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L t.3*. Health Technologists and Technicians ISBN 0-16-043056-9  Reprinted from the Occupational Outlook Handbook, 1994-95 Edition  90000  U.S. Department of Labor Bureau of Labor Statistics  9 780160 430565  Bulletin 2450-9 Federal Reserve Bank of St. Louis  ■HH  44 4 1  mi *  ♦  •  ...  '  _  f:s.s J Cardiovascular Technologists and Technicians  In addition, they spend a lot of time walking and standing. Cardi­ ology technologists may face stressful working conditions during operating procedures and are in contact with patients who have seri­ ous heart ailments.  (D.O.T. 078.264-010, .362-018, -030, -050, -062, .364-014, and .367-010)  Employment  Nature of the Work  Cardiovascular technologists and technicians assist physicians in di­ agnosing and treating cardiac (heart) and peripheral vascular (blood vessel) ailments. Cardiovascular technicians who obtain electro (electrical)- cardio (heart)- grams (record), abbreviated EKG’s or ECG’s, which trace electrical impulses transmitted by the heart, are known as electro­ cardiograph (ECG or EKG) technicians. To take a “basic” EKG, technicians attach electrodes to the patient’s chest, arms, and legs, then manipulate switches on a electrocardiograph machine to ob­ tain the reading. The test is done before most kinds of surgery and as part of a routine physical examination for persons who have passed a certain age. More skilled EKG technicians perform Holter monitor and stress testing. For a Holter monitoring, technicians place electrodes on the patient’s chest and attach a portable EKG monitor to the patient’s belt. After 24-48 hours of normal routine for the patient, they re­ move a tape from the monitor, place it in a scanner and read it for electrical interference before sending it to a physician. For a treadmill stress test, EKG technicians take a medical his­ tory, explain the procedure, connect the patient to an EKG moni­ tor, and obtain a baseline reading and resting blood pressure. They then monitor the patient’s heart while on a treadmill, gradually in­ creasing the speed of the treadmill to observe the effect of increased exertion. Those who do EKG and stress tests are also known as noninvasive technicians. Cardiovascular technologists who specialize in cardiac catheteri­ zation procedures, also known as invasive technology, are called cardiology technologists. They assist a physician who winds a small tube, or catheter, through a patient’s blood vessel, from a spot on the patient’s leg into the heart to determine if a blockage exists and for other diagnostic purposes. In balloon angioplasty, a procedure used to treat blockages of blood vessels, technologists assist physicians who insert a catheter with a balloon on the end to the point of the obstruction. Technologists may prepare patients for these proce­ dures by positioning them on an examining table, then shaving, cleaning, and administering anesthesia to the top of the patient’s leg near the groin. During the procedures, they monitor patients’ blood gases and heart rate using EKG equipment and notify the physician if something appears wrong. Technologists may also prepare and monitor patients during open heart surgery and the implantation of pacemakers. Cardiovascular technologists and technicians may also specialize in noninvasive peripheral vascular tests. They use ultrasound equip­ ment that transmits sound waves, then collects the echoes to form an image on a screen. Individuals who focus on blood flows and cir­ culation problems are known as vascular technologists, while those who use ultrasound on the heart are referred to as echocardiographers. Some cardiovascular technologists and technicians schedule ap­ pointments, type doctor’s interpretations, maintain patient’s files, and care for equipment.  Cardiovascular technologists and technicians held about 31,000 jobs in 1992. Most worked in hospital cardiology departments, while some worked in cardiologists’ offices, cardiac rehabilitation centers, or health maintenance organizations. More than half were EKG technicians. Training, Other Qualifications, and Advancement  For basic EKGs, Holter monitoring, and stress testing, 1-year cer­ tificate programs exist, although most EKG technicians are still trained on the job by an EKG supervisor or a cardiologist. On-thejob training usually lasts about 8 to 16 weeks. Applicants must be high school graduates. Most employers prefer to train people al­ ready in the health care field, nursing aides, for example. Most vascular technologists are trained on the job although some have backgrounds in nursing and sonography. Cardiology technologists need to complete a 2-year junior or community college program. One year is dedicated to core courses followed by a year of specialized instruction in either invasive, noninvasive, or noninvasive peripheral cardiology. Those who are  kit  Working Conditions  Technologists and technicians generally work a 5-day, 40-hour week, which may include Saturdays and Sundays. Those in cathe­ terization labs tend to work longer hours and also may work eve­ nings. They may also be on call during the night and on weekends.  2 Federal Reserve Bank of St. Louis  rW EKG technicians operate machines that record electrical impulses transmitted by the heart.  For sale by the U.S. Government Printing Office Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328  ISBN 0-16-043056-9  qualified in a related allied health profession only need to complete the year of specialized instruction. Cardiovascular technologists must be reliable, have mechanical aptitude, and be able to follow detailed instructions. A pleasant, re­ laxed manner for putting patients at ease is an asset. Job Outlook  Overall employment in this field is expected to grow more slowly than the average for all occupations through the year 2005, but tech­ nicians and technologists will experience different patterns of em­ ployment change. Employment of EKG technicians is expected to decline. Although the number of cardiac tests and procedures per­ formed is anticipated to grow, demand for EKG technicians is not likely to keep pace because many hospitals are expected to train reg­ istered nurses and others to perform basic EKG procedures. Indi­ viduals trained in Holter monitoring and stress testing are expected to have more favorable job prospects than those who can only per­ form a basic EKG. Some openings will occur as EKG technicians transfer to other jobs or leave the labor force. Employment of cardiology technologists is expected to grow faster than average for all occupations. Growth will occur as the population ages, because older people have a higher incidence of heart problems. Earnings  According to a University of Texas Medical Branch national survey of hospitals and medical centers, the median annual salary of EKG technicians, based on a 40 hour week and excluding shift and area differentials, was $17,222 in October 1992. The average minimum salary was $15,223 and the average maximum was $21,868. According to the American Society for Cardiovascular Profes­ sionals, the average salary for cardiovascular technologists was $28,756 in 1991. Related Occupations  Cardiovascular technologists and technicians operate sophisticated equipment to help physicians and other allied health practitioners diagnose and treat patients, so do radiologic technologists, diagnos­ tic medical sonographers, electroencephalographic technologists, perfusionists, and respiratory therapists. Sources of Additional Information  Local hospitals can supply information about employment opportu­ nities. For general information about a career in EKG and cardiovascu­ lar technology contact: W American Society for Cardiovascular Professionals, 10500 Wakeman  Dr., Fredericksburg, VA 22407.  For a list of accredited programs in cardiovascular technology, contact:  W Division of Allied Health Education and Accreditation, American Medi­ cal Association, 515 N. State St., Chicago, IL 60610.  For information on vascular technology, contact: tw The Society of Vascular Technology, 1101 Connecticut Ave. NW., Suite  700, Washington, DC 20036.  For information on cardiovascular technology, contact: ty American College of Cardiology, 9111 Old Georgetown Rd., Bethesda, MD 20814-1699.  Clinical Laboratory Technologists and Technicians (D.O.T. 078.121-010, .221-010, .261-010, -014, -026, -030, and -038, .281-010, .381-014, .687-010, and 559.361-010)  and technicians, also known as medical technologists and techni­ cians, perform most of these tests. Clinical laboratory personnel examine and analyze body fluids, tissues, and cells. They look for bacteria, parasites, or other micro­ organisms; analyze the chemical content of fluids; match blood for transfusions, and test for drug levels in the blood to show how a pa­ tient is responding to treatment. They also prepare specimens for ex­ amination, count cells, and look for abnormal cells. They use auto­ mated equipment and instruments that perform a number of tests simultaneously, as well as microscopes, cell counters, and other kinds of sophisticated laboratory equipment to perform tests. Then they analyze the results and relay them to physicians. 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. Medical technologists generally have a bachelor’s degree in medi­ cal technology or in one of the life sciences, or have a combination of formal training and work experience. They perform complex chemi­ cal, biological, hematological, immunologic, microscopic, and bac­ teriological tests. Technologists microscopically examine blood, tis­ sue, and other body substances; make cultures of body fluid or tissue samples to determine the presence of bacteria, fungi, parasites, or other micro-organisms; analyze samples for chemical content or re­ action; and determine blood glucose or cholesterol levels. They also type and cross-match blood samples for transfusions. They may evaluate the effects a patient’s condition has on test re­ sults, develop and modify procedures, and establish and monitor programs to insure the accuracy of tests. Some medical technolo­ gists supervise medical laboratory technicians. Technologists in small laboratories perform many types of tests, while those in specialty laboratories or large laboratories generally specialize. Technologists who prepare specimens and analyze the chemical and hormonal contents of body fluids are clinical chemis­ try technologists. Those who examine and identify bacteria and other micro-organisms are microbiology technologists. Blood bank technol­ ogists collect, type, and prepare blood and its components for trans­ fusions; immunology technologists examine elements and responses of the human immune system to foreign bodies. Cytotechnologists, who have specialized training, prepare slides of body cells and mi­ croscopically examine these cells for abnormalities which may sig­ nal the beginning of a cancerous growth. Medical laboratory technicians generally have an associate degree from a community or junior college, or a diploma or certificate from a vocational or technical school. They perform routine tests and lab­ oratory procedures. Technicians may prepare specimens and oper­ ate automatic analyzers, for example, or they may perform manual tests following detailed instructions. Like technologists, they may work in several areas of the clinical laboratory or specialize in just one. Histology technicians cut and stain tissue specimens for micro­ scopic examination by pathologists and phlebotomists draw and test blood. They usually work under the supervision of medical technol­ ogists or laboratory managers. Working Conditions  Hours and other working conditions vary according to the size and type of employment setting. In large hospitals or in independent lab­ oratories that operate continuously, personnel usually work the day, evening, or night shift, and may work weekends and holidays. Labo­ ratory personnel in small facilities may work on rotating shifts rather than on a regular shift. In some facilities, laboratory person­ nel are on call (available in case of emergency) several nights a week or on weekends. Clinical laboratory personnel are trained to work with infectious specimens. When proper methods of infection control and steriliza­ tion are followed, few hazards exist. Laboratories generally are well lighted and clean; however, speci­ mens, solutions, and reagents used in the laboratory sometimes pro­ duce odors. Laboratory workers may spend a great deal of time on their feet.  Nature of the Work  Employment  Clinical laboratory testing plays a crucial role in the detection, diag­ nosis, and treatment of disease. Clinical laboratory technologists  Clinical laboratory technologists and technicians held about 268,000 jobs in 1992. More than half worked in hospitals. Most Federal Reserve Bank of St. Louis  3  Experienced clinical technologists may advance to supervisory positions. others worked in medical laboratories and offices and clinics of phy­ sicians. Some worked in blood banks, research and testing laborato­ ries, and in the Federal Government—for Department of Veterans Affairs hospitals and the U.S. Public Health Service. About 1 laboratory worker in 6 worked part time. Training, Other Qualifications, and Advancement  The usual requirement for an entry level position as a medical tech­ nologist is a bachelor’s degree with a major in medical technology or in one of the life sciences. Universities and hospitals offer medical technology programs. It is also possible to qualify through a combi­ nation of on-the-job and specialized training. Bachelor’s degree programs in medical technology include courses in chemistry, biological sciences, microbiology, and mathe­ matics, and specialized courses devoted to knowledge and skills used in the clinical laboratory. Many programs also offer or require courses in management, business, and computer applications. Masters degrees in medical technology and related clinical labo­ ratory sciences provide training for specialized areas of laboratory work or teaching, administration, or research. Two universities of­ fer doctorates in clinical laboratory technology. Medical laboratory technician training is offered in community and junior colleges, hospitals, vocational and technical schools, and in the Armed Forces. A few technicians learn on the job. Commu­ nity and junior college programs last 2 years and lead to an associate degree. Others are shorter and lead to a certificate in medical labora­ tory technology. Nationally recognized accrediting agencies in the allied health field include the American Medical Association’s Committee on Al­ lied Health Education and Accreditation (CAHEA), and the Ac­ crediting Bureau of Health Education Schools (ABHES). CAHEA accredits over 800 programs that provide education for medical technologists, cytotechnologists, histologic technicians, specialists in blood bank technology, and medical laboratory technicians. ABHES accredits training programs for medical laboratory techni­ cians. Licensure and certification are methods of assuring the skill and competence of workers. Licensure refers to the process by which a government agency authorizes individuals to engage in a given oc­ cupation and use a particular job title. Some States require labora­ tory personnel to be licensed or registered. (Information on licen­ sure is available from State departments of health, boards of occupational licensing, or occupational information coordinating committees.) Certification is a voluntary process by which a nongovernmental organization such as a professional society or certifying agency grants recognition to an individual whose professional competence meets prescribed standards. Widely accepted by employers in the health industry, certification is a prerequisite for most jobs and often 4 Federal Reserve Bank of St. Louis  is necessary for advancement. Agencies that certify medical labora­ tory technologists and technicians include the Board of Registry of the American Society of Clinical Pathologists, the American Medi­ cal Technologists, the National Certification Agency for Medical Laboratory Personnel, and the Credentialing Commission of the In­ ternational Society for Clinical Laboratory Technology. These agencies have different requirements for certification and different organizational sponsors. Clinical laboratory personnel need analytical judgment and the ability to work under pressure. Close attention to detail is essential because small differences or changes in test substances or numerical readouts can be crucial for patient care. Manual dexterity and nor­ mal color vision are highly desirable. With the widespread use of au­ tomated laboratory equipment, computer skills are important. In addition, technologists in particular are expected to be good at prob­ lem solving and to have strong interpersonal and communications skills. Technologists may advance to supervisory positions in laboratory work or become chief medical technologists or laboratory managers in hospitals. Manufacturers of home diagnostic testing kits and lab­ oratory equipment and supplies seek experienced technologists to work in product development, marketing, and sales. Graduate edu­ cation in medical technology, one of the biological sciences, chemis­ try, management, or education usually speeds advancement. A doc­ torate is needed to become a laboratory director. Technicians can become technologists through additional education and experience. Job Outlook  As in most occupations, replacement needs will be the main source of job openings. Employment of clinical laboratory workers is ex­ pected to grow about as fast as the average for all occupations through the year 2005 creating additional job openings. The rapidly growing older population will spur demand, since older people gen­ erally have more medical problems. Technological changes will have two opposite effects on employment. New, more powerful di­ agnostic tests will encourage more testing and spur employment. However, advances in laboratory automation and simpler tests, which make it possible for each worker to perform more tests, should slow growth. Research and development efforts are targeted at simplifying routine testing procedures so that nonlaboratory per­ sonnel—physicians and patients in particular—can perform tests now done in laboratories. Also, robots may prepare specimens, a job now done by technologists and technicians. Fastest growth is expected in independent medical laboratories, as hospitals continue to send them a greater share of their testing. Rapid growth is also expected in offices and clinics of physicians. Slower growth is expected in hospitals. Earnings  Median annual earnings of full time, salaried clinical laboratory technologists and technicians were $26,312 in 1992. Half earned be­ tween $19,136 and $32,864. The lowest 10 percent earned less than $14,664 and the top 10 percent more than $39,000. According to a University of Texas Medical Branch national sur­ vey of hospitals and medical centers, the median annual salary of medical technologists, based on a 40 hour week and excluding shift or area differentials, was $31,202 in October 1992. The average min­ imum salary was $24,888 and the average maximum was $36,844. For medical laboratory technicians, the median was $23,340; for histology technicians, the median was $25,605; for cytotechnolo­ gists, the median was $34,414; and for phlebotomists, the median was $16,209. Related Occupations  Clinical laboratory technologists and technicians analyze body fluids, tissue, and other substances using a variety of tests. Similiar or related procedures are performed by analytical, water purifica­ tion, and other chemists; science technicians; crime laboratory ana­ lysts; food testers; and veterinary laboratory technicians. Sources of Additional Information  Career and certification information is available from:  fW American Society of Clinical Pathologists, Board of Registry, P.O. Box  12277, Chicago, IL 60612. American Medical Technologists, 710 Higgins Rd., Park Ridge, IL 60068. XW National Certification Agency for Medical Laboratory Personnel, 7910 Woodmont Ave., Suite 1301, Bethesda, MD 20814. W International Society for Clinical Laboratory Technology, 818 Olive St., Suite 918, St. Louis, MO 63101.  For more career information, write to: O" American Association of Blood Banks, 1117 N. 19th St., Suite 600, Ar­ lington, VA 22209. XS" American Society of Cytology, 1015 Chestnut St., Suite 1518, Philadel­ phia, PA 19107. XW American Society for Medical Technology, 7910 Woodmont Ave., Suite 1301, Bethesda, MD 20814.  For a list of educational programs accredited by CAHEA for clinical laboratory personnel, write to: tar Committee on Allied Health Education and Accreditation, 515 North State St., Chicago, IL 60610.  For a list of training programs for medical laboratory technicians accredited by the Accrediting Bureau of Health Education Schools, write to: Secretary-ABHES, 29089 U.S. 20 West, Elkhart, IN 46514.  Information about employment opportunities in Department of Veterans Affairs medical centers is available from local medical cen­ ters and also from:  Dental hygienists sometimes administer local anesthetic. Employment  Dental Hygienists  Dental hygienists held about 108,000jobs in 1992. Because multiple jobholding is common in this field, the number of jobs greatly ex­ ceeds the number of hygienists. About half of all dental hygienists usually worked part time—less than 35 hours a week. Almost all dental hygienists work in private dental offices. Some work in public health agencies, school systems, hospitals, and clin­ ics.  (D.O.T. 078.361-010)  Training, Other Qualifications, and Advancement  Xg* Title 38 Employment Division (054D), Department of Veterans Affairs,  810 Vermont Ave. NW., Washington, DC 20420.  Nature of the Work  Dental hygienists provide preventive dental care and teach patients how to practice good oral hygiene. Hygienists examine patients’ teeth and gums, recording the pres­ ence of diseases or abnormalities. They remove calculus, stain, and plaque from teeth; apply caries-preventive agents such as fluorides and pit and fissure sealants; take and develop dental x rays; place temporary fillings and periodontal dressings; remove sutures; and polish and recontour amalgam restorations. In some States, hygien­ ists administer local anesthetics and nitrous oxide/oxygen analge­ sia, and place and carve filling materials. Dental hygienists also help patients develop and maintain good oral health. For example, they may explain the relationship between diet and oral health, inform patients how to select toothbrushes, and show patients how to floss their teeth. Some hygienists develop and promote community dental health programs which may include teaching how to practice good oral hygiene. Dental hygienists use hand and rotary instruments to clean teeth, x-ray machines to take dental pictures, syringes with needles to ad­ minister local anesthetics, and models of teeth to explain oral hy­ giene. Working Conditions  Flexible scheduling is a distinctive feature of this job. Full-time, part-time, evening, and weekend work is widely available. Dentists frequently hire hygienists to work only 2 or 3 days a week, so hy­ gienists may hold jobs in more than one dental office. Dental hygienists work in clean, well-lighted offices. Important health safeguards include strict adherence to proper radiological procedures, compliance with recommended aseptic technique, and use of appropriate protective devices when administering nitrous oxide/oxygen analgesia. Dental hygienists also wear safety glasses, surgical masks and gloves to protect themselves from infectious dis­ eases such as hepatitis and AIDS. The occupation is one of several covered by the Consumer-Patient Radiation Health and Safety Act of 1981, which encourages the States to adopt uniform standards for the training and certification of individuals who perform medical and dental radiological procedures. Federal Reserve Bank of St. Louis  Dental hygienists must be licensed by the State in which they prac­ tice. To qualify for licensure, a candidate must graduate from an ac­ credited dental hygiene school and pass both a written and a clinical examination. The American Dental Association Joint Commission on National Dental Examinations administers the written examina­ tion that is accepted by all States and the District of Columbia. State or regional testing agencies administer the clinical examination. In addition, examinations on legal aspects of dental hygiene practice are required by most States. Alabama also allows candidates to take its examination if they have been trained through a State-regulated on-the-job program in a dentist’s office. In 1993, 208 programs in dental hygiene were accredited by the Commission on Dental Accreditation. Although some programs lead to a bachelor’s degree, most grant an associate degree. Five uni­ versities offer master’s degree programs in dental hygiene. An associate degree is sufficient for practice in a private dental of­ fice. A bachelor’s or master’s degree is usually required for research, teaching, or clinical practice in public or school health programs. About half of the dental hygiene programs prefer applicants who have completed at least 1 year of college. Some of the bachelor’s de­ gree programs require applicants to have completed 2 years. How­ ever, requirements vary from school to school. These schools offer laboratory, clinical, and classroom instruction in subjects such as anatomy, physiology, chemistry, microbiology, pharmacology, nu­ trition, radiography, histology (the study of tissue structure), periodontology (the study of gum diseases), pathology, dental materials, clinical dental hygiene, and social and behavioral sciences. Dental hygienists should work well with others, particularly pa­ tients who may be under stress. Dental hygienists must have manual dexterity because they use dental instruments with little room for er­ ror within a patient’s mouth. Recommended high school courses for aspiring dental hygienists include biology, chemistry, and mathe­ matics. Job Outlook  Employment of dental hygienists is expected to grow much faster than the average for all occupations through the year 2005 in re­ sponse to increasing demand for dental care. Demand will be stimu­ lated by population growth, greater retention of natural teeth by middle-aged and elderly people and rising real incomes. Additional 5  job openings will result from the need to replace workers who leave the occupation. Also, dentists are likely to employ more hygienists, for several reasons. Older dentists, who are less likely to employ dental hygien­ ists, will leave and be replaced by recent graduates, who are more likely to do so. In addition, as dentists’ workloads increase, they are expected to hire more hygienists to perform preventive dental care such as cleaning, so they may use their own time more profitably. Enrollments in dental hygiene programs have been on the rise re­ cently after declining during the 1980’s. Unless the number in­ creases sharply, however, opportunities are expected to remain very good. Earnings  Earnings of dental hygienists are affected by geographic location, employment setting, and education and experience. Dental hygien­ ists who work in private dental offices may be paid on an hourly, daily, salary, or commission basis. According to the American Dental Association, dental hygienists who worked 32 hours a week or more averaged $609 a week in 1991; the average hourly earnings for all dental hygienists was $18.50. Benefits vary substantially by practice setting, and may be contin­ gent upon full-time employment. Dental hygienists who work for school systems, public health agencies, the Federal Government, or State agencies usually have substantial benefits. Related Occupations  Workers in other occupations supporting health practitioners in an office setting include dental assistants, ophthalmic medical assist­ ants, podiatric assistants, office nurses, medical assistants, and phy­ sician assistants. Sources of Additional Information  For information on a career in dental hygiene and the educational requirements to enter this occupation, contact: W Division of Professional Development, American Dental Hygienists’ As­ sociation, 444 N. Michigan Ave., Suite 3400, Chicago, IL 60611. t3° SELECT, American Dental Association, Department of Career Gui­ dance, 211 E. Chicago Ave., Suite 1804, Chicago, IL 60611.  For information about accredited programs and educational re­ quirements, contact: Commission on Dental Accreditation, American Dental Association, 211 E. Chicago Ave., Suite 1814, Chicago, IL 60611.  The State Board of Dental Examiners in each State can supply in­ formation on licensing requirements.  the surface of the metal to allow the metal and porcelain to bond. They apply porcelain in layers to arrive at the precise shape and color of a tooth. Technicians place the tooth in a porcelain furnace to bake the porcelain onto the metal framework, then adjust the shape and color with subsequent grinding and addition of porcelain to achieve a sealed finish. The final product is an exact replica of the lost tooth or teeth. In some laboratories, technicians perform all stages of the work, while in others, each does only a few. Dental laboratory technicians also may specialize in one of five areas: Orthodontic appliances, crown and bridge, complete dentures, partial dentures, or ceramics. Job titles may reflect specialization in these areas. For example, technicians who make porcelain and acrylic restorations are called dental ceramists. Working Conditions  Dental laboratory technicians generally work in clean, well-lighted, and well-ventilated areas. Technicians usually have their own work­ benches, which may be equipped with Bunsen burners, grinding and polishing equipment, and hand instruments, such as wax spatulas and wax carvers. The work is extremely delicate and quite time consuming. Sala­ ried technicians usually work 40 hours a week, but self-employed technicians frequently work longer hours. Employment  Dental laboratory technicians held about 48,000 jobs in 1992. Most jobs were in commercial dental laboratories, which usually are small, privately owned businesses with fewer than five employees. However, some laboratories are larger; a few employ over 50 techni­ cians. Some dental laboratory technicians worked in dentists’ offices. Others worked for hospitals that provide dental services, including Department of Veterans Affairs hospitals. Some technicians work in dental laboratories in their homes, in addition to their regular job. Approximately 1 technician in 7 is self-employed, a higher propor­ tion than in most other occupations. Training, Other Qualifications, and Advancement  Most dental laboratory technicians learn their craft on the job. They begin with simple tasks, such as pouring plaster into an impression, and progress to more complex procedures, such as making porcelain  Dental Laboratory Technicians (D.O.T. 712.381-014, -018, -022, -026, -030, -042, -046, and -050)  Nature of the Work  Dental laboratory technicians are like pharmacists: They fill pre­ scriptions. But their prescriptions come from dentists, and their or­ ders are for crowns, bridges, dentures, and other dental prosthetics. Dentists send a specification of the item to be fabricated along with an impression (mold) of the patient’s mouth or teeth to the techni­ cians. Then dental laboratory technicians, also called dental techni­ cians, create a model of the patient’s mouth by pouring plaster into the impression and allowing it to set. They place the model on an ap­ paratus which mimics the bite and movement of the patient’s jaw. The model serves as the basis of the prosthetic device. Technicians examine the model, noting the size and shape of the adjacent teeth or gaps within the gumline. Based upon these observations and the dentist’s specifications, technicians build and shape a wax tooth or teeth using small hand instruments called wax spatulas and wax carvers. They use this wax model to cast the metal framework for the prosthetic device. Once the wax tooth has been formed, dental technicians pour the cast and form the metal. Using small hand-held tools, they prepare 6 Federal Reserve Bank of St. Louis  Many dental lab technicians are trained on the job.  crowns and bridges. Becoming a fully trained technician requires an average of 3 to 4 years depending upon the individual’s aptitude and ambition, but it may take a few more years to be recognized as an ac­ complished technician. Training in dental laboratory technology is also available through community and junior colleges, vocational-technical institutes, and the Armed Forces. Formal training programs vary greatly both in length and the level of skill they impart. In 1993, 42 programs in dental laboratory technology were ap­ proved (accredited) by the Commission on Dental Accreditation in conjunction with the American Dental Association (ADA). These programs provide classroom instruction in dental materials science, oral anatomy, fabrication procedures, ethics, and related subjects. In addition, each student is given supervised practical experience in the school or an associated dental laboratory. Accredited programs generally take 2 years to complete and lead to an associate degree. Graduates of 2-year training programs need additional hands-on experience to become fully qualified. Each dental laboratory owner operates in a different way, and classroom instruction does not nec­ essarily expose students to techniques and procedures favored by in­ dividual laboratory owners. Students who have taken enough courses to learn the basics of the craft generally are considered good candidates for training, regardless of whether they have completed the formal program. Many employers will train someone without any classroom experience. Certification, which is voluntary, is offered by the National Board for Certification in five specialty areas: Crown and bridge, ceramics, partial dentures, complete dentures, and orthodontic appliances. In larger dental laboratories, technicians may become supervisors or managers. Experienced technicians may teach or take jobs with dental suppliers in such areas as product development, marketing, or sales. Still, for most technicians, opening one’s own laboratory is the way toward advancement and higher earnings. A high degree of manual dexterity, good vision, and the ability to recognize very fine color shadings and variations in shape are neces­ sary. An inclination for detailed and precise work also is important. Useful high school courses are art, metal and wood shop, drafting, and sciences. Courses in management and business may help those wishing to operate their own laboratories. Job Outlook  Job opportunities for dental laboratory technicians should be favorable despite little growth in the occupation. Employers have difficulty filling trainee positions, probably because of relatively low entry level salaries and lack of familiarity with the occupation. Also, experienced technicians who have built up a favorable reputation with dentists should have good opportunities for establishing labo­ ratories of their own. Although job opportunities are favorable, employment of dental laboratory technicians is not expected to grow through the year 2005, due to changes in dental care. The fluoridation of drinking water, which has reduced the incidence of dental caries, and greater emphasis on preventive dental care since the early 1960’s have im­ proved the overall dental health of the population. As a result, peo­ ple are keeping their teeth longer. Instead of full or partial dentures, most people will need a bridge or crown. This means less work for the dental laboratory technician, who may need to fabricate only three or four teeth rather than a whole set of false teeth. Office-based, computer-aided equipment, designed to measure a patient’s mouth and fabricate the required prosthetic device, is cur­ rently under development and testing in Europe. While not replac­ ing the technicians completely, such equipment, when and if it comes into widespread use in this country, could reduce the amount of time required to produce dental prosthetics—and, therefore, the demand for dental laboratory technicians. Earnings  According to the American Dental Association, the average hourly earnings for dental laboratory technicians in independent dental of­ fices was $13.30 in 1991. According to limited data, trainees in den­ tal laboratories average only a little over minimum wage. However, earnings rise sharply with experience. In general, earnings of selfemployed technicians exceed those of salaried workers. Federal Reserve Bank of St. Louis  Related Occupations  Dental laboratory technicians fabricate artificial teeth, crowns and bridges, and orthodontic appliances following the specifications and instructions provided by dentists. Other workers who make medical devices include arch-support technicians, orthotics technicians (braces and surgical supports), prosthetics technicians (artificial limbs and appliances), opticians, and ophthalmic laboratory techni­ cians. Sources of Additional Information  For information about training and a list of approved schools, con­ tact: fir Commission on Dental Accreditation, American Dental Association, 211 E. Chicago Ave., Chicago, IL 60611.  General information on grants and scholarships is available from dental technology schools. For information on career opportunities in commercial laborato­ ries, contact: O" National Association of Dental Laboratories, 3801 Mt. Vernon Ave., Al­ exandria, VA 22305.  For information on requirements for certification, contact: XW National Board for Certification in Dental Technology, 3801 Mt. Vernon  Ave., Alexandria, VA 22305.  Dispensing Opticians (D.O.T. 299.361-010 and -014)  Nature of Work  Dispensing opticians fit eyeglasses and contact lenses, following pre­ scriptions written by ophthalmologists or optometrists. (The work of optometrists is described in a statement elsewhere in the Hand­ book. See the statement on physicians for information about oph thalmologists.) Dispensing opticians help customers select appropriate frames, order the necessary ophthalmic laboratory work, and adjust the fin­ ished eyeglasses. In some States, they fit contact lenses under the su­ pervision of an optometrist or ophthalmologist. Dispensing opticians examine written prescriptions to determine lens specifications. They recommend eyeglass frames, lenses, and lens coatings after considering the prescription and the customer’s occupation, habits, and facial features. Dispensing opticians mea­ sure clients for size of eyeglasses including the distance between the centers of the pupils and the distance between the eye surface and the lens. For customers without prescriptions, dispensing opticians may use a lensometer to record the present eyeglass prescription. Dispensing opticians may obtain a customer’s previous record, or verify a prescription with the examining optometrist or ophthal­ mologist. Dispensing opticians prepare work orders that give ophthalmic laboratory technicians information needed to grind and insert lenses into a frame. The work order includes lens prescriptions and infor­ mation on lens size, material, color, and style. Some dispensing opti­ cians grind and insert lenses themselves. After the glasses are made, dispensing opticians verify that the lenses have been ground to spec­ ifications. Then they may reshape or bend the frame, by hand or us­ ing pliers, so that the eyeglasses fit the customer properly and com­ fortably. Dispensing opticians also fix, adjust, and refit broken frames. They instruct clients about adapting to, wearing, or caring for eyeglasses. Some dispensing opticians specialize in fitting contacts, artificial eyes, cosmetic shells to cover blemished eyes, or low vision aids. To fit contact lenses, dispensing opticians measure eye shape and size, select the type of contact lens material, and prepare work orders specifying the prescription and lens size. Fitting contact lenses re­ quires considerable skill, care, and patience. Dispensing opticians observe customers’ eyes, corneas, lids, and contact lenses with spe­ cial instruments and microscopes. During several visits, opticians show customers how to insert, remove, and care for their contacts, and make sure the fit is correct. 7  Dispensing opticians keep records on customer prescriptions, work orders, and payments; track inventory and sales; and perform other administrative duties. Working Conditions  Dispensing opticians work indoors in attractive, well lighted, and well ventilated surroundings. They may work in small stores where customers are served one at a time, or in large stores where several dispensing opticians serve a number of customers at once. Opticians deal with customers most of the time and spend much time on their feet. If they also prepare lenses, they need to take precautions against the hazards associated with glass cutting, chemicals, and machinery. Most dispensing opticians work a 40-hour week, although some work longer hours. Those in retailing may work evenings and week­ ends. Some work part time. Employment  Dispensing opticians held about 63,000 jobs in 1992. About half work for ophthalmologists or optometrists who sell glasses directly to patients. Many also work in optical shops, including “superoptical stores.” These stores offer one-stop shopping: Customers may have their eyes examined, choose frames, and have glasses made on the spot. Some work in optical departments of drug and department stores. Training, Other Qualifications, and Advancement  Some employers hire individuals with no background in opticianry or those who have worked as ophthalmic laboratory technicians. (See the statement on ophthalmic laboratory technicians elsewhere in the Handbook.) Training may be informal, on-the-job or formal apprenticeship. Others seek people with college level training in op­ ticianry. Knowledge of physics, basic anatomy, algebra, geometry, and mechanical drawing is particularly valuable because training usu­ ally includes instruction in optical mathematics, optical physics, and the use of precision measuring instruments and other machin­ ery and tools. Because dispensing opticians deal directly with the public, they should be tactful and pleasant and communicate well. Large employers generally offer structured apprenticeship pro­ grams, and small employers provide more informal on-the-job train­ ing. In the 21 States that license dispensing opticians, individuals without formal college level training train from 2 to 4 years as ap­ prentices. Apprenticeship or formal traineeship is offered in most of the other States as well. Apprentices receive technical training and are taught office man­ agement and sales. Under the supervision of an experienced opti­ cian, optometrist, or ophthamologist, apprentices work directly  with patients, fitting eyeglasses and contact lenses. In States requir­ ing licensure, information about apprenticeships and licensing pro­ cedures is available from the State board of occupational licensing. Formal opticianry training is offered in community colleges and a few colleges and universities. In 1993, there were about 40 pro­ grams. Of these, 23 were accredited by the Commission on Op­ ticianry Accreditation and awarded 2-year associate degrees in ophthalmic dispensing or optometric technology. There are also shorter programs, including some under 1 year. Some States that li­ cense dispensing opticians allow graduates to take the licensure exam immediately upon graduation; others require a few months to a year of experience. Dispensing opticians may also gain credentials through voluntary certification or registration by the American Board of Opticianry and by the National Contact Lens Examiners. Certification must be renewed every 3 years through continuing education. Many experienced dispensing opticians go into the opticianry business for themselves. Others become managers of optical stores or sales representatives for wholesalers or manufacturers of eye­ glasses or lenses. Job Outlook  Employment in this occupation is expected to increase faster than the average for all occupations through the year 2005 in response to rising demand for corrective lenses. The number of middle-aged and elderly persons is projected to increase rapidly. Middle age is a time when many people use corrective lenses for the first time, and eld­ erly persons require more vision care, on the whole, than others. Fashion, too, influences demand. Frames come in a growing vari­ ety of styles and colors—encouraging people to buy more than one pair. Finally, demand is expected to grow in response to products such as special lens treatments; photochromic lenses (glasses that become sunglasses in sunlight), now available in plastic as well as glass; tinted lenses; and bifocal, extended wear, and disposable con­ tact lenses. This occupation is vulnerable to changes in the business cycle, with employment falling somewhat during downturns. There will be a relatively large number of job openings, both to replace those who leave the occupation and due to growth. This is a young occupation and like many other occupations in retail trade, many people trans­ fer to other occupations. Earnings  According to the Opticians Association of America, salaries for dis­ pensing opticians in retail stores averaged about $26,000 in 1992. The beginning average salary for licensed and certified opticians was $20,971. Those with 3 to 5 years of experience averaged $21,875; 6 to 9 years, $25,876; and 10 years or more, $29,640. Noncertified op­ ticians averaged about $6,000 less at each level of experience. Begin­ ning apprentices averaged about $13,000 a year. Some opticians earned well above $30,000 a year. Those who run their own stores earned more than salaried workers. In addition to base salaries, many employers provide commissions, bonuses, and profit-sharing. Related Occupations  Other workers who deal with customers and perform delicate work include jewelers, artificial eye makers, ophthalmic laboratory tech­ nicians, orthodontic technicians, dental laboratory technicians, prosthetics technicians, camera repairers, and watch repairers. Sources of Additional Information  For general information about this occupation, contact: ^Opticians Association of America, 10341 Democracy Lane, Fairfax, VA 22030-2521.  For a list of accredited training programs, contact: IS” Commission on Opticianry Accreditation, 10111 Martin Luther King, Jr. Hwy., Suite 100, Bowie, MD 20720-4299.  For general information on opticianry and a list of home-study programs, seminars, and review materials, contact: Dispensing opticians help customers select appropriate frames. 8 Federal Reserve Bank of St. Louis  tsr National Academy of Opticianry, 10111 Martin Luther King, Jr. Hwy., Suite 112, Bowie, MD 20720-4299.  EEG Technologists (D.O.T. 078.362-022)  Nature of the Work  “Brain waves” are electrical impulses which can be recorded by an electroencephalograph (EEG) technologist using an EEG machine. Since technologists often perform other related tests as well, they may also be called electroneurodiagnostic or neurophysiologic tech­ nologists. The tests performed by these technologists help neurolo­ gists—physicians who study the brain—to diagnose brain tumors, strokes, toxic/metabolic disorders, and epilepsy; to measure the ef­ fects of infectious diseases on the brain; and to determine whether individuals with mental or behavioral problems have an organic im­ pairment such as Alzheimer’s disease. They are also used to deter­ mine “cerebral” death, the absence of brain activity, and to assess the probability of a recovery from a coma. For basic, “resting” EEG’s, technologists take patients’ medical histories and help them relax. Then they apply electrodes to desig­ nated spots on the patient’s head and choose the most appropriate combination of instrument controls and electrodes to produce the kind of record needed. Technologists correct for electrical or mechanical events that come from somewhere other than the brain, such as eye movement or interference from electrical sources. Increasingly, technologists perform EEG’s in the operating room, which requires that they understand anesthesia’s effect on brain waves. For special procedure EEG’s, technologists may secure elec­ trodes to the chest, arm, leg, or spinal column to record activity from both the central and peripheral nervous systems. In ambulatory monitoring, EEG technologists monitor the brain, and sometimes the heart, while patients carry out normal activities over a 24-hour period. Then they remove the small recorder carried by the patients and obtain a readout. Technologists review the read­ outs, a process which can take several hours, selecting sections for the physician to examine. Using “evoked potential” testing, technologists measure sensory and physical responses to specific stimuli. After the electrodes have been attached, technologists set the instrument for the type and in­ tensity of the stimulus, increase the intensity until the patient reacts, and note the sensation level. The tests may take from 1 to 4 hours. For nerve conduction tests, used to diagnose muscle and nerve problems, technologists place electrodes on the patient’s skin over a nerve and over the muscle. Then they stimulate the nerve with an electrical current and record how long it takes the nerve impulse to reach the muscle. Specialized electroneurodiagnostic technologists also administer sleep studies and perform quantative EEG’s (sometimes called “brain wave mapping”). For sleep studies, technologists monitor respiration and heart activity in addition to brain wave activity. They must know the various stages of sleep and the dynamics of the neurologic and cardiopulmonary systems during each stage. Tech­ nologists coordinate readings from several organ systems, separat­ ing them according to the stages of sleep, and relay them to the phy­ sician. For quantative EEG’s, technologists decide which sections of the EEG should be transformed into color-coded pictures of brain wave frequency and intensity, for interpretation by a physician. They may also write technical reports summarizing test results. Technologists also look for changes in the patient’s neurologic, cardiac, and respiratory status, which may indicate an emergency, such as a heart attack, and provide emergency care until help ar­ rives. EEG technologists may have supervisory or administrative re­ sponsibilities. They may manage an EEG laboratory, arrange work schedules, keep records, schedule appointments, order supplies, and provide instruction in EEG techniques. Technologists may also be responsible for the equipment’s upkeep. Federal Reserve Bank of St. Louis  ITM-  ■■  ■i.mV  ;;  EEG technologists test for brain and nervous system disorders. Working Conditions  EEG technologists usually work in clean, well-lighted surround­ ings, and spend about half of their time on their feet. Bending and lifting are necessary since they may work with patients who are very ill and require assistance. EEG technologists in hospitals may do all their work in a single room, or may push equipment to patients’ bed­ sides and obtain recordings there. Most technologists work a standard workweek, although those in hospitals may be “on call” (ready to report to work at a moment’s notice) evenings, weekends, and holidays. Those performing sleep studies may work evenings and nights. Employment  EEG technologists held more than 6,000 jobs in 1992. Most worked in EEG or neurology laboratories of hospitals. Others worked in of­ fices and clinics of neurologists and neurosurgeons, health mainte­ nance organizations, and psychiatric facilities. Training, Other Qualifications, and Advancement  EEG technologists generally learn their skills on the job, although some complete formal training programs. Often, EEG trainees transfer from other hospital jobs, such as licensed practical nurse. Applicants for trainee positions in hospitals need at least a high school diploma, while some hospitals require postsecondary train­ ing. Formal postsecondary training is offered in hospitals and com­ munity colleges. In 1992, the Joint Review Committee on Education in Electroneurodiagnostic Technology had approved 13 formal pro­ grams. Programs usually last from 1 to 2 years and include labora­ tory experience as well as classroom instruction in human anatomy and physiology, neurology, neuroanatomy, neurophysiology, medi­ cal terminology, computer technology, electronics and instrumenta­ tion. Graduates receive associate degrees or certificates. The American Board of Registration of Electroencephalographic and Evoked Potential Technologists awards the credential “Regis­ tered EEG Technologist” to qualified applicants. This board also accredits technologists evoked potentials as “Registered Evoked Po­ tential Technologist.” Although not generally required for staff level jobs, registration indicates professional competence, and usu­ ally is necessary for supervisory or teaching jobs. Technologists should have manual dexterity, good vision, writing skills, an aptitude for working with electronic equipment, and the ability to work with patients as well as with other health personnel. High school courses in health, biology, and mathematics are useful. EEG technologists in large hospitals can advance to jobs perform­ ing more difficult tests and then to chief EEG technologist, who manages the EEG laboratory. Chief EEG technologists generally are supervised by a physician—an electroencephalographer, neurol­ ogist, or neurosurgeon. Technologists may also teach or go into re­ search. 9  Job Outlook  Employment of EEG technologists is expected to grow much faster than the average for all occupations through the year 2005, reflect­ ing the increased numbers of neurodiagnostic tests performed. There will be more testing as new tests and procedures are devel­ oped, and as the older population, which requires more medical care, grows rapidly. Most job openings will result from the need to replace workers who transfer to other occupations or leave the labor force. Most jobs will still be found in hospitals; however, growth will be fastest in offices and clinics of neurologists. Earnings  According to a University of Texas Medical Branch national survey of hospitals and medical centers, the median annual salary of EEG technologists, based on a 40 hour week and excluding shift or area differentials, was $23,369 in October 1992. The average minimum salary was $19,695 and the average maximum was $28,736. Related Occupations  Other health personnel who operate medical equipment include ra­ diologic technologists, nuclear medicine technologists, perfusion­ ists, and cardiovascular (EKG) technologists. Sources of Additional Information  Local hospitals can supply information about employment opportu­ nities. For general information about a career in electroencepha­ lography as well as a list of accredited training programs, contact:  EMT-Intermediates, or EMT-I’s, have more advanced training and can perform such addtional procedures as administer intrave­ nous fluids; and use defibrillators to give lifesaving shocks to a stopped heart. EMT-Paramedics provide the most extensive prehospital care. In addition to the procedures already described, paramedics may ad­ minister drugs orally and intravenously, interpret EKG’s, perform endotracheal intubations, and use monitors and other complex equipment. Some conditions are simple enough to be handled following gen­ eral rules and guidelines. More complicated problems can only be carried out under the step-by-step direction of medical personnel with whom the EMT’s are in radio contact. When victims are trapped, as in the case of an automobile acci­ dent, cave-in, or building collapse, EMT’s free them or provide emergency care while others free them. When transporting patients to a medical facility, EMT’s may use special equipment such as backboards to immobilize them before placing them on stretchers and securing them in the ambulance. While one EMT drives, the other monitors the patient’s vital signs and gives additional care as needed. Some EMT’s work for hospital trauma centers or jurisdictions which use helicopters to transport critically ill or injured patients. At a medical facility, EMT’s transfer patients to the emergency department, report to the staff their observations and the care they provided, and may help provide emergency treatment. After each run, EMT’s replace used supplies and check equip­ ment. If patients have had a contagious disease, EMT’s decontami­ nate the interior of the ambulance and report cases to the proper au­ thorities.  W Executive Office, American Society of Electroneurodiagnostic Technolo­ gists, Inc., 204 W. 7th, Carroll, IA 51401.  For information on work in sleep studies, contact: O’ Association of Polysomnographic Technology, 1610 14th St. NW., Suite 300, Rochester, MN 55901.  Information about specific accredited training programs is also available from: is1 Joint Review Committee on Electroneurodiagnostic Technology, P.O.  Box 11434, Norfolk, VA 23517.  Information on becoming a registered EEG technologist is availa­ ble from: t3p American Board of Registration of Electroencephalgraphic and Evoked Potential Technologists, P.O. Box 11434, Norfolk, VA 23517.  Working Conditions  EMT’s work both indoors and outdoors, in all kinds of weather. Much of their time is spent standing, kneeling, bending, and lifting. They may risk noise-induced hearing loss from ambulance sirens and back injuries from lifting patients. EMT’s may be exposed to diseases such as Hepatitis-B and AIDS, as well as violence from drug overdose victims. The work is not only physically strenuous, but stressful—not surprising in a job that involves life-or-death situ­ ations. However, many people find the work exciting and challeng­ ing.  Emergency Medical Technicians (D.O.T. 079.364-026 and .374-010)  Nature of the Work  Automobile accident injuries, heart attacks, near drownings, un­ scheduled childbirths, poisonings, and gunshot wounds all demand urgent medical attention. Emergency medical technicians (EMT’s) give immediate care and then transport the sick or injured to medi­ cal facilities. Following instructions from a dispatcher, EMT’s—who usually work in teams of two—drive specially equipped emergency vehicles to the scene of emergencies. If necessary, they request additional help from police, fire, or electric company personnel, or they may enlist bystanders to direct traffic or remove debris. They determine the nature and extent of the patient’s injuries or illness while also trying to determine whether the patient has epilepsy, diabetes, or other preexisting medical conditions. EMT’s then give appropriate emergency care following strict guidelines for which procedures they may perform. All EMT’s, including those with basic skills, the EMT-Basic, may open airways, restore breathing, control bleeding, treat for shock, administer oxygen, immobilize fractures, bandage wounds, assist in childbirth, manage emotionally disturbed patients, treat and assist heart attack victims, give initial care to poison and bum victims, and treat patients with anti-shock trousers, which pre­ vent a person’s blood pressure from falling too low. 10 Federal Reserve Bank of St. Louis  '  -  Most job openings for EMT’s will result from people who leave the field.  EMT’s employed by fire departments often have about a 50-hour workweek. Those employed by hospitals frequently work between 45 and 58 hours a week and those in private between 48 and 51 hours. Some EMT’s, especially those in police and fire departments, are on call for extended periods. Because most emergency services function 24 hours a day, EMT’s have irregular working hours that add to job stress. Employment  In 1992, EMT’s held 114,000jobs. Two-fifths were in private ambu­ lance services, about a third were in municipal fire, police, or rescue squad departments, and a quarter were in hospitals. In addition, there are many volunteer EMT’s. Most paid EMT’s work in metropolitan areas. In many smaller cities, towns, and rural areas, there are no paid EMT jobs. All ser­ vices are provided by volunteers. Training, Other Qualifications, and Advancement  Formal training is needed to become an EMT. EMT-Basic training is 100 to 120 hours of classroom work plus 10 hours of internship in a hospital emergency room. Training is available in 50 States and the District of Columbia, and is offered by police, fire, and health departments; in hospitals; and as a nondegree course in colleges and universities. The EMT basic program provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest, and emergency childbirth. Students learn to use and care for com­ mon emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems, and stretchers. EMT-Intermediate training varies from State to State, but in­ cludes 35-55 hours of additional instruction in patient assessment as well as the use of esophageal airways, intravenous fluids, and an­ tishock garments. Training programs for EMT-Paramedics gener­ ally last between 750 and 2,000 hours. Refresher courses and contin­ uing education are available for EMT’s at all levels. Applicants to an EMT training course generally must be at least 18 years old and have a high school diploma or the equivalent and a driver’s license. Recommended high school subjects for prospective EMT’s are driver education, health, and science. Training in the Armed Forces as a “medic” is also good preparation. In addition to EMT training, EMT’s in fire and police depart­ ments must be qualified as firefighters or police officers. Graduates of approved EMT-Basic training programs who pass a written and practical examination administered by the State certify­ ing agency or the National Registry of Emergency Medical Techni­ cians earn the title of Registered EMT-Basic. Prerequisites for tak­ ing the EMT-Intermediate examination include registration as an EMT-Basic, required classroom work, and a specified amount of clinical experience and field internship. Registration for EMTParamedics by the National Registry of Emergency Medical Tech­ nicians or a State emergency medical services agency requires cur­ rent registration or State certification as an EMT-Basic, completion of an EMT-Paramedic training program and required clinical and field interships as well as passing of a written and practical examina­ tion. Although not a general requirement for employment, registra­ tion acknowledges an EMT’s qualifications and may make higher paying jobs easier to obtain. All 50 States have some kind of certification procedure. In 29 States and the District of Columbia, registration with the National Registry is required at some or all levels of certification. Other States require their own certification examination or provide the op­ tion of taking the National Registry examination. To maintain their certification, all EMT’s must reregister, usually every 2 years. In order to reregister, an individual must be working as an EMT and meet a continuing education requirement. EMT’s should have emotional stability, good dexterity, agility, physical coordination and be able to lift and carry heavy loads. EMT’s need good eyesight (corrective lenses may be used) with ac­ curate color vision. Advancement beyond the EMT-Paramedic level usually means leaving fieldwork. An EMT-Paramedic can become a supervisor, operations manager, administrative director, or executive director of emergency services. Some EMT’s become EMT instructors, Federal Reserve Bank of St. Louis  firefighters, dispatchers, or police officers, or others move into sales or marketing of emergency medical equipment. Finally, some be­ come EMT’s to assess their interest in health care and then decide to return to school and become R.N.’s, physicians, or other health workers. Job Outlook  Most job openings will occur because of this occupation’s substan­ tial replacement needs. Turnover is quite high, reflecting this occu­ pation’s stressful working conditions, limited advancement poten­ tial, and the modest pay and benefits in the private sector. Employment of EMT’s is expected to grow faster than average for all occupations through the year 2005. Driving the growth will be an expanding population. Also, the number of older people, who are more likely to need emergency services, is increasing rapidly. Opportunities for EMT’s are expected to be excellent in hospitals and private ambulance services, where pay and benefits usually are low. Competition for jobs will be keen in fire, police, and rescue squad departments because of attractive pay and benefits and good job security. Earnings  Earnings of EMT’s depend on the employment setting and geo­ graphic location as well as the individual’s training and experience. According to a survey conducted by the Journal ofEmergency Med­ ical Services (JEMS), average starting salaries in 1993 were $20,092 for EMT-Ambulance or Basic, $19,530 for EMT-Intermediate, and $24,390 for EMT-Paramedic. EMT’s working in fire departments command the highest salaries, as the accompanying table shows. Table 1. Average annual salaries of emergency medical technicians, by type of employer, 1993 Employer  Paramedic  EMT-I  All employers (mean)..............  $28,079  $22,682  $22,848  Private ambulance services__ Hospitals.................................. Fire departments......................  25,606 24,944 34,994  20,060 21,088 30,914  19,383 18,845 31,141  EMT-Basic  SOURCE: Journal of Emergency Medical Services  Those in emergency medical services which are part of fire or police departments receive the same benefits as firefighters or police of­ ficers. Related Occupations  Other workers in occupations that require quick and level-headed reactions to life-or-death situations are police officers, firefighters, air traffic controllers, workers in other health occupations, and members of the Armed Forces. Sources of Additional Information  Information concerning training courses, registration, and job op­ portunities for EMT’s can be obtained by writing to the State Emer­ gency Medical Service Director. General information about EMT’s is available from: ty National Association of Emergency Medical Technicians, 9140 Ward Pky., Kansas City, MO 64114.  Medical Record Technicians (D.O.T. 079.362-014,-018)  Nature of the Work  When you enter a hospital, you see a whirl of white coats of physi­ cians, nurses, radiologic technologists, and others. Every time these 11  health care personnel treat a patient, they record what they ob­ served and did to the patient. This record includes information the patient provides about their symptoms and medical history, and also the results of examinations, reports of X ray and laboratory tests, and diagnoses and treatment plans. Medical record techni­ cians organize and evaluate these records for completeness and ac­ curacy. When assembling a patient’s medical record, technicians, who may also be called medical record technicians, first make sure that the medical chart is complete. They ensure that all forms are present and properly identified and signed, and that all necessary informa­ tion is on a computer file. Sometimes, they talk to physicians or others to clarify diagnoses or get additional information. Technicians assign a code to each diagnosis and procedure. They consult a classification manual and rely, too, on their knowledge of disease processes. Technicians may then use a software program to assign the patient to one of several hundred “diagnosis-related groups” or DRG’s. The DRG determines the amount the hospital will be reimbursed if the patient is covered by Medicare or other in­ surance programs that use the DRG system. Technicians who spe­ cialize in coding are called medical record coders, coder/abstrac­ tors, or coding specialists. Technicians may also tabulate and analyze data to help improve patient care, to control costs, to be used in legal actions, or to re­ spond to surveys. Tumor registrars compile and maintain records of patients who have cancer to provide information to physicians and for research studies. Medical record technicians’ duties vary with the size of the facil­ ity. In large to medium facilities, technicians may specialize in one aspect of medical records or supervise medical record clerks and transcribers while a medical record administrator manages the de­ partment (see the statement on health services managers elsewhere in the Handbook). In small facilities an accredited record technician may manage the department. Working Conditions  Medical record technicians generally work a 40-hour week. Some overtime may be required. In hospitals where medical record de­ partments are open 18-24 hours a day, 7 days a week, they may work on day, evening, and night shifts. They work in pleasant and comfortable offices. Medical record technician is one of the few health occupations in which there is lit­ tle or no contact with patients. Accuracy is essential, and this de­ mands concentration and close attention to detail. Medical record technicians who work at video display terminals for prolonged peri­ ods may experience eyestrain and muscle pain.  Employment  Medical record technicians held about 76,000 jobs in 1992. About one half of jobs were in hospitals. Most of the remainder were in nursing homes, medical group practices, health maintenance orga­ nizations, and clinics. In addition, insurance, accounting, and law firms that deal in health matters employ medical record technicians to tabulate and analyze data from medical records. Public health departments hire technicians to supervise data collection from health care institutions and to assist in research. Some self-employed medical record technicians are consultants to nursing homes and physicians’ offices. Training, Other Qualifications, and Advancement  Medical record technicians entering the field usually have formal training in a 2-year associate degree program offered at community and junior colleges. Courses include medical terminology and dis­ eases, anatomy and physiology, legal aspects of medical records, coding and abstraction of data, statistics, databases, quality assur­ ance methods, and computers as well as general education. Technicians may also gain training through an Independent Study Program in Medical Record Technology offered by the American Health Information Management Association (AHIMA). Hospitals sometimes advance promising medical record clerks to jobs as medical record technicians, although this practice may be less common in the future. Advancement generally requires 2-4 years ofjob experience and completion of the hospital’s in-house training program. Most employers prefer to hire Accredited Record Technicians (ART). Accreditation is obtained by passing a written examination offered by the AHIMA. To take the examination, a person must be a graduate of a 2-year associate degree program accredited by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association, or a graduate of the Independent Study Program in Medical Record Technology who has also obtained 30 semester hours of academic credit in pre­ scribed areas. Technicians who have received training in nonCAHEA accredited programs or on the job are not eligible to take the examination. In 1992, CAHEA accredited 90 programs for medical record technicians. Experienced medical record technicians generally advance in one of two ways—by specializing or managing. Many senior medical re­ cord technicians specialize in coding, particularly Medicare coding or in tumor registry. In large medical record departments, experienced technicians may become section supervisors, overseeing the work of the coding, correspondence, or discharge sections, for example. Senior techni­ cians with ART credentials may become director or assistant direc­ tor of a medical record department in a small facility. However, in larger institutions the director is a medical records administrator, with a bachelor’s degree in medical record administration. (See the statement on health services managers elsewhere in the Handbook.) Job Outlook  Medical record technicians may also be referred to as health information technicians. 12 Federal Reserve Bank of St. Louis  Hospitals will continue to employ the most technicians. Most job openings will occur because of replacement needs. The job prospects for formally trained technicians should be very good. Employment of medical record technicians is expected to grow much faster than the average for all occupations through the year 2005 due to rapid growth in the number of medical tests, treatments, and procedures and because medical records will be increasingly scrutinized by third-party payers, courts, and consumers. The need for detailed medical records in offices and clinics of doc­ tors of medicine should translate into rapid growth in employment opportunities for medical record technicians in large group prac­ tices and offices of specialists. Rapid growth is also expected in health maintenance organizations, nursing homes, and home health agencies.  Earnings  According to a 1992 survey of AHIMA members, accredited record technicans who worked as coders averaged $11.30 an hour; unac­ credited coders averaged $9.77 an hour; and accredited record tech­ nicians in supervisory positions averaged $29,599 a year. The aver­ age annual salary for medical record technicians in the Federal Government in nonsupervisory, supervisory, and managerial posi­ tions was $22,008 in 1993.  -Jl  Related Occupations  Medical record technicians need a strong clinical background to an­ alyze the contents of medical records. Other occupations that re­ quire a knowledge of medical terminology, anatomy, and physiol­ ogy without directly touching the patient are medical secretaries, medical transcribers, medical writers, and medical illustrators. Sources of Additional Information  Information on careers in medical record technology, including the Independent Study Program, is available from: W American Health Information Management Association, 919 N. Michi­  gan Ave., Suite 1400, Chicago, IL 60611.  A list of CAHEA-accredited programs for medical record techni­ cians is available from:  Nuclear medicine technologists must adhere to radiation safety guidelines.  (D.O.T. 078.361-018)  shift work are also available. In addition, technologists in hospitals may be on-call duty on a rotational basis. Because technologists are on their feet much of the day, and may lift or turn disabled patients, physical stamina is important. Although there is potential for radiation exposure in this field, it is kept to a minimum by the use of shielded syringes, gloves, and other protective devices. Technologists also wear badges that mea­ sure radiation levels. Because of safety programs, however, badge measurements rarely exceed established safety levels.  Nature of the Work  Employment  isr American Medical Association, Division of Allied Health Education and Accreditation, 515 N. State St., Chicago, IL 60610.  Nuclear Medicine Technologists  In nuclear medicine, radionuclides—unstable atoms that emit radi­ ation spontaneously—are used to diagnose and treat disease. Ra­ dionuclides are purified and compounded like other drugs to form radiopharmaceuticals. Nuclear medicine technologists administer these radiopharmaceuticals to patients, then moniter the character­ istics and functions of tissues or organs in which they localize. Ab­ normal areas show higher or lower concentrations of radioactivity than normal. Nuclear medicine technologists operate cameras that detect and map the radioactive drug in the patient’s body to create an image on photographic film. Radiologic technologists also operate diagnostic imaging equipment, but their equipment creates an image by pro­ jecting an x ray through the patient. (See the statement on radiologic technologists elsewhere in the Handbook.) Nuclear medicine technologists explain test procedures to pa­ tients. They prepare a dosage of the radiopharmaceutical and ad­ minister it by mouth, injection, or other means. When preparing radiopharmaceuticals, technologists adhere to safety standards that keep the radiation dose to workers and patients as low as possible. Technologists position patients and start a gamma scintillation camera, or scanner, which creates images of the distribution of a radiopharmaceutical as it passes through or localizes in the patient’s body. Technologists produce the images on a computer screen or on film for a physician to interpret. Some nuclear medicine studies, such as cardiac function studies, are processed with the aid of a computer. Nuclear medicine technologists also perform radioimmunoassay studies which assess the behavior of a radioactive substance inside the body. For example, technologists may add radioactive sub­ stances to blood or serum to determine levels of hormones or thera­ peutic drug content. Technologists keep patient records and record the amount and type of radionuclides received, used, and disposed of. Working Conditions  Nuclear medicine technologists generally work a 40-hour week. This may include evening or weekend hours in departments which operate on an extended schedule. Opportunities for part-time and Federal Reserve Bank of St. Louis  Nuclear medicine technologists held about 12,000 jobs in 1992. About 9 out of 10 jobs were in hospitals. The rest were in physicians’ offices and clinics, including imaging centers. Training, Other Qualifications, and Advancement  Nuclear medicine technology programs range in length from 1 to 4 years and lead to a certificate, associate degree, or bachelor’s degree. Generally, certificate programs are offered in hospitals; associate programs in community colleges; and baccalaureate programs in 4 year-colleges and in universities. Courses cover physical sciences, the biological effects of radiation exposure, radiation protection and procedures, the use of radiopharmaceuticals, imaging techniques, and computer applications. Associate and bachelor’s programs also cover liberal arts. One-year certificate programs are for health professionals, espe­ cially radiologic technologists and ultrasound technologists wishing to specialize in nuclear medicine. They also attract medical technol­ ogists, registered nurses, and others who wish to change fields or specialize. Others interested in the nuclear medicine technology field have three options: a 2-year certificate program, a 2-year asso­ ciate program, or a 4-year baccalaureate program. The Committee on Allied Health Education and Accreditation (CAHEA) accredits most formal training programs in nuclear medicine technology. In 1992, there were 112 CAHEA-accredited programs. All nuclear medicine technologists must meet the minimum Fed­ eral standards on the administration of radioactive drugs and the operation of radiation detection equipment. In addition, about half of all States require technologists to be licensed. Technologists also may obtain voluntary professional certification or registration. Re­ gistration or certification is available from the American Registry of Radiologic Technologists (ARRT) and from the Nuclear Medicine Technology Certification Board (NMTCB). Most employers prefer to hire certified or registered technologists. Technologists may advance to supervisor, then to chief technolo­ gist, and to department administrator or director. (See statement on health services managers elsewhere in the Handbook.) Some tech­ nologists specialize in a clinical area such as nuclear cardiology or 13  computer analysis or leave patient care to take positions in research laboratories. Some become instructors or directors in nuclear medicine technology programs, a step that usually requires a bache­ lor’s degree or master’s in nuclear medicine technology. Others leave the occupation to work as sales or training representatives for health equipment and radiopharmaceutical manufacturing firms, or as radiation safety officers in regulatory agencies or hospitals.  Job Outlook  Employment of nuclear medicine technologists is expected to grow much faster than the average for all occupations through the year 2005. Substantial growth in the number of middle-aged and older persons will spur demand for diagnostic procedures, including nu­ clear medicine tests. Furthermore, technological innovations seem likely to increase the diagnostic uses of nuclear medicine. One exam­ ple is the use of radiopharmaceuticals in combination with monoclonal antibodies to detect cancer at far earlier stages than is customary today, and without resorting to surgery. Another is the use of radionuclides to examine the heart’s ability to pump blood. Wider use of positron emission tomography imaging to observe met­ abolic and biochemical changes for neurology, cardiology, and on­ cology procedures, will also spur demand for nuclear medicine tech­ nologists. Cost considerations will affect the speed with which new applica­ tions of nuclear medicine grow. Some promising nuclear medicine procedures, such as positron emission tomography, are extremely costly, and hospitals contemplating them will have to consider equipment costs, reimbursement policies, and the number of poten­ tial users.  Earnings  According to a University of Texas Medical Branch national survey of hospitals and medical centers, the median annual salary of nu­ clear medicine technologists, based on a 40 hour week and exclud­ ing shift or area differentials, was $32,843 in October 1992. The av­ erage minimum salary was $26,402 and the average maximum was $38,840.  Related Occupations  Nuclear medical technologists operate sophisticated equipment to help physicians and other health practitioners diagnose and treat patients. So do radiologic technologists, diagnostic medical sonographers, cardiology technologists, electroencephalographic technologists, clinical laboratory technologists, perfusionists, and respiratory therapists.  Ophthalmic Laboratory Technicians (D.O.T. 711.381-010; 713.381-010, .681-010; 716.280-010, -014, and -018, .381-014, .382-010, -014, -018, and -022, .462-010, .681-010 and -018, and .682-018)  Nature of the Work  Ophthalmic laboratory technicians—also known as manufacturing opticians, optical mechanics, or optical goods workers—make pre­ scription eyeglass lenses. Some manufacture lenses for other optical instruments, such as telescopes and binoculars. Prescription lenses are curved in such a way that light is correctly focused onto the ret­ ina of the patient’s eye, improving vision. Ophthalmic laboratory technicians cut, grind, edge, and finish lenses according to specifica­ tions provided by dispensing opticians, optometrists, or ophthal­ mologists, and then assemble the lenses with frames to produce fin­ ished glasses. Ophthalmic laboratory technicians should not be confused with workers in other vision care occupations. Ophthalmologists and op­ tometrists are “eye doctors” who examine eyes, diagnose and treat vision problems, and prescribe corrective lenses. Ophthalmologists also perform eye surgery. Dispensing opticians, who may also do work described here, help patients select frames and lenses, and ad­ just finished eyeglasses. (See the statement on physicians, which in­ cludes ophthalmologists, and the statements on optometrists and dispensing opticians elsewhere in the Handbook.) Ophthalmic laboratory technicians read prescription specifica­ tions, then select standard glass or plastic lens blanks and mark them to indicate where the curves specified on the prescription should be ground. They place the lens into the lens grinder, set the dials for the prescribed curvature, and start the machine. After a minute or so, the lens is ready to be “finished” by a process in which a machine rotates the lens against a fine abrasive to grind the lens and smooth out rough edges. The lens is then placed in a polishing machine, with an even finer abrasive, to polish the lens to a smooth, bright finish. Next, the technician examines the lens through a lensometer, an instrument similar in shape to a microscope, and makes sure the de­ gree and placement of the curve is correct. The technician then cuts the lenses and bevels the edges to fit the frame, dips each lens into dye if the prescription calls for tinted or coated lenses, polishes the edges, and assembles the lenses and frame parts into a finished pair of glasses. In small laboratories, technicians generally handle every phase of the operation. In large ones, technicians may specialize in one or more steps, assembly-line style.  Sources of Additional Information  Additional information on a career as a nuclear medicine technolo­ gist is available from: r^The Society of Nuclear Medicine-Technologist Section, 136 Madison Ave., New York, NY 10016. W American Society of Radiologic Technologists, 15000 Central Ave., Al­ buquerque, NM 87123.  For a list of accredited programs in nuclear medicine technology, write to: fW Joint Review Committee on Educational Programs in Nuclear Medicine Technology, 1144 West 3300 South, Salt Lake City, UT 84119.  Information on certification is available from: W Nuclear Medicine Technology Certification Board, 2970 Clairmont Rd.,  Suite 610, Atlanta, GA 30329. I^The American Registry of Radiologic Technologists, 1255 Northland Dr., Mendota Heights, MN 55120.  14 Federal Reserve Bank of St. Louis  Nearly all ophthalmic laboratory technicians learn their skills on the job.  Working Conditions  Related Occupations  Ophthalmic laboratory technicians work in relatively clean and well-lighted laboratories and have limited contact with the public. Surroundings are relatively quiet despite the humming of machines. At times, technicians may need to wear goggles to protect their eyes, and may spend a great deal of time standing. Most ophthalmic laboratory technicians work a 5-day, 40-hour week, which may include weekends, evenings, or occasionally, some overtime. Some work part time. Ophthalmic laboratory technicians need to take precautions against the hazards associated with cutting glass, handling chemi­ cals, and working near machinery.  Workers in other precision production occupations include bi­ omedical equipment technicians, dental laboratory technicians, or­ thodontic technicians, orthotics technicians, prosthetics techni­ cians, and instrument repairers. Sources of Additional Information  For general information about a career as an ophthalmic laboratory technician and for a list of accredited programs in ophthalmic labo­ ratory technology, contact: iw Commission on Opticianry Accreditation, 10111 Martin Luther King, Jr. Hwy., Suite 100, Bowie, MD 20720-4299.  Employment  Ophthalmic laboratory technicians held about 19,000 jobs in 1992. About half of these jobs were in retail stores that manufacture and sell prescription glasses—mostly chains of optical goods stores or independent retailers. Most of the rest were in optical laboratories. These laboratories manufacture eyewear for dispensing by retail stores that sell but do not fabricate prescription glasses, and by oph­ thalmologists and optometrists. A few work for optometrists or ophthalmologists who dispense glasses directly to patients. Training, Other Qualifications, and Advancement  Nearly all ophthalmic laboratory technicians learn their skills on the job. Employers filling trainee jobs prefer applicants who are high school graduates. Courses in science and mathematics are valuable; manual dexterity and the ability to do precision work is essential. Technician trainees start on simple tasks such as marking or blocking lenses for grinding, then progress to lens grinding, lens cut­ ting, edging, beveling, and eyeglass assembly. Depending on the in­ dividual’s aptitude, it may take 6 to 18 months to become proficient in all phases of the work. Some ophthalmic technicians learn their trade in the Armed Forces. Others attend the few programs in optical technology of­ fered by vocational-technical institutes or trade schools. These pro­ grams have classes in optical theory, surfacing and lens finishing, and the reading and applying of prescriptions. Programs vary in length from 6 months to 1 year, and award certificates or diplomas. Ophthalmic laboratory technicians can become supervisors and managers. Some technicians become dispensing opticians, although further education or training may be required. Job Outlook  Employment of ophthalmic laboratory technicians is expected to in­ crease about as fast as the average for all occupations through the year 2005 due to rising demand for corrective lenses. Nonetheless, most job openings will come from the need to replace technicians who transfer to other occupations or leave the labor force. Demographic trends make it likely that many more Americans will wear glasses in the years ahead. Not only will the population grow, but the number of middle-aged and older adults will grow particularly rapidly. Middle age is a time when many people use corrective lenses for the first time, and older persons require appre­ ciably more vision care than the rest of the population. The public’s heightened awareness of vision care should also in­ crease demand for corrective lenses. The emergence of eyewear as a fashion item—eyewear now comes in an assortment of attractive shapes and colors—has been enticing many people to purchase two or three pair of glasses rather than just one. Most new jobs for ophthalmic laboratory technicians will be in retail optical chains that manufacture prescription glasses on the premises and provide fast service. Earnings  According to the Opticians Association of America, the beginning average salary for ophthalmic laboratory technicians in retail opti­ cal stores was $15,040 in 1992. Those with 3 to 5 years of experience averaged $16,700; 6 to 9 years, $21,700; and 10 years or more, $24,370. Trainees may start at the minimum wage. Federal Reserve Bank of St. Louis  Radiologic Technologists (D.O.T. 078.361-034, .362-026, -046, -054, -058, .364-010)  Nature of the Work  Perhaps the most familiar use of the x ray is the diagnosis of broken bones. However, medical uses of radiation go far beyond that. Radi­ ation is used not only to produce images of the interior of the body, but to treat cancer as well. At the same time, the use of imaging techniques that do not involve x rays, such as ultrasound and mag­ netic resonance scans, is growing rapidly. The term “diagnostic imaging” embraces these procedures as well as the familiar x ray. 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, removing articles such as jewelry, through which x rays cannot pass, and positioning patients so that the correct parts of the body can be radiographed. To prevent unnecessary radiation exposure, technol­ ogists surround the exposed area with radiation protection devices, such as lead shields, or limit the size of the x-ray beam. Radi­ ographers position radiographic equipment at the correct angle and height over the appropriate area of a patient’s body. Using instru­ ments similar to a measuring tape, technologists may measure the thickness of the section to be radiographed and set controls on the machine to produce radiographs of the appropriate density, detail, and contrast. They place the x-ray film under the part of the pa­ tient’s body to be examined and make the exposure. They then re­ move the film and develop it. Experienced radiographers may perform more complex imaging tests. For fluoroscopies, radiographers prepare a solution of con­ trast medium for the patient to drink, allowing the radiologist, a physician who interprets x rays, to see soft tissues in the body. Some radiographers operate computed tomography scanners to produce cross-sectional views of patients and may be called CT technolo­ gists. Others operate machines using giant magnets and radiowaves rather than radiation to create an image and may be called magnetic resonance imaging (MRI) technologists. Radiation therapy technologists, also known as radiation ther­ apists, prepare cancer patients for treatment and administer pre­ scribed doses of ionizing radiation to specific body parts. They oper­ ate many kinds of equipment, including high-energy linear accelerators with electron capabilities. They position patients under the equipment with absolute accuracy in order to expose affected body parts to treatment while protecting the rest of the body from radiation. They also check the patients reactions for radiation side effects such as nausea, hair loss, and skin irritation. They give instructions and explanations to patients who are likely to be very ill and may be dying. Radiation therapists, in contrast to other radiologic technol­ ogists, are likely to see the same patient a number of times during the course of treatment. Sonographers, also known as ultrasound technologists, use non­ ionizing, high frequency sound waves into areas of the patient’s body; the equipment then collects reflected echoes to form an image. The image is viewed on a screen and may be recorded on a printout 15  strip or photographed for interpretation and diagnosis by physi­ cians. Sonographers explain the procedure, record additional medi­ cal history, and then position the patient for testing. Viewing the screen as the scan takes place, sonographers look for subtle differ­ ences between healthy and pathological areas, and judge if the images are satisfactory for diagnostic purposes. Sonographers may specialize in neurosonography (the brain), vascular (blood flows), echocardiography (the heart), abdominal (the liver, kidneys, spleen, and pancreas), obstetrics/gynecology (the female reproductive sys­ tem), and ophthalmology (the eye). Radiologic technologists follow precisely physicians’ instructions and regulations concerning use of radiation to insure that they, pa­ tients, and co-workers are protected from over exposure. In addition to preparing patients and operating equipment, radio­ logic technologists keep patient records and adjust and maintain equipment. They may also prepare work schedules, evaluate equip­ ment purchases, or manage a radiology department. Working Conditions  Most full-time radiologic technologists work about 40 hours a week; they may have evening and weekend or on- call hours. Technologists are on their feet for long periods and may lift or turn disabled patients. They work at radiologic machines but may also do some procedures at patients bedsides. Some radiologic tech­ nologists travel to patients in large vans equipped with sophisticated diagnostic equipment. Radiation therapists are prone to emotional “bum out” since they regularly treat extremely ill and dying patients on a daily basis. Al­ though potential radiation hazards exist in this occupation, they have been minimized by the use of lead aprons, gloves, and other shielding devices, as well as by instruments that measure radiation exposure. Technologists wear badges that measure radiation levels in the radiation area, and detailed records are kept on their cumula­ tive lifetime dose. Employment  Radiologic technologists held about 162,000 jobs in 1992. Most technologists were radiographers. Some were sonographers and ra­ diation therapists. About 1 radiologic technologist in 5 worked part­ time. About 3 out of 5 jobs are in hospitals. The rest are in physicians’ offices and clinics, including diagnostic imaging centers. Training, Other Qualifications, and Advancement  Preparation for this profession is offered in hospitals, colleges and universities, vocational-technical institutes, and the Armed Forces. Hospitals, which employ most radiologic technologists, prefer to hire those with formal training.  Formal training is offered in radiography, radiation therapy, and diagnostic medical sonography (ultrasound). Programs range in length from 1 to 4 years and lead to a certificate, associate degree, or bachelor’s degree. Two-year programs are most prevalent. Some 1-year certificate programs are for individuals from other health occupations such as medical technologists and registered nurses who want to change fields or experienced radiographers who want to specialize in radiation therapy technology or sonography. A bachelor’s or master’s degree in one of the radiologic technologies is desirable for supervisory, administrative, or teaching positions. The Committee on Allied Health Education and Accreditation (CAHEA) accredits most formal training programs for this field. CAHEA accredited 687 radiography programs, 120 radiation ther­ apy programs, and 52 diagnostic medical sonography programs in 1992. Radiography programs require, at a minimum, a high school di­ ploma or the equivalent. High school courses in mathematics, phys­ ics, chemistry, and biology are helpful. The programs provide both classroom and clinical instruction in anatomy and physiology, pa­ tient care procedures, radiation physics, radiation protection, prin­ ciples of imaging, medical terminology, positioning of patients, medical ethics, radiobiology, and pathology. For training programs in radiation therapy and diagnostic medi­ cal sonography, applicants with a background in science, or experi­ ence in one of the health professions, generally are preferred. Some programs consider applicants with liberal arts backgrounds, how­ ever, as well as high school graduates with courses in math and sci­ ence. Radiographers and radiation therapists are covered by provisions of the Consumer-Patient Radiation Health and Safety Act of 1981, which aims to protect the public from the hazards of unnecessary exposure to medical and dental radiation by ensuring operators of radiologic equipment are properly trained. The act requires the Fed­ eral Government to set standards that the States, in turn, may use for accrediting training programs and certifying individuals who en­ gage in medical or dental radiography. By 1992, 26 States required radiographers to be licensed, and 23 required radiation therapists to be licensed. (Puerto Rico requires a license for the practice of either specialty.) One State, Utah, licenses diagnostic medical sonographers. Voluntary registration is offered by the American Registry of Ra­ diologic Technologists (ARRT) in both radiography and radiation therapy. The American Registry of Diagnostic Medical So­ nographers (ARDMS) certifies the competence of sonographers. To become registered, technologists must be graduates of a CAHEAaccredited program or meet other prerequisites and have passed an examination. Many employers prefer to hire registered technolo­ gists. With experience and additional training, staff technologists may become specialists, performing CT scanning, ultrasound, angiogra­ phy, and magnetic resonance imaging. Experienced technologists may also be promoted to supervisor, chief radiologic technologist, and—ultimately—department administrator or director. Depend­ ing on the institution, courses or a master’s degree in business or health administration may be necessary for the director’s position. Some technologists progress by becoming instructors or directors in radiologic technology programs; others take jobs as sales represent­ atives or instructors with equipment manufacturers. With additional education, available at major cancer centers, ra­ diation therapy technologists can specialize as medical radiation dosimetrists. Dosimetrists work with health physicists and oncolo­ gists (physicians who specialize in the study and treatment of tu­ mors) to develop treatment plans. Job Outlook  Radiologic technologists may be on their feet for extended periods of time. 16 Federal Reserve Bank of St. Louis  Employment radiologic technologists is expected to grow much faster than the average for all occupations through 2005, as the health care industries grow, and because of the vast clinical poten­ tial of diagnostic imaging and therapeutic technology. Current as well as new uses of imaging equipment are virtually certain to sharply increase demand for radiologic technologists. Technology will continue to evolve. New generations of diagnos­ tic imaging equipment are expected to give even better information  to physicians and be used more widely. Since ultrasound is non-invasive, it is also less risky and uncomfortable for the patient than ex­ ploratory surgery. Radiation therapy will continue to be used—alone or in combina­ tion with surgery or chemotherapy—to treat cancer. More treat­ ment of cancer is anticipated due to the aging of the population, edu­ cational efforts aimed at early detection, and improved ability to detect malignancies through radiologic procedures such as mam­ mography. Although physicians are enthusiastic about the clinical benefits of new technologies, the extent to which they are adopted depends largely on cost and reimbursement considerations. Some promising new technologies may not come into widespread use because they are too expensive and third-party payers may not be willing to pay for their use. But on the whole, it appears that radiologic procedures will be used more widely. Hospitals will remain the principal employer of radiologic tech­ nologists. However, employment is expected to grow most rapidly in offices and clinics of physicians, including diagnostic imaging centers. Health facilities such as these are expected to grow very rapidly through 2005 due to the strong shift toward outpatient care, encouraged by third-party payers and made possible by technologi­ cal advances that permit more procedures to be performed outside the hospital. Some jobs will also come from the need to replace tech­ nologists who leave the occupation. Earnings  In 1992, the median annual earnings for radiologic technologists who worked year round full time were $28,236. The middle 50 per­ cent earned between $22,932 and $33,748 a week; 10 percent earned less than $19,708 a week; and 10 percent earned more than $40,456. According to a University of Texas Medical Branch national sur­ vey of hospitals and medical centers, the median annual salary for radiation technologists, based on a 40 hour week and excluding shift or area differentials, was $25,615 in October 1992. The average min­ imum salary was $22,250 and the average maximum was $32,553. For radiation therapy technologists the median was $34,278 and for ultrasound technologists, $32,219.  Surgical Technologists (D.O.T. 079.374-022)  Nature of the Work  Surgical technologists, also called operating room technicians, assist in operations under the supervision of surgeons or registered nurses. Before an operation, surgical technologists help set up the operating room with surgical instruments, equipment, sterile linens, and fluids such as saline (a salt solution), or glucose (a sugar solution). They assemble, adjust, and check nonsterile equipment to ensure that it is in working order. Technologists also “prep” (prepare) patients 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 scrub and put on gloves, gowns, and masks. During surgery, technologists pass instruments and other sterile supplies to surgeons and surgeon assistants. They may hold retrac­ tors, cut sutures, and help count sponges, needles, supplies, and in­ struments. Surgical technologists help prepare, care for, and dispose of specimens taken for laboratory analysis and may help apply dressings. They may operate sterilizers, lights, or suction machines, and help operate diagnostic equipment. Technologists may also maintain specified supplies of fluids such as plasma and blood. After an operation, surgical technologists may help transfer pa­ tients to the recovery room and clean and restock the operating room. Working Conditions  Surgical technologists work in clean, well-lighted, cool environ­ ments. They must stand for long periods of time and and remain alert during operations. Most surgical technologists work a regular 40-hour week, al­ though they may be “on call” (available to work on short notice for emergencies) during weekends and evenings on a rotating basis.  Related Occupations  Employment  Radiologic technologists operate sophisticated equipment to help physicians, dentists, and other health practitioners diagnose and treat patients. Workers in related occupations include nuclear medicine technologists, cardiovascular technologists and techni­ cians, perfusionists, respiratory therapists, clinical laboratory tech­ nologists, and electroencephalographic technologists.  Surgical technologists held about 44,000 jobs in 1992. Most surgical technologists are employed by hospitals. Others are employed in clinics and surgicenters, and in the offices of physicians and dentists who perform outpatient surgery. A few, known as private scrubs, are employed directly by surgeons who have special surgical teams like those for liver transplants.  Sources of Additional Information  -M  For career information, enclose a stamped, self-addressed businesssize envelope with your request to: fS“ American Society of Radiologic Technologists, 15000 Central Ave. SE., Albuquerque, NM 87123-3917. fW Society of Diagnostic Medical Sonographers, 12770 Coit Rd., Suite 508, Dallas, TX 75251. S’American Healthcare Radiology Administrators, 111 Boston Post Rd., Suite 215, P.O. Box 334, Sudbury, MA 01776.  For the current list of accredited education programs in radiogra­ phy, radiation therapy technology, or diagnostic medical so­ nography, write to: XS” Division of Allied Health Education and Accreditation, American Medi­ cal Association, 515 N. State St., Chicago, IL 60610.  For information on certification in radiologic technology, con­ tact: O’American Registry of Radiologic Technologists, 1255 Northland Dr., Mendota Heights, MN 55120.  For information on certification in sonography, contact: O’ American Registry of Diagnostic Medical Sonographers, 2368 Victory Pky., Suite 510, Cincinnati, OH 45206. Federal Reserve Bank of St. Louis  Surgical technologists set up the operating room with surgical instruments and equipment. 17  Training, Other Qualifications, and Advancement  Job Outlook  Surgical technologists receive their training in formal programs of­ fered by community and junior colleges, vocational schools, univer­ sities, hospitals, and the military. In 1993, the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association recognized 130 accredited programs. High school graduation normally is required for admission. Programs last 9 to 24 months and lead to a certificate, diploma, or associate de­ gree. Programs provide classroom education and supervised clinical experience. Required study includes anatomy, physiology, microbi­ ology, pharmacology, and medical terminology. Other studies cover care and safety of patients during surgery, aseptic techniques, and surgical procedures. Students also learn to sterilize instruments; prevent and control infection; and handle special drugs, solutions, supplies, and equipment. Technologists may obtain voluntary professional certification from the Liaison Council on Certification for the Surgical Technol­ ogist by graduating from a formal program and passing a national certification examination. Continuing education or reexamination is required to maintain certification, which must be renewed every 6 years. Some employers prefer to hire certified technologists. Surgical technologists need manual dexterity to handle instru­ ments quickly. They also must be conscientious, orderly, and emo­ tionally stable to handle the demands of surgeons. Technologists must respond quickly and know procedures well so that they may have instruments ready for surgeons without having to be told. They are expected to keep abreast of new developments in the field. Rec­ ommended high school courses include health, biology, chemistry, and mathematics. Technologists may advance by specializing in a particular area of surgery, such as neurosurgery or open heart surgery. They may also work as circulating technologists. A circulating technologist is the “unsterile” member of the surgical team who prepares patients; helps with anesthesia; gets, opens, and holds packages for the “ster­ ile” persons during the procedure; interviews the patient before sur­ gery; keeps a written account of the surgical procedure; and answers the surgeon’s questions about the patient during the surgery. With additional training, some technologists advance to first assistants, who help with retracting, sponging, suturing, cauterizing bleeders, and closing and treating wounds. Surgical technologists may man­ age central supply departments in hospitals, or take positions with insurance companies, sterile supply services, and operating equip­ ment firms.  Employment of surgical technologists is expected to grow much faster than the average for all occupations through the year 2005, as the volume of surgery increases and operating room staffing pat­ terns change. The number of surgical procedures is expected to rise as the popu­ lation grows and ages. Older people require more surgical proce­ dures. Technological advances, such as fiber optics and laser tech­ nology, will also permit new surgical procedures. Some employers may seek to substitute surgical technologists for operating room nurses to reduce costs. However, because some fa­ cilities and States limit the work that surgical technologists can do, widespread displacement of operating room nurses is not likely to occur. Hospitals will continue to be the primary employer of surgical technologists. Nonetheless, the shift to outpatient or ambulatory surgery will create faster growth for technologists in offices and clinics of physicians, including “surgicenters.”  18 Federal Reserve Bank of St. Louis  Earnings  According to a University of Texas Medical Branch survey of hospi­ tals and medical centers, the median annual salary of surgical tech­ nologists, based on a 40 hour week and excluding shift or area differ­ entials, was $21,741 in October 1992. The average minimum salary was $18,087 and the average maximum was $26,480. Related Occupations  Other health occupations requiring approximately 1 year of training after high school are licensed practical nurses, respiratory therapy technicians, medical laboratory assistants, medical assistants, dental assistants, optometric assistants, and physical therapy aides. Sources of Additional Information  For additional information on a career as a surgical technologist and a list of CAHEA-accredited programs, contact: fW Association of Surgical Technologists, 7108-C S. Alton Way, Engle­ wood, CO 80112.  For information on certification, contact: xw Liaison Council on Certification for the Surgical Technologist, 7108-C S.  Alton Way, Englewood, CO 80112.  ☆ U.S. GOVERNMENT PRINTING OFFICE: 1994 363-539 2450-9  Selected items from The Bureau of Labor Statistics library of  Career and Job Outlook Publications latest editions?  Occupational OutiookHandbook-1994-95Edition The original, and still leading source of authoritative, nontechnical career information for about 250 occupations. Each description includes information on nature of the work, training required, earnings, job prospects, and sources of additional information. 473 pp., {26, hard cover; $23, soft cover. OccupationalOuUookHandbookReprinls Groups of related jobs covered in the 1994-95 Occupational OutlookHandbooks available as individual reprints. These reprints are especially useful for jobseekers who wantto know about a single field and for counselors who need to stretch the contents of a single Handbook among many students.  1  Occupational  Outlook BureauojUOOf  1994  .  No.  2450 2450-1 2450-2 2450-3 2450-4 2450-5 2450-6 2450-7 2450-8 2450-9 2450-10 2450-11 2450-12 2450-13 2450-14 2450-15 2450-16 2450-17 2450-18 2450-19 2450-20  Collated set ofall20reprints  Tomorrow's Jobs: Overview Business and Managerial Occupations Engineering, Scientific, and Related Occupations Computer and Mathematics-Related Occupations Social Science and Legal Occupations Education and Social Service Occupations and Clergy Health Diagnosing Occupations and Assistants Dietetics, Nursing, Pharmacy, and Therapy Occupations Health Technologists and Technicians Communications, Design, Performing Arts, and Related Occupations Technologists and Technicians, Except Health Sales Occupations Clerical and Other Administrative Support Occupations Protective Service Occupations and Compliance Inspectors Service Occupations: Cleaning, Food, Health, and Personal Mechanics, Equipment Installers and Repairers Construction Trade and Extractive Occupations Metalworking, Plastic-working, and Woodworking Occupations Production Occupations Transportation and Forestry, Fishing, and Related Occupations  OccupationalOutlookQuarterly Keeps you informed about new studies by the Bureau of Labor Statistics. Articles covera wide range of subjects useful to job counselors, labor force analysts, and people choosing careers. New and emerging jobs, unusual jobs, employment projections and trends, and changing technology area few of theareascoveredbythisaward-winning magazine. Four issues, 40 pages each, in color, $8.00; single copy $2.75.  TO oRD.Ee%cW^ .  sssBggft Federal Reserve Bank of St. Louis  m  >arferiy  •  SMSU LIBRARIES  Related Publics  3 2356 00395031 6  The American Work Force: 1992-2005  1994  Occupational Projections and Training Data  Edition  U.S. Department of Labor Bureau of Labor Statistics  A Statistical and Research Supplement to the 1994-95 Occupational Outlook Handbook  Bulletin 2452 April 1994  U.S. Department of Labor Bureau of Labor Statistics May 1994 Bulletin 2451  1 •  lock scrMn  repeat with i* ] to 10 ' set hihgr-t of bLn I to fa!sr end repeat  set hiligr.t of the8tn to true repeat with x *} to ?iC‘ if htlight of btn x * true then ■ e t Visible of fid X to true  r££&. -  BLS Bulletin 2451  BLS Bulletin 2452  Occupational Projections and TVaining Data, 1994 Edition  The American Work Force: 1992-2005  This supplement to the Occupational Outlook Handbook provides the statistical and technical data supporting the information presented in the Handbook. Education and training planners, career counselors, and jobseekers can find valuable information that ranks occupations by employment growth, earnings, susceptibility to unemployment, separation rates, and part-time work. Hote: At press time, prices for these publications were not available. For prices and ordering information, contact any of the Bureau of Labor Statistics Regional Offices. Federal Reserve Bank of St. Louis  Every 2 years, the Bureau of Labor Statistics producers de­ tailed projections of the U.S. economy and labor force. This bulletin presents the Bureau’s latest analyses of economic and industrial growth, the labor force, and trends in occupa­ tional employment into the 21 st century. An overview article fo­ cuses on important issues raised by these projections.  Bureau of Labor Statistics Regional Offices Boston  1 Congress St., 10th Floor Boston, MA 02114-2023  Phone (617) 565-2327  New York  Room 808, 201 Varick St. New York, NY 10014-4811  Phone (212) 337-2400  Philadelphia  P.O. Box 13309 Philadelphia, PA 19101-3309  Phone (215) 596-1154  Atlanta  1371 Peachtree St. NE. Atlanta, GA 30367-2302  Phone (404) 347-4416  Chicago  9th Floor, Federal Office Bldg. 230 South Dearborn St. Chicago, IL 60604-1595  Phone (312) 353-1880  Dallas  Federal Bldg. 525 Griffin St., Room 221 Dallas, TX 75202-5028  Phone (214) 767-6970  Kansas City  911 Walnut St. Kansas City, MO 64106-2009  Phone (816) 426-2481  San Francisco  71 Stevenson St. P.O. Box 193766 San Francisco, CA 94119-3766  Phone (415) 744-6600
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