change. Employment of workers in fire fight­ ing occupations is expected to grow by 12 percent over the 2006-2016 decade, which is as fast as the average for all oc­ cupations. Most job growth will stem from volunteer fire fighting positions being converted to paid positions. In recent years, it has become more difficult for volunteer fire depart­ ments to recruit and retain volunteers. This may be the result of the considerable amount of training and time commitment required. Furthermore, a trend towards more people living in and around cities has increased the demand for fire fighters. When areas develop and become more densely populated, emergencies and fires affect more buildings and more people and therefore require more fire fighters. Job prospects. Prospective fire fighters are expected to face keen competition for available job openings. Many people are attracted to fire fighting because, it is challenging and provides the opportunity to perform an essential public service; a high school education is usually sufficient for entry; and a pension is usually guaranteed after 25 years work. Consequently, the number of qualified applicants in most areas far exceeds the number of job openings, even though the written examination and physical requirements eliminate many applicants. This situation is expected to persist in coming years. Applicants with the best chances are those who are physically fit and score the highest on physical conditioning and mechanical aptitude exams. Those who have completed some fire fighter education at a community college and have EMT or paramedic certifica­ tion will have an additional advantage.  Earnings Median annual earnings of fire fighters were $41,190 in May 2006. The middle 50 percent earned between $29,550 and $54,120. The lowest 10 percent earned less than $20,660, and the highest 10 percent earned more than $66,140. Median an­ nual earnings were $41,600 in local government, $41,070 in the Federal Government, and $37,000 in State governments. Median annual earnings of first-line supervisors/managers of fire fighting and prevention workers were $62,900 in May 2006. The middle 50 percent earned between $50,180 and $79,060. The lowest 10 percent earned less than $36,820, and the highest 10 percent earned more than $97,820. First-line supervisors/managers of fire fighting and prevention work­ ers employed in local government earned a median of about $64,070 a year.  456 Occupational Outlook Handbook  Median annual earnings of fire inspectors and investigators were $48,050 in May 2006. The middle 50 percent earned between $36,960 and $61,160 a year. The lowest 10 percent earned less than $29,840, and the highest 10 percent earned more than $74,930. Fire inspectors and investigators em­ ployed in local government earned a median of about $49,690 a year. According to the International City-County Management Association, average salaries in 2006 for sworn full-time posi­ tions were as follows:  Rank Fire chief.......................................... ... Deputy chief..................................... ... Battalion chief.................................. Assistant fire chief............................ ... Fire captain....................................... ... Fire lieutenant.................................. ... Fire prevention/code inspector....... ... Engineer............................................ ...  Minimum annual base salary $73,435 66,420 62 199 61,887 51,808 47,469 45,951 43,232  Maximum annual base salary $95,271 84,284 78 611 78,914 62,785 56,511 58,349 56,045  Police and Detectives (0*NET 33-1012.00, 33-3021.00, 33-3021.01, 33-3021.02, 33-3021.03, 33-3021.05, 33-3031.00, 33-3051.00, 33-3051.01, 33-3051.03, 33-3052.00)  Significant Points  •  Police work can be dangerous and stressful.  •  Education requirements range from a high school di­ ploma to a college degree or higher. Job opportunities in most local police departments will be excellent for qualified individuals, while com­ petition is expected for jobs in State and Federal agen­ cies.  •  •  Applicants with college training in police science or military police experience will have the best oppor­ tunities.  Nature of the Work Fire fighters who average more than a certain number of work hours per week are required to be paid overtime. The hours threshold is determined by the department. Fire fighters often earn overtime for working extra shifts to maintain mini­ mum staffing levels or during special emergencies. Fire fighters receive benefits that usually include medical and liability insurance, vacation and sick leave, and some paid holidays. Almost all fire departments provide protective cloth­ ing (helmets, boots, and coats) and breathing apparatus, and many also provide dress uniforms. Fire fighters generally are covered by pension plans, often providing retirement at half pay after 25 years of service or if the individual is disabled in the line of duty.  Related Occupations Like fire fighters, emergency medical technicians and para­ medics and police and detectives respond to emergencies and save lives.  Sources of Additional Information Information about a career as a fire fighter may be obtained from local fire departments and from either of the following organizations: V International Association of Fire Fighters, 1750 New York Ave. NW„ Washington, DC 20006. Internet: http://www.iaff.org y U.S. Fire Administration, 16825 South Seton Ave., Emmitsburg, MD 21727. Internet: http://www.usfa.dhs.gov Information about professional qualifications and a list of colleges and universities offering 2- or 4-year degree programs in fire science or fire prevention may be obtained from: y National Fire Academy, 16825 South Seton Ave., Emmitsburg, MD 21727. Internet: http://www.usfa.dhs.gov/nfa/index.htm  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  People depend on police officers and detectives to protect their lives and property. Law enforcement officers, some of whom are State or Federal special agents or inspectors, perform these duties in a variety of ways depending on the size and type of their organization. In most jurisdictions, they are expected to exercise authority when necessary, whether on or off duty. Police and detectives pursue and apprehend individuals who break the law and then issue citations or give warnings. A large proportion of their time is spent writing reports and maintain­ ing records of incidents they encounter. Most police officers patrol their jurisdictions and investigate any suspicious activity they notice. Detectives, who are often called agents or special agents, perform investigative duties such as gathering facts and collecting evidence. The daily activities of police and detectives differ depending on their occupational specialty—such as police officer, game warden, or detective—and whether they are working for a local, State, or Federal agency. Duties also differ substantially among various Federal agencies, which enforce different aspects of the law. Regardless of job duties or location, police officers and de­ tectives at all levels must write reports and maintain meticulous records that will be needed if they testify in court. Uniformed police officers have general law enforcement du­ ties, including maintaining regular patrols and responding to calls for service. Much of their time is spent responding to calls and doing paperwork. They may direct traffic at the scene of an accident, investigate a burglary, or give first aid to an ac­ cident victim. In large police departments, officers usually are assigned to a specific type of duty. Many urban police agencies are involved in community policing—a practice in which an officer builds relationships with the citizens of local neighbor­ hoods and mobilizes the public to help fight crime. Police agencies are usually organized into geographic dis­ tricts, with uniformed officers assigned to patrol a specific area such as part of the business district or outlying residential neighborhoods. Officers may work alone, but in large agen­  Service Occupations 457  cies, they often patrol with a partner. While on patrol, officers attempt to become thoroughly familiar with their patrol area and remain alert for anything unusual. Suspicious circumstances and hazards to public safety are investigated or noted, and offi­ cers are dispatched to individual calls for assistance within their district. During their shift, they may identify, pursue, and arrest suspected criminals; resolve problems within the community; and enforce traffic laws. Some agencies have special geographic jurisdictions and en­ forcement responsibilities. Public college and university po­ lice forces, public school district police, and agencies serving transportation systems and facilities are examples. Most law enforcement workers in special agencies are uniformed officers; a smaller number are investigators. Some police officers specialize in a particular field, such as chemical and microscopic analysis, training and firearms in­ struction, or handwriting and fingerprint identification. Others work with special units, such as horseback, bicycle, motorcy­ cle, or harbor patrol; canine corps; special weapons and tactics (SWAT); or emergency response teams. A few local and special law enforcement officers primarily perform jail-related duties or work in courts. (For information on other officers who work in jails and prisons, see correctional officers elsewhere in the Handbook.) Sheriffs and deputy sheriffs enforce the law on the county level. Sheriffs are usually elected to their posts and perform du­ ties similar to those of a local or county police chief. Sheriffs’ departments tend to be relatively small, most having fewer than 50 sworn officers. Deputy sheriffs have law enforcement duties similar to those of officers in urban police departments. Police and sheriffs’ deputies who provide security in city and county courts are sometimes called bailiffs State police officers, sometimes called State troopers or highway patrol officers, arrest criminals Statewide and patrol highways to enforce motor vehicle laws and regulations. State police officers often issue traffic citations to motorists. At the scene of accidents, they may direct traffic, give first aid, and call for emergency equipment. They also write reports used to determine the cause of the accident. State police officers are frequently called upon to render assistance to other law enforce­ ment agencies, especially those in rural areas or small towns. State law enforcement agencies operate in every State except Hawaii. Most full-time sworn personnel are uniformed officers who regularly patrol and respond to calls for service. Others work as investigators, perform court-related duties, or carry out administrative or other assignments. Detectives are plainclothes investigators who gather facts and collect evidence for criminal cases. Some are assigned to in­ teragency task forces to combat specific types of crime. They conduct interviews, examine records, observe the activities of suspects, and participate in raids or arrests. Detectives and State and Federal agents and inspectors usually specialize in investi­ gating one type of violation, such as homicide or fraud. They are assigned cases on a rotating basis and work on them until an arrest and conviction is made or until the case is dropped. Fish and game wardens enforce fishing, hunting, and boating laws. They patrol hunting and fishing areas, conduct search and rescue operations, investigate complaints and accidents, and aid in prosecuting court cases.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  The Federal Government works in many areas of law enforce­ ment. Federal Bureau of Investigation (FBI) agents are the Government’s principal investigators, responsible for investigat­ ing violations of more than 200 categories of Federal law and conducting sensitive national security investigations. Agents may conduct surveillance, monitor court-authorized wiretaps, examine business records, investigate white-collar crime, or participate in sensitive undercover assignments. The FBI in­ vestigates a wide range of criminal activity, including organized crime, public corruption, financial crime, bank robbery, kidnap­ ping, terrorism, espionage, drug trafficking, and cyber crime. There are many other Federal agencies that enforce particular types of laws. U.S. Drug Enforcement Administration (DEA) agents enforce laws and regulations relating to illegal drugs. U. S. marshals and deputy marshals protect the Federal courts and ensure the effective operation of the judicial system. Bureau of Alcohol, Tobacco, Firearms, and Explosives agents enforce and investigate violations of Federal firearms and explosives laws, as well as Federal alcohol and tobacco tax regulations. The U.S. Department of State Bureau of Diplomatic Security special agents are engaged in the battle against terrorism. The Department of Homeland Security also employs numer­ ous law enforcement officers within several different agencies, including Customs and Border Protection, Immigration and Customs Enforcement, and the U.S. Secret Service. U.S. Bor­ der Patrol agents protect more than 8,000 miles of international land and water boundaries. Immigration inspectors interview and examine people seeking entrance to the United States and its territories. Customs inspectors enforce laws governing imports and exports by inspecting cargo, baggage, and articles worn or carried by people, vessels, vehicles, trains, and aircraft entering or leaving the United States. Federal Air Marshals provide air security by guarding against attacks targeting U.S. aircraft, pas­ sengers, and crews. U.S. Secret Service special agents and U.S.  Job opportunities in most local police departments will be ex­ cellent, while competition is expectedfor jobs in State and Fed­ eral agencies.  458 Occupational Outlook Handbook  Secret Service uniformed officers protect the President, Vice President, their immediate families, and other public officials. Secret Service special agents also investigate counterfeiting, forgery of Government checks or bonds, and fraudulent use of credit cards. Other Federal agencies employ police and special agents with sworn arrest powers and the authority to carry firearms. These agencies include the Postal Service, the Bureau of Indian Affairs Office of Law Enforcement, the Forest Service, and the National Park Service. Work environment. Police and detective work can be very dangerous and stressful. In addition to the obvious dangers of confrontations with criminals, police officers and detectives need to be constantly alert and ready to deal appropriately with a number of other threatening situations. Many law enforcement officers witness death and suffering resulting from accidents and criminal behavior. A career in law enforcement may take a toll on their private lives. The jobs of some Federal agents such as U.S. Secret Service and DEA special agents require extensive travel, often on very short notice. They may relocate a number of times over the course of their careers. Some special agents in agencies such as the U.S. Border Patrol work outdoors in rugged terrain for long periods and in all kinds of weather. Uniformed officers, detectives, agents, and inspectors are usually scheduled to work 40-hour weeks, but paid overtime is common. Shift work is necessary because protection must be provided around the clock. Junior officers frequently work weekends, holidays, and nights. Police officers and detectives are required to work whenever they are needed and may work long hours during investigations. Officers in most jurisdictions, whether on or off duty, are expected to be armed and to exercise their authority when necessary.  Training, Other Qualifications, and Advancement Most police and detectives learn much of what they need to know on the job, often in their agency’s police academy. Civil service regulations govern the appointment of police and de­ tectives in most States, large municipalities, and special police agencies, as well as in many smaller jurisdictions. Candidates must be U.S. citizens, usually at least 20 years old, and must meet rigorous physical and personal qualifications. Education and training. Applicants usually must have at least a high school education, and some departments require 1 or 2 years of college coursework or, in some cases, a college degree. Law enforcement agencies encourage applicants to take courses or training related to law enforcement subjects after high school. Many entry-level applicants for police jobs have completed some formal postsecondary education, and a signifi­ cant number are college graduates. Many junior colleges, col­ leges, and universities offer programs in law enforcement or administration of justice. Physical education classes and participating in sports are also helpful in developing the competitiveness, stamina, and agility needed for many law enforcement positions. Knowledge of a foreign language is an asset in many Federal agencies and ur­ ban departments.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Many agencies pay all or part of the tuition for officers to work toward degrees in criminal justice, police science, ad­ ministration of justice, or public administration and pay higher salaries to those who earn such a degree. Before their first assignments, officers usually go through a period of training. In State and large local police departments, recruits get training in their agency’s police academy, often for 12 to 14 weeks. In small agencies, recruits often attend a re­ gional or State academy. Training includes classroom instruc­ tion in constitutional law and civil rights, State laws and local ordinances, and accident investigation. Recruits also receive training and supervised experience in patrol, traffic control, the use of firearms, self-defense, first aid, and emergency response. Police departments in some large cities hire high school gradu­ ates who are still in their teens as police cadets or trainees. They do clerical work and attend classes, usually for 1 to 2 years, until they reach the minimum age requirement and can be ap­ pointed to the regular force. To be considered for appointment as an FBI agent, an appli­ cant must be a college graduate and have at least 3 years of pro­ fessional work experience, or have an advanced degree plus 2 years of professional work experience. An applicant who meets these criteria must also have one of the following: a college major in accounting, electrical engineering, information tech­ nology, or computer science; fluency in a foreign language; a degree from an accredited law school; or 3 years of related full­ time work experience. All new FBI agents undergo 18 weeks of training at the FBI Academy on the U.S. Marine Corps base in Quantico, Virginia. Most other Federal law enforcement agencies require either a bachelor’s degree or related work experience or a combination of the two. Federal law enforcement agents undergo extensive training, usually at the U.S. Marine Corps base in Quantico, Virginia, or the Federal Law Enforcement Training Center in Glynco, Georgia. The educational requirements, qualifications, and training information for a particular Federal agency can be found on the agency’s Web site, most of which are listed in the last section of this statement. Fish and game wardens also must meet specific requirements. Most States require at least 2 years of college study. Once hired, fish and game wardens attend a training academy lasting from 3 to 12 months, sometimes followed by further training in the field. Other qualifications. Civil service regulations govern the appointment of police and detectives in most States, large mu­ nicipalities, and special police agencies, as well as in many smaller jurisdictions. Candidates must be U.S. citizens, usually at least 20 years old, and must meet rigorous physical and per­ sonal qualifications. Physical examinations for entrance into law enforcement often include tests of vision, hearing, strength, and agility. Eligibility for appointment usually depends on performance in competitive written examinations and previous education and experience. Candidates should enjoy working with people and meeting the public. Because personal characteristics such as honesty, sound judgment, integrity, and a sense of responsibility are especially important in law enforcement, candidates are interviewed by senior officers, and their character traits and backgrounds are  Service Occupations 459  Projections data from the National Employment Matrix Occupational Title Police and detectives......................................................................... .... First-line supervisors/managers of police and detectives......... .... Detectives and criminal investigators.......................................... .... Fish and game wardens................................................................ .... Police officers................................................................................. .... Police and sheriff’s patrol officers.......................................... .... Transit and railroad police....................................................... ....  soc  Code  Employment, 2006  --  33-1012 33-3021 33-3031 33-3050 33-3051 33-3052  861,000 93,000 106,000 8,000 654,000 648,000 5,600  Projected employment, 2016 959,000 102,000 125,000 8,000 724,000 719,000 5,900  Change, 2006-16 Number Percent 97,000 11 8,500 9 18,000 17 0 0 70,000 11 70,000 11 400 6  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  investigated. In some agencies, candidates are interviewed by a psychiatrist or a psychologist or given a personality test. Most applicants are subjected to lie detector examinations or drug testing. Some agencies subject sworn personnel to random drug testing as a condition of continuing employment. Advancement. Police officers usually become eligible for promotion after a probationary period ranging from 6 months to 3 years. In large departments, promotion may enable an of­ ficer to become a detective or to specialize in one type of police work, such as working with juveniles. Promotions to corporal, sergeant, lieutenant, and captain usually are made according to a candidate’s position on a promotion list, as determined by scores on a written examination and on-the-job performance. Continuing training helps police officers, detectives, and special agents improve their job performance. Through police department academies, regional centers for public safety em­ ployees established by the States, and Federal agency training centers, instructors provide annual training in self-defense tac­ tics, firearms, use-of-force policies, sensitivity and communica­ tions skills, crowd-control techniques, relevant legal develop­ ments, and advances in law enforcement equipment.  Employment Police and detectives held about 861,000 jobs in 2006. Sev­ enty-nine percent were employed by local governments. State police agencies employed about 11 percent, and various Federal agencies employed about 7 percent. A small proportion worked for educational services, rail transportation, and contract inves­ tigation and security services. According to the U.S. Bureau of Justice Statistics, police and detectives employed by local governments primarily worked in cities with more than 25,000 inhabitants. Some cities have very large police forces, while thousands of small communities em­ ploy fewer than 25 officers each.  Job Outlook Job opportunities in most local police departments will be ex­ cellent for qualified individuals, while competition is expected for jobs in State and Federal agencies. Average employment growth is expected. Employment change. Employment of police and detectives is expected to grow 11 percent over the 2006-16 decade, about as fast as the average for all occupations. A more security-con­ scious society and population growth will contribute to the in­ creasing demand for police services.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Job prospects. Overall opportunities in local police depart­ ments will be excellent for individuals who meet the psycho­ logical, personal, and physical qualifications. In addition to openings from employment growth, many openings will be cre­ ated by the need to replace workers who retire and those who leave local agencies for Federal jobs and private sector security jobs. There will be more competition for jobs in Federal and State law enforcement agencies than for jobs in local agencies. Less competition for jobs will occur in departments that offer relatively low salaries or those in urban communities where the crime rate is relatively high. Applicants with military experi­ ence or college training in police science will have the best op­ portunities in local and State departments. Applicants with a bachelor’s degree and several years of law enforcement or mili­ tary experience, especially investigative experience, will have the best opportunities in Federal agencies. The level of government spending determines the level of employment for police and detectives. The number of job op­ portunities, therefore, can vary from year to year and from place to place. Layoffs, on the other hand, are rare because retire­ ments enable most staffing cuts to be handled through attrition. Trained law enforcement officers who lose their jobs because of budget cuts usually have little difficulty finding jobs with other agencies.  Earnings Police and sheriff’s patrol officers had median annual earn­ ings of $47,460 in May 2006. The middle 50 percent earned between $35,600 and $59,880. The lowest 10 percent earned less than $27,310, and the highest 10 percent earned more than $72,450. Median annual earnings were $43,510 in Federal Government, $52,540 in State government, and $47,190 in lo­ cal government. In May 2006, median annual earnings of police and detec­ tive supervisors were $69,310. The middle 50 percent earned between $53,900 and $83,940. The lowest 10 percent earned less than $41,260, and the highest 10 percent earned more than $104,410. Median annual earnings were $85,170 in Federal Government, $68,990 in State government, and $68,670 in lo­ cal government. In May 2006, median annual earnings of detectives and crim­ inal investigators were $58,260. The middle 50 percent earned between $43,920 and $76,350. The lowest 10 percent earned less than $34,480, and the highest 10 percent earned more than $92,590. Median annual earnings were $69,510 in Federal  460 Occupational Outlook Handbook  Government, $49,370 in State government, and $52,520 in lo­ cal government. Federal law provides special salary rates to Federal employ­ ees who serve in law enforcement. Additionally, Federal spe­ cial agents and inspectors receive law enforcement availabil­ ity pay (LEAP)—equal to 25 percent of the agent’s grade and step—awarded because of the large amount of overtime that these agents are expected to work. For example, in 2007, FBI agents entered Federal service as GS-10 employees on the pay scale at a base salary of $48,159, yet they earned about $60,199 a year with availability pay. They could advance to the GS13 grade level in field nonsupervisory assignments at a base salary of $75,414, which was worth $94,268 with availability pay. FBI supervisory, management, and executive positions in grades GS-14 and GS-15 paid a base salary of about $89,115 and $104,826 a year, respectively, which amounted to $111,394 or $131,033 per year including availability pay. Salaries were slightly higher in selected areas where the prevailing local pay level was higher. Because Federal agents may be eligible for a special law enforcement benefits package, applicants should ask their recruiter for more information. Total earnings for local, State, and special police and detec­ tives frequently exceed the stated salary because of payments for overtime, which can be significant. According to the International City-County Management Association’s annual Police and Fire Personnel, Salaries, and Expenditures Survey, average salaries for sworn full-time posi­ tions in 2006 were:  Rank Police chief........................... .............. Deputy chief.......................... .............. Police captain....................... .............. Police lieutenant................... Police sergeant..................... .............. Police corporal..................... ..............  Minimum annual base salary $78,547 68.797 65,408 59,940 53,734 44,160  Maximum annual base salary $99,698 87,564 81,466 72,454 63,564 55,183  In addition to the common benefits—paid vacation, sick leave, and medical and life insurance—most police and sher­ iffs’ departments provide officers with special allowances for uniforms. Because police officers usually are covered by lib­ eral pension plans, many retire at half-pay after 25 or 30 years of service.  For general information about sheriffs and to learn more about the National Sheriffs’ Association scholarship, contact: y National Sheriffs’ Association, 1450 Duke St., Alexandria, VA 22314. Internet: http://www.sheriffs.org Information about qualifications for employment as a FBI Special Agent is available from the nearest State FBI office. The address and phone number are listed in the local telephone directory. Internet: http://www.fbi.gov Information on career opportunities, qualifications, and train­ ing for U.S. Secret Service Special Agents and Uniformed Of­ ficers is available from the Secret Service Personnel Division at (202) 406-5800, (888) 813-877, or (888) 813-USSS. Internet: http://www.secretservice.gov/join Information about qualifications for employment as a DEA Special Agent is available from the nearest DEA office, or call (800) DEA-4288. Internet: http://www.usdoj.gov/dea Information about career opportunities, qualifications, and training to become a deputy marshal is available from: y U.S. Marshals Service, Human Resources Division—Law Enforcement Recruiting, Washington, DC 20530-1000. Internet: http ://www.usmarshals.gov For information on operations and career opportunities in the U.S. Bureau of Alcohol, Tobacco, Firearms, and Explosives, contact: y U.S. Bureau of Alcohol, Tobacco, Firearms, and Explosives, Office of Governmental and Public Affairs, 650 Massachusetts Ave., NW., Room 8290, Washington D.C., 20226. Internet: http://www.atf.gov Information about careers in U.S. Customs and Border Pro­ tection is available from: y U.S. Customs and Border Protection, 1300 Pennsylvania Ave. NW., Washington, DC 20229. Internet: http://www.cbp.gov Information about law enforcement agencies within the De­ partment of Homeland Security is available from: y U.S. Department of Homeland Security, Washington, DC 20528. Internet: http://www.dhs.gov To find Federal, State, and local law enforcement job fairs and other recruiting events across the country, contact: y National Law Enforcement Recruiters Association, 2045 15th St.North, Suite 210, Arlington, VA 22201. Internet: http://www.nlera.org  Private Detectives and Investigators (Q*NET 33-9021.00)  Related Occupations Police and detectives maintain law and order, collect evidence and information, and conduct investigations and surveillance. Workers in related occupations include correctional officers, private detectives and investigators, probation officers and cor­ rectional treatment specialists, and security guards and gaming surveillance officers. Like police and detectives, firefighters and emergency medical technicians and paramedics provide public safety services and respond to emergencies.  Sources of Additional Information Information about entrance requirements may be obtained from Federal, State, and local law enforcement agencies.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Significant Points  Work hours are often irregular, and the work can be dangerous. About 30 percent are self-employed. Applicants typically have related experience in areas such as law enforcement, insurance, the military, or government investigative or intelligence jobs. Keen competition is expected for most jobs despite faster-than-average employment growth.  Service Occupations 461  Nature of the Work Private detectives and investigators assist individuals, business­ es, and attorneys by finding and analyzing information. They connect small clues to solve mysteries or to uncover facts about legal, financial, or personal matters. Private detectives and in­ vestigators offer many services, including executive, corporate, and celebrity protection; pre-employment verification; and indi­ vidual background profiles. Some investigate computer crimes, such as identity theft, harassing e-mails, and illegal download­ ing of copyrighted material. They also provide assistance in criminal and civil liability cases, insurance claims and fraud, child custody and protection cases, missing persons cases, and premarital screening. They are sometimes hired to investigate individuals to prove or disprove infidelity. Private detectives and investigators have many methods to choose from when determining the facts in a case. Much of their work is done using a computer, recovering deleted e-mails and documents, for example. They may also perform computer database searches or work with someone who does. Computers allow investigators to quickly obtain huge amounts of informa­ tion such as a subject’s prior arrests, convictions, and civil legal judgments; telephone numbers; motor vehicle registrations; as­ sociation and club memberships; and even photographs. Detectives and investigators also perform various other types of surveillance or searches. To verify facts, such as an individu­ al’s income or place of employment, they may make phone calls or visit a subject’s workplace. In other cases, especially those involving missing persons and background checks, investiga­ tors interview people to gather as much information as possible about an individual. Sometimes investigators go undercover, pretending to be someone else to get information or to observe a subject inconspicuously. Most detectives and investigators are trained to perform physical surveillance, which may be high-tech or low-tech. They may observe a site, such as the home of a subject, from an inconspicuous location or a vehicle. Using photographic and video cameras, binoculars, and cell phones, detectives often use surveillance to gather information on an individual; this can be quite time consuming. The duties of private detectives and investigators depend on the needs of their clients. In cases that involve fraudulent workers’ compensation claims, for example, investigators may carry out long-term covert observation of a person suspected of fraud. If an investigator observes him or her performing an ac­ tivity that contradicts injuries stated in a worker’s compensation claim, the investigator would take video or still photographs to document the activity and report it to the client. Detectives and investigators must be mindful of the law when conducting investigations. They keep up with Federal, State, and local legislation, such as privacy laws and other legal issues affecting their work. The legality of certain methods may be unclear, and investigators and detectives must make judgment calls when deciding how to pursue a case. They must also know how to collect evidence properly so that they do not compro­ mise its admissibility in court. Private detectives and investigators often specialize. Those who focus on intellectual property theft, for example, investi­ gate and document acts of piracy, help clients stop illegal activ­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  ity, and provide intelligence for prosecution and civil action. Other investigators specialize in developing financial profiles and asset searches. Their reports reflect information gathered through interviews, investigation and surveillance, and research, including review of public documents. Computer forensic investigators specialize in recovering, an­ alyzing, and presenting data from computers for use in investi­ gations or as evidence. They determine the details of intrusions into computer systems, recover data from encrypted or erased files, and recover e-mails and deleted passwords. Legal investigators assist in preparing criminal defenses, lo­ cating witnesses, serving legal documents, interviewing police and prospective witnesses, and gathering and reviewing evi­ dence. Legal investigators also may collect information on the parties to the litigation, take photographs, testify in court, and assemble evidence and reports for trials. They often work for law firms or lawyers. Corporate investigators conduct internal and external in­ vestigations for corporations. In internal investigations, they may investigate drug use in the workplace, ensure that expense accounts are not abused, or determine whether employees are stealing merchandise or information. External investigations attempt to thwart criminal schemes from outside the corpora­ tion, such as fraudulent billing by a supplier. Financial investigators may be hired to develop confidential financial profiles of individuals or companies that are prospec­ tive parties to large financial transactions. These investigators often are certified public accountants (CPAs) who work closely with investment bankers and other accountants. They might also search for assets in order to recover damages awarded by a court in fraud or theft cases. Detectives who work for retail stores or hotels are responsible for controlling losses and protecting assets. Store detectives, also known as loss prevention agents, safeguard the assets of re­ tail stores by apprehending anyone attempting to steal merchan­ dise or destroy store property. They prevent theft by shoplift­ ers, vendor representatives, delivery personnel and even store employees. Store detectives also conduct periodic inspections of stock areas, dressing rooms, and restrooms, and sometimes assist in opening and closing the store. They may prepare loss prevention and security reports for management and testify in court against people they apprehend. Hotel detectives protect guests of the establishment from theft of their belongings and preserve order in hotel restaurants and bars. They also may keep undesirable individuals, such as known thieves, off the premises. Work environment. Many detectives and investigators spend time away from their offices conducting interviews or doing surveillance, but some work in their office most of the day con­ ducting computer searches and making phone calls. When the investigator is working on a case, the environment might range from plush boardrooms to seedy bars. Store and hotel detec­ tives work in the businesses that they protect. Investigators generally work alone, but they sometimes work with others during surveillance or when following a subject in order to avoid detection by the subject. Some of the work in­ volves confrontation, so the job can be stressful and dangerous. Some situations call for the investigator to be armed, such as  462 Occupational Outlook Handbook  Despite rapid employment growth, keen competition is expected for private detective jobs. certain bodyguard assignments for corporate or celebrity cli­ ents. In most cases, however, a weapon is not necessary be­ cause the purpose of the work is gathering information and not law enforcement or criminal apprehension. Owners of inves­ tigative agencies have the added stress of having to deal with demanding and sometimes distraught clients. Private detectives and investigators often work irregular hours because of the need to conduct surveillance and contact people who are not available during normal working hours. Early morning, evening, weekend, and holiday work is common.  Training, Other Qualifications, and Advancement Most private detectives and investigators have some college ed­ ucation and previous experience in investigative work. In most States, they are required to be licensed. Education and training. There are no formal education re­ quirements for most private detective and investigator jobs, al­ though many have college degrees. Courses in criminal justice and police science are helpful to aspiring private detectives and investigators. Although related experience is usually required, some people enter the occupation directly after graduation from college, generally with an associate or bachelor’s degree in criminal justice or police science. The 2006 educational attain­ ment for private detectives and investigators, in percent, was as follows: Percent High school graduate or equivalent...............................................18 Some college, no degree.............................................................. 26 Associate’s degree.......................................................................... 8 Bachelor’s degree......................................................................... 34 Master’s degree.............................................................................13 Professional degree or PhD............................................................ 3 Most corporate investigators must have a bachelor’s degree, preferably in a business-related field. Some corporate investi­ gators have a master’s degree in business administration or a law degree; others are CPAs. For computer forensics work, a computer science or account­ ing degree is more helpful than a criminal justice degree. An accounting degree provides good background knowledge for   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  investigating fraud through computer forensics. Either of these two degrees provides a good starting point after which inves­ tigative techniques can be learned on the job. Alternatively, many colleges and universities now offer certificate programs, requiring from 15 to 21 credits, in computer forensics. These programs are most beneficial to law enforcement officers, para­ legals, or others who are already involved in investigative work. A few colleges and universities now offer bachelor’s or master’s degrees in computer forensics, and others are planning to begin offering such degrees. Most of the work of private detectives and investigators is learned on the job. New investigators will usually start by learning how to use databases to gather information. The train­ ing they receive depends on the type of firm. At an insurance company, a new investigator will learn to recognize insurance fraud. At a firm that specializes in domestic cases, a new work­ er might observe a senior investigator performing surveillance. Learning by doing, in which new investigators are put on cases and gain skills as they go, is a common approach. Corporate investigators hired by large companies, however, may receive formal training in business practices, management structure, and various finance-related topics. Because they work with changing technologies, computer forensic investigators never stop training. They learn the lat­ est methods of fraud detection and new software programs and operating systems by attending conferences and courses offered by software vendors and professional associations. Licensure. The majority of States and the District of Colum­ bia require private detectives and investigators to be licensed. Licensing requirements vary, however. Seven States—Alabama, Alaska, Colorado, Idaho, Mississippi, Missouri, and South Da­ kota—have no Statewide licensing requirements, some States have few requirements, and many others have stringent regula­ tions. For example, the Bureau of Security and Investigative Services of the California Department of Consumer Affairs re­ quires private investigators to be 18 years of age or older; have a combination of education in police science, criminal law, or justice and experience equaling 3 years (6,000 hours); pass a criminal history background check by the California Depart­ ment of Justice and the FBI (in most States, convicted felons cannot be issued a license); and receive a qualifying score on a 2-hour written examination covering laws and regulations. De­ tectives and investigators in all States who carry handguns must meet additional requirements for a firearms permit. There are no licenses specifically for computer forensic in­ vestigators, but some States require them to be licensed private investigators. Even where licensure is not required, a private investigator license is useful to some because it allows them to perform follow-up or complementary tasks. Other qualifications. Private detectives and investigators typically have previous experience in other occupations. Some have worked in other occupations for insurance or collections companies, in the private security industry, or as paralegals. Many investigators enter the field after serving in law enforce­ ment, the military, government auditing and investigative po­ sitions, or Federal intelligence jobs. Former law enforcement officers, military investigators, and government agents, who are  Service Occupations 463  frequently able to retire after 25 years of service, often become private detectives or investigators in a second career. Others enter from jobs in finance, accounting, commercial credit, investigative reporting, insurance, and law. These indi­ viduals often can apply their prior work experience in a related investigative specialty. Most computer forensic investigators learn their trade while working for a law enforcement agency, either as a sworn officer or a civilian computer forensic analyst. They are trained at their agency’s computer forensics training program. Many people enter law enforcement specifically to get this training and estab­ lish a reputation before moving to the private sector. For private detective and investigator jobs, most employers look for individuals with ingenuity, persistence, and assertive­ ness. A candidate must not be afraid of confrontation, should communicate well, and should be able to think on his or her feet. Good interviewing and interrogation skills also are impor­ tant and usually are acquired in earlier careers in law enforce­ ment or other fields. Because the courts often are the judge of a properly conducted investigation, the investigator must be able to present the facts in a manner that a jury will believe. The screening process for potential employees typically includes a background check for a criminal history. Certification and advancement. Some investigators receive certification from a professional organization to demonstrate competency in a field. For example, the National Association of Legal Investigators confers the Certified Legal Investigator designation to licensed investigators who devote a majority of their practice to negligence or criminal defense investigations. To receive the designation, applicants must satisfy experience, educational, and continuing-training requirements and must pass written and oral exams. ASIS, a trade organization for the security industry, offers the Professional Certified Investigator certification. To qualify, ap­ plicants must have a high school diploma or equivalent; have 5 years of investigations experience, including 2 years managing investigations; and must pass an exam. Most private-detective agencies are small, with little room for advancement. Usually, there are no defined ranks or steps, so advancement takes the form of increases in salary and assign­ ment status. Many detectives and investigators start their own firms after gaining a few years of experience. Corporate and legal investigators may rise to supervisor or manager of the se­ curity or investigations department.  Employment Private detectives and investigators held about 52,000 jobs in 2006. About 30 percent were self-employed, including many for whom investigative work was a second job. Around 34 percent of detective and investigator jobs were in investiga­ tion and security services, including private detective agencies,  while another 9 percent were in department or other general merchandise stores. The rest worked mostly in State and local government, legal services firms, employment services compa­ nies, insurance agencies, and credit mediation establishments, including banks and other depository institutions.  Job Outlook Keen competition is expected for most jobs despite faster-thanaverage employment growth. Employment change. Employment of private detectives and investigators is expected to grow 18 percent over the 2006-16 decade, faster than the average for all occupations. Increased demand for private detectives and investigators will result from heightened security concerns, increased litigation, and the need to protect confidential information and property of all kinds. The proliferation of criminal activity on the Internet, such as identity theft, spamming, e-mail harassment, and illegal down­ loading of copyrighted materials, will also increase the demand for private investigators. Employee background checks, con­ ducted by private investigators, will become standard for an in­ creasing number of jobs. Growing financial activity worldwide will increase the demand for investigators to control internal and external financial losses, to monitor competitors, and to prevent industrial spying. Job prospects. Keen competition is expected for most jobs because private detective and investigator careers attract many qualified people, including relatively young retirees from law enforcement and military careers. The best opportunities for new jobseekers will be in entry-level jobs in detective agencies or stores, particularly large chain and discount stores that hire detectives on a part-time basis. Opportunities are expected to be excellent for qualified computer forensic investigators.  Earnings Median annual eamings of salaried private detectives and in­ vestigators were $33,750 in May 2006. The middle 50 percent earned between $24,180 and $47,740. The lowest 10 percent earned less than $19,720, and the highest 10 percent earned more than $64,380. Eamings of private detectives and inves­ tigators vary greatly by employer, specialty, and geographic area.  Related Occupations Private detectives and investigators often collect information and protect the property and other assets of companies and in­ dividuals. Others with related duties include bill and account collectors; claims adjusters, appraisers, examiners, and investi­ gators; police and detectives; and security guards and gaming surveillance officers. Investigators who specialize in conduct­ ing financial profiles and asset searches perform work closely  Projections data from the National Employment Matrix Occupational Title Private detectives and investigators.............................. ......................  soc Code 33-9021  Employment, 2006 52,000  Projected employment, 2016 61,000  Change, 2006-16 Number Percent 9,400 18  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  464 Occupational Outlook Handbook  related to that of accountants and auditors, as well as financial analysts and personal financial advisors.  Sources of Additional Information For information on local licensing requirements, contact your State Department of Public Safety, State Division of Licensing, or local or State police headquarters. For information on a career as a legal investigator and about the Certified Legal Investigator credential, contact: y National Association of Legal Investigators, 908 21st St., Sacramento, CA 95814-3118. Internet: http://www.nalionline.org For more information about investigative and other security careers, about the Professional Certified Investigator creden­ tial, and for a list of colleges and universities offering securityrelated courses and majors, contact: > ASIS, 1625 Prince St., Alexandria, VA 22314-2818. Internet: http://www.asisonline.org  Security Guards and Gaming Surveillance Officers (0*NET 33-9031.00, 33-9032.00)  Significant Points •  Jobs should be plentiful, but competition is expected for higher paying positions at facilities requiring lon­ ger periods of training and a high level of security, such as nuclear power plants and weapons installa­ tions.  •  Because of limited formal training requirements and flexible hours, this occupation attracts many individu­ als seeking a second or part-time job.  •  Some positions, such as those of armored car guards, are hazardous.  Nature of the Work Security guards, also called security officers, patrol and inspect property to protect against fire, theft, vandalism, terrorism, and illegal activity. These workers protect their employer’s invest­ ment, enforce laws on the property, and deter criminal activity and other problems. They use radio and telephone communi­ cations to call for assistance from police, fire, or emergency medical services as the situation dictates. Security guards write comprehensive reports outlining their observations and activities during their assigned shift. They also may interview witnesses or victims, prepare case reports, and testify in court. Although all security guards perform many of the same du­ ties, their specific tasks depend on whether they work in a “stat­ ic” security position or on a mobile patrol. Guards assigned to static security positions usually stay at one location for a specified length of time. These guards must become closely acquainted with the property and people associated with their station and must often monitor alarms and closed-circuit TV   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  cameras. In contrast, guards assigned to mobile patrol drive or walk from one location to another and conduct security checks within an assigned geographical zone. They may detain or ar­ rest criminal violators, answer service calls concerning crimi­ nal activity or problems, and issue traffic violation warnings. The security guard’s job responsibilities also vary with the size, type, and location of the employer. In department stores, guards protect people, records, merchandise, money, and equip­ ment. They often work with undercover store detectives to prevent theft by customers or employees, and help apprehend shoplifting suspects prior to the arrival of the police. Some shopping centers and theaters have officers who patrol their parking lots to deter car thefts and robberies. In office build­ ings, banks, and hospitals, guards maintain order and protect the institution’s customers, staff and property. At air, sea, and rail terminals and other transportation facilities, guards protect people, freight, property, and equipment. Using metal detec­ tors and high-tech equipment, they may screen passengers and visitors for weapons and explosives, ensure that nothing is sto­ len while a vehicle is being loaded or unloaded, and watch for fires and criminals. Guards who work in public buildings such as museums or art galleries protect paintings and exhibits by inspecting peo­ ple and packages entering and leaving the building. In fac­ tories, laboratories, government buildings, data processing centers, and military bases, security officers protect informa­ tion, products, computer codes, and defense secrets and check the credentials of people and vehicles entering and leaving the premises. Guards working at universities, parks, and sports stadiums perform crowd control, supervise parking and seat­ ing, and direct traffic. Security guards stationed at the entrance to bars and nightclubs, prevent access by minors, collect cover charges at the door, maintain order among customers, and pro­ tect patrons and property. Armored car guards protect money and valuables during transit. In addition, they protect individuals responsible for making commercial bank deposits from theft or injury. They pick up money or other valuables from businesses to transport to another location. Carrying money between the truck and the business can be extremely hazardous. As a result, armored car guards usually wear bulletproof vests. Gaming surveillance officers, also known as surveillance agents, and gaming investigators act as security agents for ca­ sino managers and patrons. Using primarily audio and video equipment in an observation room, they observe casino op­ erations for irregular activities, such as cheating or theft, and monitor compliance to rules, regulations and laws. They main­ tain and organize recordings from security cameras as they are sometimes used as evidence in police investigations. Some casinos use a catwalk over one-way mirrors located above the casino floor to augment electronic surveillance equipment. Surveillance agents occasionally leave the surveillance room and walk the casino floor. All security officers must show good judgment and common sense, follow directions, testify accurately in court, and follow company policy and guidelines. In an emergency, they must be able to take charge and direct others to safety. In larger organi­ zations, a security manager might oversee a group of security  Service Occupations 465  officers. In smaller organizations, however, a single worker may be solely responsible for all security. Work environment. Most security guards and gaming sur­ veillance officers spend considerable time on their feet, either assigned to a specific post or patrolling buildings and grounds. Guards may be stationed at a guard desk inside a building to monitor electronic security and surveillance devices or to check the credentials of people entering or leaving the prem­ ises. They also may be stationed at a guardhouse outside the entrance to a gated facility or community and may use a por­ table radio or cellular telephone to be in constant contact with a central station. The work usually is routine, but guards must be constantly alert for threats to themselves and the property they are protecting. Guards who work during the day may have a great deal of contact with other employees and the pub­ lic. Gaming surveillance officers often work behind a bank of monitors controlling numerous cameras in a casino and thus can develop eyestrain. Guards usually work shifts of 8 hours or longer for 40 hours per week and are often on call in case of an emergency. Some employers offer three shifts, and guards rotate to divide day­ time, weekend, and holiday work equally. Guards usually eat on the job instead of taking a regular break away from the site. In 2006, about 15 percent of guards worked part time, and some held a second job as a guard to supplement their primary earnings.  Training, Other Qualifications, and Advancement Generally, there are no specific education requirements for se­ curity guards, but employers usually prefer to fill armed guard positions with people who have at least a high school diploma. Gaming surveillance officers often need some education be­ yond high school. In most States, guards must be licensed. Education and training. Many employers of unarmed guards do not have any specific educational requirements. For armed guards, employers usually prefer individuals who are high school graduates or who hold an equivalent certification. Many employers give newly hired guards instruction before they start the job and provide on-the-job training. The amount of training guards receive varies. Training is more rigorous for armed guards because their employers are legally responsible for any use of force. Armed guards receive formal training in areas such as weapons retention and laws covering the use of force. They may be periodically tested in the use of firearms. An increasing number of States are making ongoing train­ ing a legal requirement for retention of licensure. Guards may receive training in protection, public relations, report writing, crisis deterrence, first aid, and specialized training relevant to their particular assignment. The American Society for Industrial Security International has written voluntary training guidelines that are intended to provide regulating bodies consistent minimum standards for the quality of security services. These guidelines recommend that security guards receive at least 48 hours of training within the first 100 days of employment. The guidelines also suggest that security guards be required to pass a written or performance examination covering topics such as sharing information with law enforcement, crime prevention, handling evidence, the   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Security guards patrol property and buildings to deter crime. use of force, court testimony, report writing, interpersonal and communication skills, and emergency response procedures. In addition, they recommend annual retraining and additional firearms training for armed officers. Guards who are employed at establishments that place a heavy emphasis on security usually receive extensive formal training. For example, guards at nuclear power plants undergo several months of training before going on duty—and even then, they perform their tasks under close supervision for a significant period of time. They are taught to use firearms, administer first aid, operate alarm systems and electronic secu­ rity equipment, and spot and deal with security problems. Gaming surveillance officers and investigators usually need some training beyond high school but not usually a bachelor’s degree. Several educational institutes offer certification pro­ grams. Classroom training usually is conducted in a casino­ like atmosphere and includes the use of surveillance camera equipment. Previous security experience is a plus. Employers prefer either individuals with casino experience and significant knowledge of casino operations or those with law enforcement and investigation experience. Licensure. Most States require that guards be licensed. To be licensed as a guard, individuals must usually be at least 18 years old, pass a background check, and complete classroom training in such subjects as property rights, emergency pro­ cedures, and detention of suspected criminals. Drug testing often is required and may be random and ongoing. Guards who carry weapons must be licensed by the appro­ priate government authority, and some receive further certifi­ cation as special police officers, allowing them to make limited types of arrests while on duty. Armed guard positions have more stringent background checks and entry requirements than those of unarmed guards.  466 Occupational Outlook Handbook  Other qualifications. Most jobs require a driver’s license. For positions as armed guards, employers often seek people who have had responsible experience in other occupations. Rigorous hiring and screening programs consisting of back­ ground, criminal record, and fingerprint checks are becoming the norm in the occupation. Applicants are expected to have good character references, no serious police record, and good health. They should be mentally alert, emotionally stable, and physically fit to cope with emergencies. Guards who have fre­ quent contact with the public should communicate well. Like security guards, gaming surveillance officers and gam­ ing investigators must have keen observation skills and excel­ lent verbal and writing abilities to document violations or sus­ picious behavior. They also need to be physically fit and have quick reflexes because they sometimes must detain individuals until local law enforcement officials arrive. Advancement. Compared with unarmed security guards, armed guards and special police usually enjoy higher earn­ ings and benefits, greater job security, and more potential for advancement. Because many people do not stay long in this occupation, opportunities for advancement are good for those who make a career in security. Most large organizations use a military type of ranking that offers the possibility of advance­ ment in both position and salary. Some guards may advance to supervisor or security manager positions. Guards with manage­ ment skills may open their own contract security guard agen­ cies. Guards can also move to an organization with more strin­ gent security and higher pay.  Employment Security guards and gaming surveillance officers held over 1 million jobs in 2006. More than half of all jobs for security guards were in investigation and security services, including guard and armored car services. These organizations provide security on a contract basis, assigning their guards to buildings and other sites as needed. Most other security officers were employed directly by educational services, hospitals, food ser­ vices and drinking places, traveler accommodation (hotels), department stores, manufacturing firms, lessors of real estate (residential and nonresidential buildings), and governments. Guard jobs are found throughout the country, most commonly in metropolitan areas. Gaming surveillance officers work primarily in gambling industries; traveler accommodation, which includes casino hotels; and local government. They are employed only in those States and on those Indian reservations where gambling is legal. A significant number of law enforcement officers work as security guards when they are off duty, in order to supplement  their incomes. Often working in uniform and with the official cars assigned to them, they add a high-profile security pres­ ence to the establishment with which they have contracted. At construction sites and apartment complexes, for example, their presence often deters crime. (Police and detectives are discussed elsewhere in the Handbook.)  Job Outlook Opportunities for security guards and gaming surveillance of­ ficers should be favorable. Numerous job openings will stem from employment growth, driven by the demand for increased security, and from the need to replace those who leave this large occupation each year. Employment change. Employment of security guards is ex­ pected to grow by 17 percent between 2006 and 2016, which is faster than the average for all occupations. This occupa­ tion will have a very large number of new jobs arise, about 175,000 over the projections decade. Concern about crime, vandalism, and terrorism continues to increase the need for security. Demand for guards also will grow as private security firms increasingly perform duties—such as providing security at public events and in residential neighborhoods—that were formerly handled by police officers. Employment of gaming surveillance officers is expected to grow by 34 percent between 2006 and 2016, which is much faster than the average for all occupations. Casinos will con­ tinue to hire more surveillance officers as more States legal­ ize gambling and as the number of casinos increases in States where gambling is already legal. In addition, casino security forces will employ more technically trained personnel as tech­ nology becomes increasingly important in thwarting casino cheating and theft. Job prospects. Job prospects for security guards should be excellent because of growing demand for these workers and the need to replace experienced workers who leave the occu­ pation. In addition to full-time job opportunities, the limited training requirements and flexible hours attract many people seeking part-time or second jobs. However, competition is ex­ pected for higher paying positions that require longer periods of training; these positions usually are found at facilities that require a high level of security, such as nuclear power plants or weapons installations. Job prospects for gaming surveillance officers should be good, but they will be better for those with experience in the gaming industry.  Earnings Median annual wage-and-salary earnings of security guards were $21,530 in May 2006. The middle 50 percent earned  Projections data from the National Employment Matrix Occupational Title Security guards and gaming surveillance officers......................... .... Gaming surveillance officers and gaming investigators.......... .... Security euards............................................................................. ....  soc Code  Employment, 2006  33-9030 33-9031 33-9032  1.049.000 8,700 1.040.000  Projected employment, 2016 1.227.000 12,000 1.216.000  Change, 2006-16 Number Percent 178.000 17 2,900 34 175.000 17  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Service Occupations 467  between $17,620 and $27,430. The lowest 10 percent earned less than $15,030, and the highest 10 percent earned more than $35,840. Median annual earnings in the industries employing the largest numbers of security guards were: General medical and surgical hospitals...............................$26,610 Elementary and secondary schools.......................................26,290 Local government................................................................. 24,950 Investigation, guard and armored car services......................20,280 Gaming surveillance officers and gaming investigators had median annual wage-and-salary earnings of $27,130 in May 2006. The middle 50 percent earned between $21,600 and $35,970. The lowest 10 percent earned less than $18,720, and the highest 10 percent earned more than $45,940.  Related Occupations Guards protect property, maintain security, and enforce regula­ tions and standards of conduct in the establishments at which they work. Related security and protective service occupations include correctional officers, police and detectives, private de­ tectives and investigators, and gaming services occupations.  Sources of Additional Information Further information about work opportunities for guards is available from local security and guard firms and State employ­ ment service offices. Information about licensing requirements for guards may be obtained from the State licensing commis­ sion or the State police department. In States where local juris­ dictions establish licensing requirements, contact a local gov­ ernment authority such as the sheriff, county executive, or city manager.  Food Preparation and Serving Related Occupations Chefs, Cooks, and Food Preparation Workers (0*NET 35-1011.00, 35-2011.00, 35-2012.00, 35-2013.00, 35-2014.00, 35-2015.00, 35-2019.99, 35-2021.00)  Significant Points •  Many cooks and food preparation workers are young—37 percent are below the age of 24.  •  One-third of these workers are employed part time.  •  Job openings are expected to be plentiful because many of these workers will leave the occupation for full-time employment or better wages.  Nature of the Work Chefs, cooks, and food preparation workers prepare, season, and cook a wide range of foods—from soups, snacks, and sal­ ads to entrees, side dishes, and desserts. They work in a variety of restaurants and other food services establishments. Chefs and cooks create recipes and prepare meals, while food prepa­ ration workers peel and cut vegetables, trim meat, prepare poul­ try, and perform other duties, such as keeping work areas clean and monitoring temperatures of ovens and stovetops. Specifically, chefs and cooks measure, mix, and cook ingredi­ ents according to recipes, using a variety of equipment, includ­ ing pots, pans, cutlery, ovens, broilers, grills, slicers, grinders, and blenders. Chefs and head cooks also are responsible for directing the work of other kitchen workers, estimating food requirements, and ordering food supplies. Food preparation workers perform routine, repetitive tasks under the direction of chefs and cooks. These workers ready the ingredients for complex dishes by slicing and dicing veg­ etables, and composing salads and cold items. They weigh and measure ingredients, go after pots and pans, and stir and strain   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soups and sauces. Food preparation workers may cut and grind meats, poultry, and seafood in preparation for cooking. They also clean work areas, equipment, utensils, dishes, and silver­ ware. Larger restaurants and food services establishments tend to have varied menus and larger kitchen staffs. Staffs often in­ clude several chefs and cooks, sometimes called assistant or line cooks. Each chef or cook works an assigned station that is equipped with the types of stoves, grills, pans, and ingredients needed for the foods prepared at that station. Job titles often reflect the principal ingredient prepared or the type of cook­ ing performed—vegetable cook, fry cook, or grill cook, for ex­ ample. These cooks also may direct or work with other food preparation workers. Executive chefs and head cooks coordinate the work of the kitchen staff and direct the preparation of meals. They deter­ mine serving sizes, plan menus, order food supplies, and over­ see kitchen operations to ensure uniform quality and presenta­ tion of meals. An executive chef, for example, is in charge of all food service operations and also may supervise the many kitch­ ens of a hotel, restaurant group, or corporate dining operation. A chefde cuisine reports to an executive chef and is responsible for the daily operations of a single kitchen. A sous chef, or sub chef, is the second-in-command and runs the kitchen in the absence of the chef. Many chefs earn fame both for themselves and for their kitchens because of the quality and distinctive na­ ture of the food they serve. Responsibilities depend on where cooks work. Institu­ tion and cafeteria cooks, for example, work in the kitchens of schools, cafeterias, businesses, hospitals, and other institutions. For each meal, they prepare a large quantity of a limited number of entrees, vegetables, and desserts according to preset menus. Meals generally are prepared in advance so diners seldom get the opportunity to special order a meal. Restaurant cooks usu­ ally prepare a wider selection of dishes, cooking most orders individually. Short-order cooks prepare foods in restaurants and coffee shops that emphasize fast service and quick food  468 Occupational Outlook Handbook  preparation. They grill and garnish hamburgers, prepare sand­ wiches, fry eggs, and cook French fries, often working on sev­ eral orders at the same time. Fast-food cooks prepare a limited selection of menu items in fast-food restaurants. They cook and package batches of food, such as hamburgers and fried chicken, to be kept warm until served. {Combinedfood preparation and service workers, who both prepare and serve items in fast-food restaurants, are included with the material on food and beverage serving and related workers elsewhere in the Handbook.) The number and types of workers employed in kitchens also depends on the type of establishment. Small, full-service res­ taurants offering casual dining often feature a limited number of easy-to-prepare items supplemented by short-order special­ ties and ready-made desserts. Typically, one cook prepares all the food with the help of a short-order cook and one or two other kitchen workers. Grocery and specialty food stores employ chefs, cooks, and food preparation workers to develop recipes and prepare meals for customers to carry out. Typically, entrees, side dishes, sal­ ads, or other items are prepared in large quantities and stored at an appropriate temperature. Counter assistants portion and package items according to customer orders for serving at home. Some cooks, called research chefs, combine culinary skills with knowledge of food science to develop recipes for chain restaurants and food processors and manufacturers. They test new formulas and flavors for prepared foods and determine the most efficient and safest way to prepare new foods. Some cooks work for individuals rather than for restaurants, cafeterias, or food manufacturers. These private household cooks plan and prepare meals in private homes according to the client’s tastes or dietary needs. They order groceries and supplies, clean the kitchen, and wash dishes and utensils. They also may serve meals. Private chefs are employed directly by a single individual or family or sometimes by corporations or in­ stitutions, such as universities and embassies, to perform cook­ ing and entertaining tasks. These chefs usually live in and may travel with their employer. Because of the sensitive nature of their employment, they are usually required to sign confidenti­ ality agreements. As part of the job, private chefs often perform additional services, such as paying bills, coordinating sched­ ules, and planning events. Another type of private household cooks, called personal chefs, usually prepare a week’s worth of meals in the client’s home for the client to heat and serve according to directions throughout the week. Personal chefs are self-employed or em­ ployed by a company that provides this service. Work environment. Many restaurant and institutional kitch­ ens have modem equipment, convenient work areas, and air conditioning, but kitchens in older and smaller eating places are often not as well designed. Kitchen staffs invariably work in small quarters against hot stoves and ovens. They are un­ der constant pressure to prepare meals quickly, while ensuring quality is maintained and safety and sanitation guidelines are observed. Because the pace can be hectic during peak dining times, workers must be able to communicate clearly so that food orders are completed correctly.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  I  >;  Chefs, cooks, and food preparation workers often prepare in­ gredients ahead of time so that they can be cooked quickly when ordered. Working conditions vary with the type and quantity of food prepared and the local laws governing food service operations. Workers usually must stand for hours at a time, lifting heavy pots and kettles, and working near hot ovens and grills. Job hazards include slips and falls, cuts, and bums, but injuries are seldom serious. Work hours in restaurants may include early mornings, late evenings, holidays, and weekends. Work schedules of chefs, cooks and other kitchen workers in factory and school cafeterias may be more regular. In 2006, about 29 percent of cooks and 44 percent of food preparation workers had part-time schedules, compared to 15 percent of workers throughout the economy. Work schedules in fine-dining restaurants, however, tend to be longer because of the time required to prepare ingredients in advance. Many executive chefs regularly work 12-hour days because they oversee the delivery of foodstuffs early in the day, plan the menu, and prepare those menu items that take the most skill. The wide range in dining hours and the need for fully-staffed kitchens during all open hours creates work opportunities for students, youth, and other individuals seeking supplemental income, flexible work hours, or variable schedules. Eighteen percent of cooks and food preparation workers were 16 to 19  Service Occupations 469  years old in 2006; nineteen percent were age 20 to 24. Ten percent had variable schedules. Kitchen workers employed by schools may work during the school year only, usually for 9 or 10 months. Similarly, resort establishments usually only offer seasonal employment.  Training, Other Qualifications, and Advancement On-the-job training is most common for fast-food cooks, shortorder cooks, and food preparation workers. Chefs and oth­ ers with more advanced cooking duties often attend cooking school. Vocational training programs are available to many high school students, but advanced positions usually require training after high school. Experience, an ability to develop and enhance cooking skills, and a strong desire to cook are the most common requirements for advancement. Education and training. A high school diploma is not re­ quired for beginning jobs, but it is recommended for those planning a career as a cook or chef. Most fast-food or shortorder cooks and food preparation workers require little educa­ tion or training to start because most skills are learned on the job. Training generally starts with basic sanitation and work­ place safety and continues with instruction on food handling, preparation, and cooking procedures. Training in food han­ dling, sanitation, and health and safety procedures are manda­ tory in most jurisdictions for all workers. Those who become proficient and who show an interest in learning complicated cooking techniques may advance to more demanding cooking positions or into supervisory positions. Some high school or vocational school programs offer cours­ es in basic food safety and handling procedures, cooking, and general business and computer classes that can be helpful for those who might someday want to be a chef or to open their own restaurant. Many school districts, in cooperation with State departments of education, provide on-the-job training and summer workshops for cafeteria kitchen workers who aspire to become cooks. Food service management companies or hotel and restaurant chains, also offer paid internships and summer jobs to those starting out in the field. Internships provide valu­ able experience and can lead to placement in more formal chef training programs. When hiring chefs and others in advanced cooking positions, however, employers usually prefer applicants who have train­ ing after high school. These training programs range from a few months to 2 years or more. Vocational or trade-school programs typically offer basic training in food handling and sanitation procedures, nutrition, slicing and dicing methods for various kinds of meats and vegetables, and basic cook­ ing methods, such as baking, broiling, and grilling. Longer programs leading to a certificate or a 2- or 4-year degree train chefs for fine-dining or upscale restaurants. They offer a wider array of training specialties, such as advanced cooking tech­ niques; cooking for banquets, buffets, or parties; and cuisines and cooking styles from around the world. A growing number of chefs participate in these longer train­ ing programs through independent cooking schools, profes­ sional culinary institutes, 2- or 4-year college degree programs in hospitality or culinary arts, or in the armed forces. Some large hotels and restaurants also operate their own training and   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  job-placement programs for chefs and cooks. Executive chefs and head cooks who work in fine-dining restaurants require many years of training and experience and an intense desire to cook. Although curricula may vary, students in culinary train­ ing programs spend most of their time in kitchens learning to prepare meals by practicing cooking skills. They learn good knife techniques and proper use and care of kitchen equipment. Training programs also include courses in nutrition, menu plan­ ning, portion control, purchasing and inventory methods, prop­ er food storage procedures, and use of leftover food to mini­ mize waste. Students also learn sanitation and public health rules for handling food. Training in food service management, computer accounting and inventory software, and banquet service are featured in some training programs. Most formal training programs also require students to get experience in a commercial kitchen through an internship, apprenticeship, or out-placement program. Many chefs are trained on the job, receiving real work expe­ rience and training from chef-mentors in the restaurants where they work. Professional culinary institutes, industry associa­ tions, and trade unions sponsor formal apprenticeship programs in coordination with the U.S. Department of Labor. The American Culinary Federation accredits more than 200 formal academic training programs and sponsors apprentice­ ship programs around the country. Typical apprenticeships last 2 years and combine classroom training and work experience. Accreditation is an indication that a culinary program meets recognized standards regarding course content, facilities, and quality of instruction. Other qualifications. Chefs, cooks, and food preparation workers must be efficient, quick, and work well as part of a team. Manual dexterity is helpful for cutting, chopping, and plating. These workers also need creativity and a keen sense of taste and smell. Personal cleanliness is essential because most States require health certificates indicating that workers are free from communicable diseases. Knowledge of a foreign language can be an asset because it may improve communica­ tion with other restaurant staff, vendors, and the restaurant’s clientele. Certification and advancement. The American Culinary Federation certifies pastry professionals, personal chefs, and culinary educators in addition to various levels of chefs. Cer­ tification standards are based primarily on experience and for­ mal training. Although certification is not required, it can help to prove accomplishment and lead to advancement and higher­ paying positions. Advancement opportunities for chefs, cooks, and food prep­ aration workers depend on their training, work experience, and ability to perform more responsible and sophisticated tasks. Many food preparation workers, for example, may move into assistant or line cook positions. Chefs and cooks who demon­ strate an eagerness to learn new cooking skills and to accept greater responsibility may also move up and be asked to train or supervise lesser skilled kitchen staff. Others may move to larger or more prestigious kitchens and restaurants. Some chefs and cooks go into business as caterers or person­ al chefs or open their own restaurant. Others become instruc-  470 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Chefs, cooks, and food preparation workers...................... ............. Chefs and head cooks........................................................................ Cooks and food preparation workers.............................. ................ Cooks............................................................................................. Cooks, fast food........................................................................ Cooks, institution and cafeteria............................... ................ Cooks, private household......................................................... Cooks, restaurant....................................................................... Cooks, short order..................................................................... Cooks, all other......................................................................... Food preparation workers............................................................  soc Code  Employment, 2006  ...  3,113,000 115,000 2,998,000 2,097,000 629,000 401,000 4,900 850,000 195,000 16,000 902,000  35-1011 35-2000 35-2010 35-2011 35-2012 35-2013 35-2014 35-2015 35-2019 35-2021  Projected employment, 2016 3,464,000 124,000 3,340,000 2,301,000 681,000 445,000 5,400 948,000 205,000 16,000 1,040,000  Change, 2006-16 Number Percent 351,000 11 8 8,700 11 342,000 10 204,000 8 52,000 43,000 11 400 9 12 98,000 9,500 5 3 500 138,000 15  NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.  tors in culinary training programs. A number of cooks and chefs advance to executive chef positions or food service man­ agement positions, particularly in hotels, clubs, or larger, more elegant restaurants. (See the section on food service managers elsewhere in the Handbook.)  Employment Chefs, cooks, and food preparation workers held 3.1 million jobs in 2006. The distribution of jobs among the various types of chefs, cooks, and food preparation workers was as follows: Food preparation workers ................................................. 902,000 Cooks, restaurant................................................................ 850,000 Cooks, fast food ................................................................. 629,000 Cooks, institution and cafeteria.......................................... 401,000 Cooks, short order...............................................................195,000 Chefs and head cooks........................................................ 115,000 Cooks, private household....................................................... 4,900 Cooks, all other......................................................................16,000 Two-thirds of all chefs, cooks, and food preparation work­ ers were employed in restaurants and other food services and drinking places. About 15 percent worked in institutions such as schools, universities, hospitals, and nursing care facilities. Grocery stores, hotels, and gasoline stations with convenience stores employed most of the remainder.  Job Outlook Job opportunities for chefs, cooks, and food preparation workers are expected to be plentiful because of the continued growth and expansion of food services outlets, resulting in av­ erage employment growth, and because of the large numbers of workers who leave these occupations and need to be replaced. However, those seeking the highest-paying positions will face keen competition. Employment change. Employment of chefs, cooks, and food preparation workers is expected to increase by 11 percent over the 2006-16 decade, which is about as fast as the average for all occupations. This occupation will have among the larg­ est numbers of new jobs arise, about 351,000 over the period. Growth will be spurred by increases in population, household   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  income, and demand for convenience that will lead to more people dining out and taking vacations that include hotel stays and restaurant visits. In addition, employment of chefs, cooks, and food preparation workers who prepare meals-to-go, such as those who work in the prepared foods sections of grocery or specialty food stores, should grow faster than average as these stores compete with restaurants for people’s food dol­ lars. Also, there is a growing consumer desire for convenient, healthier, made-from-scratch meals. Projected employment growth varies by detailed occupa­ tion. The number of higher-skilled chefs and cooks working in full-service restaurants—those that offer table service and more varied menus—is expected to increase about as fast as the average for all occupations. Much of this increase will come from job growth in more casual dining settings, rather than in up-scale full-service restaurants. Dining trends suggest that an increasing number of meals are eaten away from home, which creates growth in family dining restaurants, but greater lim­ its on expense-account meals is expected to generate slower growth for up-scale restaurants. Employment of food preparation workers is expected to grow faster than the average for all occupations, reflecting din­ ers’ desires for convenience as they shop for carryout meals in a greater variety of places, including full-service restaurants, limited-service eating places, and grocery stores. Employment of fast-food cooks is expected to grow about as fast as the average for all occupations. Duties of cooks in fast-food restaurants are limited; most workers are likely to be combined food preparation and serving workers, rather than fast-food cooks. Employment of short-order cooks is expected to increase more slowly than average. Employment of institution and cafeteria chefs and cooks will show growth about as fast as the average. Their employment will not keep pace with the rapid growth in the educational and health services industries—where their employment is concentrated. Offices, schools, and hospitals increasingly con­ tract out their food services in an effort to make “institutional food” more attractive to office workers, students, staff, visitors, and patients. Much of the growth of these workers will be in contract food service establishments that provide catering services or food management and staff for employee dining  Service Occupations 471  rooms, sports complexes, convention centers, and educational or health care facilities. Employment of private household cooks is projected to grow by 9 percent, about as fast as the average. While the employ­ ment of personal chefs is expected to increase—reflecting the growing popularity and convenience of eating restaurant-qual­ ity meals at home—the number of private chefs will not grow as fast, reflecting slower growth in private household service employment. Job prospects. Job openings for chefs, cooks, and food preparation workers are expected to be plentiful through 2016; however, competition should be keen for jobs in the top kitch­ ens of higher end restaurants. Although job growth will create many new positions, the overwhelming majority of job open­ ings will stem from the need to replace workers who leave this large occupational group. Many chef, cook, and food prepa­ ration worker jobs are attractive to people seeking first-time or short-term employment, additional income, or a flexible schedule. Employers typically hire a large number of part­ time workers, but many of these workers soon transfer to other occupations or stop working, creating numerous openings for those entering the field. At higher end restaurants, the fast pace, long hours, and high energy levels required to succeed also cause some top chefs and cooks to leave for other jobs, creating job openings.  Earnings Earnings of chefs, cooks, and food preparation workers vary greatly by region and the type of employer. Earnings usually are highest in elegant restaurants and hotels, where many ex­ ecutive chefs are employed, and in major metropolitan and re­ sort areas. Median annual wage-and-salary earnings of chefs and head cooks were $34,370 in May 2006. The middle 50 percent earned between $25,910 and $46,040. The lowest 10 percent earned less than $20,160, and the highest 10 percent earned more than $60,730. Median annual earnings in the industries employing the largest number of chefs and head cooks were: Other amusement and recreations industries .....................$46,460 Traveler accommodation....................................................... 40,020 Special food services............................................................ 36,450 Full-service restaurants ........................................................ 32,360 Limited-service eating places .............................................. 27,560 Median annual wage-and-salary earnings of cooks, private household were $22,870 in May 2006. The middle 50 percent earned between $17,960 and $31,050. The lowest 10 percent earned less than $14,690, and the highest 10 percent earned more than $55,040. Median annual wage-and-and salary earnings of institution and cafeteria cooks were $20,410 in May 2006. The middle 50 percent earned between $16,280 and $25,280. The lowest 10 percent earned less than $13,450, and the highest 10 per­ cent earned more than $30,770. Median annual earnings in the industries employing the largest numbers of institution and cafeteria cooks were:   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  General medical and surgical hospitals...............................$22,980 Special food services............................................................. 21,650 Community care facilities for the elderly.............................20,910 Nursing care facilities...........................................................20,470 Elementary and secondary schools.......................................18,770 Median annual wage-and-salary earnings of restaurant cooks were $20,340 in May 2006. The middle 50 percent earned between $16,860 and $24,260. The lowest 10 percent earned less than $14,370, and the highest 10 percent earned more than $28,850. Median annual earnings in the industries employing the largest numbers of restaurant cooks were: Traveler accommodations ..................................................$23,400 Full-service restaurants ........................................................20,100 Limited-service eating places .............................................. 18,200 Median annual wage-and-salary earnings of short-order cooks were $17,880 in May 2006. The middle 50 percent earned between $14,960 and $21,820. The lowest 10 percent earned less than $12,930, and the highest 10 percent earned more than $26,110. Median annual earnings in full-service restaurants were $18,340. Median annual wage-and-salary earnings of food prepa­ ration workers were $17,410 in May 2006. The middle 50 percent earned between $14,920 and $21,230. The lowest 10 percent earned less than $13,190, and the highest 10 percent earned more than $25,940. Median annual earnings in the industries employing the largest number of food preparation workers were: Grocery stores..................................................................... $18,920 Full-service restaurants......................................................... 17,390 Limited-service eating places.....................................................15,550  Median annual wage-and-salary earnings of fast-food cooks were $15,410 in May 2006. The middle 50 percent earned between $13,730 and $17,700. The lowest 10 percent earned less than $12,170, and the highest 10 percent earned more than $20,770. Median annual earnings were $15,360 in full-service restaurants and $15,350 in limited-service eating places. Some employers provide employees with uniforms and free meals, but Federal law permits employers to deduct from their employees’ wages the cost or fair value of any meals or lodging provided, and some employers do so. Chefs, cooks, and food preparation workers who work full time often receive typical benefits, but part-time and hourly workers usually do not. In some large hotels and restaurants, kitchen workers belong to unions. The principal unions are the Hotel Employees and Restaurant Employees International Union and the Service Employees International Union.  Related Occupations People who perform tasks similar to those of chefs, cooks, and food preparation workers include those in food processing oc­ cupations, such as butchers and meat cutters, and bakers. Oth­ ers who work closely with these workers include food service managers and food and beverage serving and related workers.  472 Occupational Outlook Handbook  Sources of Additional Information Information about job opportunities may be obtained from local employers and local offices of the State employment service. Career information about chefs, cooks, and other kitchen workers, including a directory of 2- and 4-year colleges that offer courses or training programs is available from: y National Restaurant Association, 1200 17th St.NW., Washington, DC 20036. Internet: http://www.restaurant.org Information on the American Culinary Federation’s appren­ ticeship and certification programs for cooks and a list of ac­ credited culinary programs is available from: y American Culinary Federation, 180 Center Place Way, St.Augustine, FL 32095. Internet: http://www.acfchefs.org For information about becoming a personal or private chef, contact: y American Personal & Private Chef Association, 4572 Delaware St., San Diego, CA 92116. Internet: http://www.personalchef.com For information about culinary apprenticeship programs regis­ tered with the U.S. Department of Labor, contact the local office of your State employment service agency, check the department’s apprenticeship Web site: http://www.doleta.gov/atels_bat or call the toll free helpline: (877) 872-5627.  Food and Beverage Serving and Related Workers (0*NET 35-3011.00, 35-3021.00, 35-3022.00, 35-3031.00, 35-3041.00, 35-9011.00, 35-9021.00, 35-9031.00, 35­ 9099.99)  ing areas clean and set for new diners. Most work as part of a team, helping coworkers to improve workflow and customer service. Waiters and waitresses, the largest group of these workers, take customers’ orders, serve food and beverages, prepare item­ ized checks, and sometimes accept payment. Their specific du­ ties vary considerably, depending on the establishment. In cof­ fee shops serving routine, straightforward fare, such as salads, soups, and sandwiches, servers are expected to provide fast, ef­ ficient, and courteous service. In fine dining restaurants, where more complicated meals are prepared and often served over several courses, waiters and waitresses provide more formal service emphasizing personal, attentive treatment and a more leisurely pace. They may recommend certain dishes and iden­ tify ingredients or explain how various items on the menu are prepared. Some prepare salads, desserts, or other menu items tableside. Additionally, servers may meet with managers and chefs, before each shift to discuss the menu and any new items or specials, review ingredients for any potential food allergies, or talk about any food safety concerns, coordination between the kitchen and the dining room, and any customer service is­ sues from the previous day or shift. Servers usually also check the identification of patrons to ensure they meet the minimum age requirement for the purchase of alcohol and tobacco prod­ ucts wherever those items are sold. Waiters and waitresses sometimes perform the duties of other food and beverage service workers. These tasks may include escorting guests to tables, serving customers seated at coun­ ters, clearing and setting up tables, or operating a cash register. However, full-service restaurants frequently hire other staff, such as hosts and hostesses, cashiers, or dining room attendants, to perform these duties. Bartenders fill drink orders either taken directly from patrons at the bar or through waiters and waitresses who place drink  Significant Points •  Most jobs are part time and have few educational re­ quirements, attracting many young people to the oc­ cupation—more than one-fifth of these workers were 16 to 19 years old, about five times the proportion for all workers.  •  Job openings are expected to be abundant through 2016, which will create excellent opportunities for jobseekers.  •  Tips comprise a major portion of earnings, so keen competition is expected for jobs in fine dining and more popular restaurants where potential tips are greatest.  Nature of the Work Food and beverage serving and related workers are the front line of customer service in restaurants, coffee shops, and other food service establishments. These workers greet customers, escort them to seats and hand them menus, take food and drink orders, and serve food and beverages. They also answer ques­ tions, explain menu items and specials, and keep tables and din­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Food and beverage serving and related workers need good in­ terpersonal skills to deal with customers.  Service Occupations 473  orders for dining room customers. Bartenders check the iden­ tification of customers seated at the bar to ensure they meet the minimum age requirement for the purchase of alcohol and tobacco products. They prepare mixed drinks, serve bottled or draught beer, and pour wine or other beverages. Bartenders must know a wide range of drink recipes and be able to mix drinks accurately, quickly, and without waste. Besides mixing and serving drinks, bartenders stock and prepare garnishes for drinks; maintain an adequate supply of ice, glasses, and other bar supplies; and keep the bar area clean for customers. They also may collect payment, operate the cash register, wash glass­ ware and utensils, and serve food to customers who dine at the bar. Bartenders usually are responsible for ordering and main­ taining an inventory of liquor, mixes, and other bar supplies. Most bartenders directly serve and interact with patrons. Bartenders should be friendly and at ease talking with custom­ ers. Bartenders at service bars, on the other hand, have less contact with customers. They work in small bars often located off the kitchen in restaurants, hotels, and clubs where only wait­ ers and waitresses place drink orders. Some establishments, especially larger, higher volume ones, use equipment that au­ tomatically measures, pours, and mixes drinks at the push of a button. Bartenders who use this equipment, however, still must work quickly to handle a large volume of drink orders and be familiar with the ingredients for special drink requests. Much of a bartender’s work still must be done by hand. Hosts and hostesses welcome guests and maintain reserva­ tion or waiting lists. They may direct patrons to coatrooms, restrooms, or to a place to wait until their table is ready. Hosts and hostesses assign guests to tables suitable for the size of their group, escort patrons to their seats, and provide menus. They also schedule dining reservations, arrange parties, and organize any special services that are required. In some restaurants, they act as cashiers. Dining mom and cafeteria attendants and bartender help­ ers assist waiters, waitresses, and bartenders by cleaning tables, removing dirty dishes, and keeping serving areas stocked with supplies. Sometimes called backwaiters or runners, they bring meals out of the kitchen and assist waiters and waitresses by distributing dishes to individual diners. They also replenish the supply of clean linens, dishes, silverware, and glasses in the dining room and keep the bar stocked with glasses, liquor, ice, and drink garnishes. Dining room attendants set tables with clean tablecloths, napkins, silverware, glasses, and dishes and serve ice water, rolls, and butter. At the conclusion of meals, they remove dirty dishes and soiled linens from tables. Caf­ eteria attendants stock serving tables with food, trays, dishes, and silverware and may carry trays to dining tables for pa­ trons. Bartender helpers keep bar equipment clean and glasses washed. Dishwashers clean dishes, cutlery, and kitchen uten­ sils and equipment. Counter attendants take orders and serve food in cafeterias, coffee shops, and carryout eateries. In cafeterias, they serve food displayed on steam tables, carve meat, dish out vegetables, ladle sauces and soups, and fill beverage glasses. In lunchrooms and coffee shops, counter attendants take orders from customers seated at the counter, transmit orders to the kitchen, and pick up and serve food. They also fill cups with coffee, soda, and other   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  beverages and prepare fountain specialties, such as milkshakes and ice cream sundaes. Counter attendants also take carryout orders from diners and wrap or place items in containers. They clean counters, write itemized bills, and sometimes accept pay­ ment. Some counter attendants may prepare short-order items, such as sandwiches and salads. Some food and beverage serving workers take orders from customers at counters or drive-through windows at fast-food restaurants. They assemble orders, hand them to customers, and accept payment. Many of these are combined food prepa­ ration and serving workers who also cook and package food, make coffee, and fill beverage cups using drink-dispensing ma­ chines. Other workers serve food to patrons outside of a restaurant environment. They might deliver room service meals in hotels or meals to hospital rooms or act as carhops, bringing orders to parked cars. Work environment. Food and beverage service workers are on their feet most of the time and often carry heavy trays of food, dishes, and glassware. During busy dining periods, they are under pressure to serve customers quickly and efficiently. The work is relatively safe, but care must be taken to avoid slips, falls, and bums. Part-time work is more common among food and beverage serving and related workers than among workers in almost any other occupation. In 2006, those on part-time schedules in­ cluded half of all waiters and waitresses and 39 percent of all bartenders. Food service and drinking establishments typically maintain long dining hours and offer flexible and varied work opportu­ nities. Many food and beverage serving and related workers work evenings, weekends, and holidays. Many students and teenagers seek part time or seasonal work as food and beverage serving and related workers as a first job to gain work experi­ ence or to earn spending money. More than one-fifth of all food and beverage serving and related workers were 16 to 19 years old—about five times the proportion for all workers.  Training, Other Qualifications, and Advancement Most food and beverage service jobs require little or no previ­ ous experience and provide training on the job. Education and training. There are no specific educational requirements for most food and beverage service jobs. Many employers prefer to hire high school graduates for waiter and waitress, bartender, and host and hostess positions, but comple­ tion of high school usually is not required for fast-food workers, counter attendants, dishwashers, and dining room attendants and bartender helpers. For many people, a job as a food and beverage service worker serves as a source of immediate in­ come, rather than a career. Many entrants to these jobs are in their late teens or early twenties and have a high school educa­ tion or less. Usually, they have little or no work experience. Many are full-time students or homemakers. Food and bever­ age service jobs are a major source of part-time employment for high school and college students. All new employees receive some training from their employer. They learn safe food handling procedures and sanitation prac­ tices, for example. Some employers, particularly those in fast-  474 Occupational Outlook Handbook   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  better. Some bartenders, hosts and hostesses, and waiters and waitresses advance to supervisory jobs, such as dining room supervisor, maitre d’hotel, assistant manager, or restaurant gen­ eral manager. A few bartenders open their own businesses. In larger restaurant chains, food and beverage service workers who excel often are invited to enter the company’s formal manage­ ment training program. (For more information, see the section on food service managers elsewhere in the Handbook.)  Employment Food and beverage serving and related workers held 7.4 million jobs in 2006. The distribution of jobs among the various food and beverage serving occupations was as follows: Combined food preparation and serving workers, including fast food ........................................................ 2,503,000 Waiters and waitresses .................................................... 2,361,000 Counter attendants, cafeteria, food concession, and coffee shop....................................................................... 533,000 Dishwashers ....................................................................... 517,000 Bartenders ................................................................................... 495,000  Dining room and cafet