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Professional and Related Occupations 301  Art and Design Occupations Artists and Related Workers Significant Points • About 60 percent of artists and related workers are self-employed. • Keen competition is expected for both salaried jobs and freelance work because the arts attract many tal­ ented people with creative ability. • Artists usually develop their skills through a bach­ elor’s degree program or other postsecondary training in art or design. • Earnings for self-employed artists vary widely; some well-established artists earn more than salaried art­ ists, while others find it difficult to rely solely on in­ come earned from selling art.  Nature of the Work Artists create art to communicate ideas, thoughts, or feel­ ings. They use a variety of methods—painting, sculpting, or illustration—and an assortment of materials, including oils, watercolors, acrylics, pastels, pencils, pen and ink, plaster, clay, and computers. Artists’ works may be realistic, stylized, or ab­ stract and may depict objects, people, nature, or events. Artists generally fall into one of four categories. Art directors formulate design concepts and presentation approaches for visual communications. Craft artists create or reproduce hand­ made objects for sale or exhibition. Fine artists, including paint­ ers, sculptors, and illustrators, create original artwork, using a variety of media and techniques. Multimedia artists and anima­ tors create special effects, animation, or other visual images on film, on video, or with computers or other electronic media. (Designers, including graphic designers, are discussed else­ where in the Handbook.) Art directors develop design concepts and review material that is to appear in periodicals, newspapers, and other printed or digital media. They control the overall visual direction of a project in fields such as advertising and publishing. They decide how best to present a concept visually, so that it is organized, eye catching, and appealing. Art directors decide which pho­ tographs or artwork to use and oversee the design, layout, and production of material to be produced. They may direct workers engaged in artwork, design, layout, and copywriting. Craft artists make a wide variety of objects, mostly by hand, that are sold in their own studios, in retail outlets, or at arts-andcrafts shows. Some craft artists display their works in galleries and museums. Craft artists work with many different materials, including ceramics, glass, textiles, wood, metal, and paper, to create unique pieces of art such as pottery, stained glass, quilts, tapestries, lace, candles, and clothing. Many craft artists also use fine-art techniques—for example, painting, sketching, and Digitized printing—to for FRASER add finishing touches to their art. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Fine artists typically display their work in museums, com­ mercial art galleries, corporate collections, and private homes. Some of their artwork may be commissioned (done on request from clients), but most is sold by the artist or through private art galleries or dealers. The gallery and the artist predetermine how much each will earn from the sale. Only the most success­ ful fine artists are able to support themselves solely through the sale of their works. Most fine artists have at least one other job to support their art careers. Some work in museums or art gal­ leries as fine-arts directors or as curators, planning and setting up art exhibits. A few artists work as art critics for newspapers or magazines or as consultants to foundations or institutional collectors. Other artists teach art classes or conduct workshops in schools or in their own studios. Some artists also hold full­ time or part-time jobs unrelated to art and pursue fine art as a hobby or second career. Usually, fine artists specialize in one or two art forms, such as painting, illustrating, sketching, sculpting, printmaking, and restoring. Painters, illustrators, cartoonists, and sketch artists work with two-dimensional art forms, using shading, perspec­ tive, and color to produce realistic scenes or abstractions. Illustrators usually create pictures for books, magazines, and other publications and for commercial products such as tex­ tiles, wrapping paper, stationery, greeting cards, and calendars. Increasingly, illustrators are working in digital format—for example, creating scenery or objects for a video game. This has created new opportunities for illustrators to work with anima­ tors and in broadcast media. Medical and scientific illustrators combine drawing skills with knowledge of biology or other sciences. Medical illustra­ tors work digitally or traditionally to create images of human anatomy and surgical procedures as well as three-dimensional models and animations. Scientific illustrators draw animal and plant life, atomic and molecular structures, and geologic and planetary formations. These illustrations are used in medical and scientific publications and in audiovisual presentations for teaching purposes. Illustrators also work for lawyers, producing exhibits for court cases. Cartoonists draw political, advertising, social, and sports car­ toons. Some cartoonists work with others who create the idea or story and write captions. Some cartoonists write captions them­ selves. Most cartoonists have comic, critical, or dramatic talents in addition to drawing skills. Sketch artists create likenesses of subjects with pencil, charcoal, or pastels. Sketches are used by law enforcement agencies to assist in identifying suspects, by the news media to depict courtroom scenes, and by individual patrons for their own enjoyment. Sculptors design three-dimensional artworks, either by mold­ ing and joining materials such as clay, glass, wire, plastic, fabric, or metal, or by cutting and carving forms from a block of plaster, wood, or stone. Some sculptors combine various ma­ terials to create mixed-media installations. Some incorporate light, sound, and motion into their works.  302 Occupational Outlook Handbook  model objects in three dimensions by computer and work with programmers to make the images move. Work environment. Many artists work in fine art or com­ mercial art studios located in office buildings, warehouses, or lofts. Others work in private studios in their homes. Some fine artists share studio space, where they also may exhibit their work. Studio surroundings usually are well lighted and venti­ lated; however, fine artists may be exposed to fumes from glue, paint, ink, and other materials and to dust or other residue from filings, splattered paint, or spilled cleaners and other fluids. Artists who sit at drafting tables or who use computers for ex­ tended periods may experience back pain, eyestrain, or fatigue. Artists employed by publishing companies, advertising agencies, and design firms generally work a standard work­ week. During busy periods, they may work overtime to meet deadlines. Self-employed artists can set their own hours. They may spend much time and effort selling their artwork to poten­ tial customers or clients and building a reputation.  Training, Other Qualifications, and Advancement  Many artists receive formal training in their specialty. Printmakers create printed images from designs cut or etched into wood, stone, or metal. After creating the design, the art­ ist uses a printing press to roll the image onto paper or fabric. Some make prints by pressing the inked surface onto paper by hand or by graphically encoding and processing data, using a computer. The digitized images can then be printed onto paper. Painting restorers preserve and restore damaged and faded paintings. They apply solvents and cleaning agents to clean the surfaces of the paintings, they reconstruct or retouch damaged areas, and they apply preservatives to protect the paintings. Restoration is highly detailed work and usually is reserved for experts in the field. Multimedia artists and animators work primarily in motion picture and video industries, advertising, and computer systems design services. They draw by hand and use computers to cre­ ate the series of pictures that form the animated images or spe­ cial effects seen in movies, television programs, and computer games. Some draw storyboards for television commercials, movies, and animated features. Storyboards present television commercials in a series of scenes similar to a comic strip and allow an advertising agency to evaluate commercials proposed by advertising companies. Storyboards also serve as guides to placing actors and cameras on the television or motion picture setforand to other production details. Many multimedia artists Digitized FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Art directors usually have years of work experience and gener­ ally need at least a bachelor’s degree. Because of the level of technical expertise demanded, multimedia artists and animators also need a bachelor’s degree. Although formal schooling is not strictly required for craft and fine artists, it is very difficult to become skilled enough to make a living without some training. Education and training. Many colleges and universities offer programs leading to a bachelor’s or master’s degree in fine arts. Courses usually include core subjects such as English, social science, and natural science, in addition to art history and studio art. Independent schools of art and design also offer postsecondary studio training in the craft, fine, and multimedia arts leading to certificates in the specialties or to an associate or bachelor’s degree in fine arts. Typically, these programs focus more intensively on studio work than do the academic programs in a university setting. In 2009 the National Association of Schools of Art and Design accredited approximately 300 post­ secondary institutions with programs in art and design; most of these schools award a degree in art. Art directors usually begin as entry-level artists or designers in advertising, publishing, design, or motion picture production firms. An artist is promoted to art director after having demon­ strated artistic and leadership abilities. Depending on the scope of their responsibilities, some art directors may pursue a degree in art administration or management, which teaches business skills such as project management and finance. Many educational programs in art also provide training in computer techniques. Computers are used widely in the visual arts, and knowledge and training in computer graphics and other visual display software are critical elements of many jobs in these fields. Medical illustrators must have both a demonstrated artistic ability and a detailed knowledge of living organisms, surgical and medical procedures, and human and animal anatomy. A bachelor’s degree combining art and premedical courses usu­ ally is required. However, most medical illustrators also choose to pursue a master’s degree in medical illustration. This degree is offered in four accredited schools in the United States.  Professional and Related Occupations 303  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Artists and related workers............................................. ... 27-1010 221,900 247,700 25,800 12 Art directors.................................................................. ... 27-1011 84,200 94,000 9,800 12 Craft artists......................................................................... ... 27-1012 13,600 14,600 7 1,000 Fine artists, including painters, sculptors, and illustrators......... ... 27-1013 23,600 25,700 9 2,100 Multi-media artists and animators........................................... ... 27-1014 79,000 90,200 14 11,200 Artists and related workers, all other.................................. ... 27-1019 21,500 23,200 1,700 8 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  Occupational Title  soc  Employment, 2008  tion Included in the Handbook.  Those who want to teach fine arts at public elementary or secondary schools usually must have a teaching certificate in addition to a bachelor’s degree. An advanced degree in fine arts or arts administration is usually necessary for management or administrative positions in government or in foundations or for teaching in colleges and universities. (See the statements titled “teachers—postsecondary” and “teachers—kindergarten, elementary, middle, and secondary school” elsewhere in the Handbook.) Other qualifications. Evidence of appropriate talent and skill, displayed in an artist’s portfolio, is an important factor used by art directors, clients, and others in deciding whether to hire an individual or contract for his or her work. A portfolio is a collection of samples of the artist’s best work. Assembling a successful portfolio requires skills usually developed through postsecondary training in art or visual communications. Intern­ ships also provide excellent opportunities for artists to develop and enhance their portfolios. Advancement. Artists hired by firms often start with rela­ tively routine work. While doing this work, however, they may observe other artists and practice their own skills. Craft and fine artists advance professionally as their work cir­ culates and as they establish a reputation for a particular style. Many of the most successful artists continually develop new ideas, and their work often evolves over time. Many artists do freelance work while continuing to hold a full-time job until they are established. Others freelance part time while still in school to develop experience and to build a portfolio of published work. Freelance artists try to develop a set of clients who regularly contract for work. Some freelance artists are widely recognized for their skill in specialties such as cartooning or children’s book illustration. These artists may earn high incomes and can choose the type of work they do.  Employment Artists held about 221,900 jobs in 2008. About 60 percent were self-employed. Employment was distributed as follows: Art directors..................................................................84,200 Multimedia artists and animators.................................79,000 Fine artists, including painters, sculpters and illustrators.......................................................... 23,600 Craft artists....................................................................13,600 and related workers, allother.......................... 21,500 Digitized forArtists FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Of the artists who were not self-employed, many worked for advertising and related services; newspaper, periodical, book, and software publishers; motion picture and video industries; specialized design services; and computer systems design and related services. Some self-employed artists offered their ser­ vices to advertising agencies, design firms, publishing houses, and other businesses.  Job Outlook Employment is projected to grow about as fast as the average. Competition for jobs is expected to be keen for both salaried and freelance jobs in all specialties because the number of peo­ ple with creative ability and an interest in this career is expected to continue to exceed the number of available openings. Despite the competition, employers and individual clients are always on the lookout for talented and creative artists. Employment change. Employment of artists and related workers is expected to grow 12 percent through 2018, about as fast as the average for all occupations. An increasing reliance on artists to create digital or multimedia artwork will drive growth. Art directors will see an increase in jobs in advertising due to demand for the overall vision they bring to a project. How­ ever, declining opportunities in publishing will hold down job growth. With many magazines moving to an online-only for­ mat, art directors are used less in this field. Demand for illustrators who work on a computer will in­ crease as media companies use more detailed images and back­ grounds in their designs. However, illustrators and cartoonists who work in publishing may see job opportunities decline as newspapers continue to cut staffs. Many are instead opting to post their work on political Web sites and online publications. The small number of medical illustrators will also be in greater demand as medical research continues to grow. Demand for multimedia artists and animators will increase as consumers continue to demand more realistic video games, movie and television special effects, and 3D animated movies. Additional job openings will arise from an increasing need for computer graphics in the growing number of mobile technolo­ gies. The demand for animators is also increasing in alterna­ tive areas such as scientific research and design services. Some lower priority animation has been offshored, negatively affect­ ing employment of animators. Job prospects. Competition for jobs as artists and related workers will be keen because there are more qualified candi­ dates than available jobs. Employers in all industries should be able to choose from among the most qualified candidates.  304 Occupational Outlook Handbook  Despite the competition, studios, galleries, and individual cli­ ents are always on the lookout for artists who display outstand­ ing talent, creativity, and style. Among craft and fine artists, talented individuals who have developed a mastery of artistic techniques and skills will have the best job prospects. Multime­ dia artists and animators should have better job opportunities than other artists but still will experience competition. Despite an expanding number of opportunities, art directors should experience keen competition for the available openings. Craft and fine artists work mostly on a freelance or commission basis and may find it difficult to earn a living solely by selling their artwork. Only the most successful craft and fine artists receive major commissions for their work. Competition among artists for the privilege of being shown in galleries is expected to re­ main intense, as will competition for grants from sponsors such as private foundations, State and local arts councils, and the National Endowment for the Arts. Because of their reliance on grants, and because the demand for artwork is dependent on consumers having disposable income, many of these artists will find that their income fluctuates with the overall economy.  Earnings Median annual wages of salaried art directors were $76,980 in May 2008. The middle 50 percent earned between $54,490 and $108,090. The lowest 10 percent earned less than $40,730, and the highest 10 percent earned more than $154,840. Median an­ nual wages were $80,170 in advertising, public relations and related services. Median annual wages of salaried craft artists were $29,080. The middle 50 percent earned between $20,730 and $39,120. The lowest 10 percent earned less than $16,290, and the highest 10 percent earned more than $54,550. Median annual wages of salaried fine artists, including paint­ ers, sculptors, and illustrators, were $42,650. The middle 50 percent earned between $29,230 and $60,650. The lowest 10 percent earned less than $20,780, and the highest 10 percent earned more than $83,410. Median annual wages of salaried multimedia artists and ani­ mators were $56,330. The middle 50 percent earned between $41,710 and $77,010. The lowest 10 percent earned less than $31,570, and the highest 10 percent earned more than $100,390. Median annual wages were $65,600 in motion picture and video industries, and $52,530 in advertising and related services. Earnings for self-employed artists vary widely. Some charge only a nominal fee while they gain experience and build a repu­ tation for their work. Others, such as well-established freelance fine artists and illustrators, can earn more than salaried artists. Many, however, find it difficult to rely solely on income earned from selling paintings or other works of art. Like other selfemployed workers, freelance artists must provide their own benefits.  Jewelers and precious stone and metal workers...................... 770 Photographers........................................................................... 347 Woodworkers........................................................................... 757 Some workers who use computers extensively and may re­ quire art skills are: Computer software engineers and computer programmers.......................................................134 Desktop publishers.................................................................. 579  Sources of Additional Information For general information about art and design and a list of ac­ credited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet:  http ://nasad.arts-accredit.org For information on careers in the craft arts and for a list of schools and workshops, contact: y American Craft Council Library, 72 Spring St., 6th Floor, New York, NY 10012. Internet: http://www.craftcouncil.org For information on careers in illustration, contact: y Society of Illustrators, 128 E. 63rd St., New York, NY 10065. Internet: http://www.societyillustrators.org For information on careers in medical illustration, contact: y Association of Medical Illustrators, P.O. Box 1897 Lawrence, KS 66044. Internet: http://www.ami.org For information on workshops, scholarships, internships, and competitions for art students interested in advertising careers, contact: y Art Directors Club, 106 W. 29th St., New York, NY 10001. Internet: http ://www.adcglobal.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at  http://www.bls.gov/ooh/ocos092.htm  Commercial and Industrial Designers Significant Points • Commercial and industrial designers usually work closely with a range of specialists including engi­ neers, materials scientists, marketing and corporate strategy staff, cost estimators, and accountants. • A bachelor’s degree is usually required for entry. • Keen competition for jobs is expected.  Related Occupations  Nature of the Work  Other workers who apply artistic skills include:  Commercial and industrial designers combine the fields of art, business, and engineering to design the products people use every day. In fact, these designers are responsible for the style, function, quality, and safety of almost every manufactured good. Usually designers specialize in one particular product category, such as automobiles and other transportation vehicles, appli-  Page Archivists, curators, and museum technicians........................ 265 Commercial and industrial designers.......................................304 Fashion designers.....................................................................307 designers..................................................................... 312 DigitizedGraphic for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 305  al  .•.'.'••■Mr*j  »*-  St  Many commercial and industrial designers use computer-aided design software to create new products. ances, technology goods, medical equipment, furniture, toys,  tools and construction equipment, or housewares. The first steps in developing a new design, or altering an existing one, are to determine the requirements of the client, the purpose of the product, and the tastes of customers or us­ ers. When creating a new design, designers often begin by researching the product user or the context in which the product will be used. They ascertain desired product characteristics, such as size, shape, weight, color, materials used, cost, ease of use, fit, and safety. To gather this information, designers meet with clients, conduct market research, read design and con­ sumer publications, attend trade shows, and visit potential us­ ers, suppliers and manufacturers. Next, designers prepare conceptual sketches or diagrams— by hand or with the aid of a computer—to illustrate their vision of the product. After conducting research and consulting with a creative director or other members of the product develop­ ment team, designers then create detailed sketches or render­ ings using computer-aided design (CAD) tools. Computer mod­ els make it easier to adjust designs and to experiment with a greater number of alternatives, speeding and improving the de­ sign process. Industrial designers who work for manufacturing firms also use computer-aided industrial design (CAID) tools to create designs and machine-readable instructions that can direct automated production tools to build the designed product to ex­ specifications. Digitized act for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Designers present the designs and prototypes to their client or managers and incorporate any changes and suggestions. De­ signers often work with engineers, accountants, and cost esti­ mators to determine if a product can be made safer, easier to assemble or use, or cheaper to manufacture. Before a product is completed and manufactured, designers may participate in us­ ability and safety tests, watching consumers use prototypes and then making adjustments based on those observations. Increasingly, designers are working with corporate strategy staff to ensure that their designs fit into the company’s business plan and strategic vision. They work with marketing staff to develop plans to best market new product designs to consumers. They work to design products that accurately reflect the com­ pany’s image and values. And although designers have always tried to identify and design products that fit consumers’ needs, more designers are now focused on creating that product before a competitor does. More of today’s designers must also focus on creating innovative products as well as considering the style and technical aspects of the product. Work environment. Designers employed by manufacturing establishments, large corporations, or design firms generally work regular hours in well-lighted and comfortable settings. Designers in smaller design consulting firms, or those who free­ lance, may work under a contract to do specific tasks or designs. They frequently adjust their workday to suit their clients’ sched­ ules and deadlines, meeting with the clients evenings or week­ ends when necessary. Consultants and self-employed designers tend to work longer hours and in smaller, more congested, envi­ ronments. Additional hours may be required to meet deadlines. Designers may work in their own offices or studios or in cli­ ents’ homes or offices. They also may travel to other locations, such as testing facilities, design centers, clients’ exhibit sites, users’ homes or workplaces, and manufacturing facilities. With the increased speed and sophistication of computers and ad­ vanced communications networks, designers may form interna­ tional design teams and serve a more geographically dispersed clientele.  Training, Other Qualifications, and Advancement A bachelor’s degree is required for most entry-level commercial and industrial design positions. Experience through internships and a good portfolio of work are also important for jobseekers to have. Education and training. A bachelor’s degree in industrial design, architecture, or engineering is required for most entrylevel commercial and industrial design jobs. Coursework in­ cludes principles of design, sketching, computer-aided design, industrial materials and processes, manufacturing methods, and some classes in engineering, physical science, mathematics, psychology, and anthropology. Many programs also include in­ ternships at design or manufacturing firms. Because of the growing emphasis on strategic design and how products fit into a firm’s overall business plan, an increas­ ing number of designers are pursing a master’s degree in busi­ ness administration to gain business skills. The National Association of Schools of Art and Design ac­ credits approximately 300 postsecondary colleges, universities, and private institutes with programs in art and design. About 40  306 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Commercial and industrial designers......................... ...................  soc  Code  Employment, 2008  27-1021  44,300  Projected Employment, 2018 48,300  Change, 2008-2018 Number Percent 4,000 9  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa tion Included in the Handbook.  of these schools award a bachelor’s degree in industrial design. Many schools require the successful completion of 1 year of ba­ sic art and design courses before entry into a bachelor’s degree program. Applicants also may be required to submit sketches and other examples of their artistic ability. Other qualifications. Creativity and technical knowledge are crucial in this occupation. People in this field must have a strong sense of the esthetic—an eye for color and detail and a sense of balance and proportion. Employers expect new de­ signers to know computer-aided design software, but despite the advancement of this software, sketching ability remains im­ portant. Designers must also understand the technical aspects of how products function. The deciding factor in getting a job often is a good portfolio—examples of a person’s best work. Designers must be imaginative and persistent and must be able to communicate their ideas visually, verbally, and in writ­ ing. Because tastes and styles can change quickly, designers need to be well read, open to new ideas and influences, and quick to react to changing trends. Problem-solving skills and the ability to work independently and under pressure also are important traits. People in this field need self-discipline to start projects on their own, to budget their time, and to meet dead­ lines and production schedules. As strategic design becomes more important, employers will seek designers with project management skills and knowledge of accounting, marketing, quality assurance, purchasing, and strategic planning. Good business sense and sales ability are important, especially for those who freelance or run their own business. Advancement. Beginning commercial and industrial de­ signers usually receive on-the-job training and normally need a few years of training before they can advance to higher level positions. Experienced designers in large firms may advance to chief designer, design department head, or other supervi­ sory positions. Some designers leave the occupation to become teachers in design schools or in colleges and universities. Many faculty members continue to consult privately or operate small design studios to complement their classroom activities. Some experienced designers open their own design firms.  Employment Commercial and industrial designers held about 44,300 jobs in 2008. About 30 percent of designers were employed by manu­ facturing firms, 9 percent worked in architectural, engineering and related services and another 8 percent worked for special­ ized design services firms.  Job Outlook Employment is expected to grow about as fast as the average. Keen competition for jobs is expected; those with strong back­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  grounds in engineering and computer-aided design and busi­ ness knowledge will have the best prospects. Employment change. Employment of commercial and in­ dustrial designers is expected to grow 9 percent between 2008 and 2018, as fast as the average for all occupations. Employ­ ment growth will arise from an increase in consumer and busi­ ness demand for new or upgraded products. The continued emphasis on the quality and safety of products, the increasing demand for new products that are easy and comfortable to use, and the development of high-technology products in consumer electronics, medicine, transportation, and other fields will in­ crease the demand for commercial and industrial designers. However, some companies use design firms overseas, espe­ cially for the design of high-technology products. These over­ seas design firms are located closer to their suppliers, which reduces the time it takes to design and sell a product—an im­ portant consideration when technology is changing quickly. This offshoring of design work could continue to slow employ­ ment growth of U.S. commercial and industrial designers. Despite the increase in design work performed overseas, most design jobs, particularly jobs not related to high-technol­ ogy product design, will still remain in the U.S. Design is es­ sential to a firm’s success, and firms will want to retain control over the design process. Job prospects. Competition for jobs will be keen because many talented individuals are attracted to the design field. The best job opportunities will be in specialized design firms which are used by manufacturers to design products or parts of prod­ ucts. Increasingly, manufacturers have been outsourcing design work to these design services firms to cut costs and to find the most qualified design talent, creating more opportunities in these firms. As the demand for design work becomes more consumerdriven, designers who can closely monitor, and react to, chang­ ing customer demands—and who can work with marking and strategic planning staffs to come up with new products—will also improve their job prospects. Employment of designers can be affected by fluctuations in the economy. For example, during periods of economic down­ turns, companies may cut research and development spending, including new product development.  Earnings Median annual wage-and-salary wages for commercial and in­ dustrial designers were $57,350 in May 2008. The middle 50 percent earned between $41,550 and $76,700. The lowest 10 percent earned less than $31,400, and the highest 10 percent earned more than $97,770. Median annual wages of salaried  Professional and Related Occupations 307  commercial and industrial designers in the largest industries that employed them in May 2008 were: Management of companies and enterprises...............$63,940 Architectural, engineering, and related services......... 61,450 Specialized design services.......................................... 59,150 Other miscellaneous manufacturing.............................50,990  Related Occupations Workers in other art and design occupations include: Page Artists and related workers.......................................................301 Fashion designers..................................................................... 307 Floral designers........................................................................ 310 Graphic designers..................................................................... 312 Interior designers...................................................................... 314 Some other occupations that require computer-aided design skills are: Architects, except landscape and naval....................................151 Computer software engineers and computer programmers.................................................. 161 Desktop publishers................................................................... 134 Drafters..................................................................................... 579 Engineers...................................................................................170  Sources of Additional Information For general career information on commercial and industrial design, contact: y Industrial Designers Society of America, 45195 Business Court, Suite 250, Dulles, VA 20166. Internet: http://www.idsa.org For general information about art and design and a list of accredited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasad.arts-accredit.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos290.htm  Fashion Designers Significant Points • The highest numbers of fashion designers were em­ ployed in New York and California. • Employers usually seek designers with a 2-year or 4-year degree who are knowledgeable about textiles, fabrics, ornamentation, and fashion trends. • Keen competition for jobs is expected as many ap­ plicants are attracted to the creativity and glamour as­ sociated with the occupation.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Fashion designers help create the billions of dresses, suits, shoes, and other clothing and accessories purchased every year by consumers. Designers study fashion trends, sketch designs of clothing and accessories, select colors and fab­ rics, and oversee the final production of their designs. Cloth­ ing designers create and help produce men’s, women’s, and children’s apparel, including casual wear, suits, sportswear, formal wear, outerwear, maternity, and intimate apparel. Foot­ wear designers help create and produce different styles of shoes and boots. Accessory designers help create and produce items such as handbags, belts, scarves, hats, hosiery, and eye­ wear, which add the finishing touches to an outfit. (The work of jewelers and precious stone and metal workers is described elsewhere in the Handbook.) Some fashion designers special­ ize in clothing, footwear, or accessory design, but others cre­ ate designs in all three fashion categories. The design process from initial design concept to final production takes between 18 and 24 months. The first step in creating a design is researching current fashion and mak­ ing predictions of future trends. Some designers conduct their own research, while others rely on trend reports published by fashion industry trade groups. Trend reports indicate what styles, colors, and fabrics will be popular for a particular sea­ son in the future. Textile manufacturers use these trend reports to begin designing fabrics and patterns while fashion design­ ers begin to sketch preliminary designs. Designers then visit manufacturers or trade shows to procure samples of fabrics and decide which fabrics to use with which designs. Once designs and fabrics are chosen, a prototype of the ar­ ticle using cheaper materials is created and then tried on a model to see what adjustments to the design need to be made. This also helps designers to narrow their choices of designs to offer for sale. After the final adjustments and selections have been made, samples of the article using the actual materials are sewn and then marketed to clothing retailers. Many de­ signs are shown at fashion and trade shows a few times a year. Retailers at the shows place orders for certain items, which are then manufactured and distributed to stores. Computer-aided design (CAD) is increasingly being used in the fashion design industry. Although most designers initially sketch designs by hand, a growing number also translate these hand sketches to the computer. CAD allows designers to view designs of clothing on virtual models and in various colors and shapes, thus saving time by requiring fewer adjustments of prototypes and samples later. Depending on the size of their design firm and their experi­ ence, fashion designers may have varying levels of involve­ ment in different aspects of design and production. In large design firms, fashion designers often are the lead designers who are responsible for creating the designs, choosing the colors and fabrics, and overseeing technical designers who turn the designs into a final product. They are responsible for creating the prototypes and patterns and work with the manu­ facturers and suppliers during the production stages. Large de­ sign houses also employ their own patternmakers, tailors, and sewers who create the master patterns for the design and sew the prototypes and samples. Designers working in small firms,  308 Occupational Outlook Handbook  SSSflSSSfl  |Mt w m *Nl N\ }M ‘-ft  el «' Ml]  Jin'* M| MIKMlMmujlWWM  )£*** l ^ Ml -?  ICMUAI M  ■  '  '  fW\  -  I14'  ;,. :!i.: i, 4M—IIM.M n\ «mi  -=m  Fashion designers study trends and design clothing and acces­ sories for consumers. or those new to the job, usually perform most of the techni­ cal, patternmaking, and sewing tasks, in addition to designing the clothing. (The work of pattern makers, hand sewers, and tailors is covered in the statement on textile, apparel, and fur­ nishings occupations elsewhere in the Handbook.) Fashion designers working for apparel wholesalers or man­ ufacturers create designs for the mass market. These designs are manufactured in various sizes and colors. A small number of high-fashion (haute couture) designers are self-employed and create custom designs for individual clients, usually at very high prices. Other high-fashion designers sell their de­ signs in their own retail stores or cater to specialty stores or high-fashion department stores. These designers create a mix­ ture of original garments and those that follow established fashion trends. Some fashion designers specialize in costume design for performing arts, motion picture, and television productions. The work of costume designers is similar to other fashion designers. Costume designers, however, perform extensive research on the styles worn during the period in which the performance takes place, or they work with directors to select and create appropriate attire. They make sketches of designs, select fabric and other materials, and oversee the production of the costumes. They also must stay within the costume bud­ get for the particular production item. Work environment. Fashion designers employed by manufacturing establishments, wholesalers, or design firms generally work regular hours in well-lighted and comfortable settings. Designers who freelance generally work on a con­ tract, or by the job. They frequently adjust their workday to suit their clients’ schedules and deadlines, meeting with the clients during evenings or weekends when necessary. Free­ lance designers tend to work longer hours and in smaller, more congested, environments, and are under pressure to please cli­ ents and to find new ones in order to maintain a steady in­ come. Regardless of their work setting, all fashion designers occasionally work long hours to meet production deadlines or prepare for fashion shows.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  The global nature of the fashion business requires constant communication with suppliers, manufacturers, and customers all over the United States and the world. Most fashion design­ ers travel several times a year to trade and fashion shows to learn about the latest fashion trends. Designers also may travel frequently to meet with fabric and materials suppliers and with manufacturers who produce the final apparel products.  Training, Other Qualifications, and Advancement In fashion design, employers usually seek individuals with a 2-year or 4-year degree who are knowledgeable about textiles, fabrics, ornamentation, and fashion trends. Education and training. Fashion designers typically need an associate or a bachelor’s degree in fashion design. Some fashion designers also combine a fashion design degree with a business, marketing, or fashion merchandising degree, especially those who want to run their own business or retail store. Basic coursework includes color, textiles, sewing and tailoring, pattern making, fashion history, computer-aided de­ sign (CAD), and design of different types of clothing such as menswear or footwear. Coursework in human anatomy, math­ ematics, and psychology also is useful. The National Association of Schools of Art and Design ac­ credits approximately 300 postsecondary institutions with programs in art and design. Most of these schools award de­ grees in fashion design. Many schools do not allow formal en­ try into a program until a student has successfully completed basic art and design courses. Applicants usually have to sub­ mit sketches and other examples of their artistic ability. Aspiring fashion designers can learn these necessary skills through internships with design or manufacturing firms. Some designers also gain valuable experience working in retail stores, as personal stylists, or as custom tailors. Such experi­ ence can help designers gain sales and marketing skills while learning what styles and fabrics look good on different people. Designers also can gain exposure to potential employers by entering their designs in student or amateur contests. Because of the global nature of the fashion industry, experience in one of the international fashion centers, such as Milan or Paris, can be useful. Other qualifications. Designers must have a strong sense of the esthetic—an eye for color and detail, a sense of bal­ ance and proportion, and an appreciation for beauty. Fashion designers also need excellent communication and problem­ solving skills. Despite the advancement of computer-aided design, sketching ability remains an important advantage in fashion design. A good portfolio—a collection of a person’s best work—often is the deciding factor in getting a job. In addition to creativity, fashion designers also need to have sewing and patternmaking skills, even if they do not perform these tasks themselves. Designers need to be able to under­ stand these skills so they can give proper instruction in how the garment should be constructed. Fashion designers also need strong sales and presentation skills to persuade clients to purchase their designs. Good teamwork and communication skills also are necessary because increasingly the business requires constant contact with suppliers, manufacturers, and buyers around the world.  Professional and Related Occupations 309  Projections data from the National Employment Matrix Projected Employment, 2018 22,900  Change, 2008-2018 Code Number Percent Fashion designers........................................ ................................. 27-1022 22,700 200 1 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. Occupational Title  Advancement. Beginning fashion designers usually start out as pattern makers or sketching assistants for more expe­ rienced designers before advancing to higher level positions. Experienced designers may advance to chief designer, design department head, or another supervisory position. Some de­ signers may start their own design company, or sell their de­ signs in their own retail stores. A few of the most successful designers can work for high-fashion design houses that offer personalized design services to wealthy clients.  Employment Fashion designers held about 22,700 jobs in 2008. About 31 percent of fashion designers worked for apparel, piece goods, and notions merchant wholesalers; and 13 percent worked for apparel manufacturers. Many others were self employed. Employment of fashion designers tends to be concentrated in regional fashion centers. In 2008, the highest numbers of fash­ ion designers were employed in New York and California.  Job Outlook Little or no change in employment is projected. Competition for jobs is expected to be keen as many applicants are attracted to the creativity and glamour associated with the occupation. Employment change. Employment of fashion designers is projected to grow by 1 percent between 2008 and 2018. Some new jobs will arise from an increasing population demanding more clothing, footwear, and accessories. Demand is increasing for stylish clothing that is affordable, especially among middleincome consumers which will increase the need for fashion designers among apparel wholesalers. However, job opportu­ nities in cut and sew manufacturing will continue to decline as apparel is increasingly manufactured overseas. Employment of fashion designers in this industry will not decline as fast as other occupations because firms are more likely to keep design work in house. Job prospects. Job competition is expected be keen as many applicants are attracted to the creativity and glamour associated with the occupation. The best job opportunities will be in de­ sign firms that design mass-market clothing sold in department stores and retail chain stores, such as apparel wholesale firms. Few employment opportunities are expected in design firms that cater to high-end department stores and specialty boutiques as demand for expensive, high-fashion design declines relative to other luxury goods and services.  Earnings Median annual wages for salaried fashion designers were $61,160 in May 2008. The middle 50 percent earned between $42,150 and $87,120. The lowest 10 percent earned less than $32,150, and the highest 10 percent earned more than $124,780. Median annual wages of salaried fashion design­ ers in the largest industries that employed them in May 2008 Digitized were: for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  Management of companies and enterprises.............. $72,560 Cut and sew apparel manufacturing.............................66,000 Apparel, piece goods, and notions merchant wholesalers...............................................61,600 Specialized design services..........................................59,560 Earnings in fashion design can vary widely based on the em­ ployer and years of experience. Starting salaries in fashion de­ sign tend to be very low until designers are established in this occupation. Salaried fashion designers usually earn higher and more stable incomes than self-employed or freelance designers. However, a few of the most successful self-employed fashion designers may earn many times the salary of the highest paid salaried designers. Self-employed fashion designers must pro­ vide their own benefits and retirement.  Related Occupations Workers in other art and design occupations include: Page Artists and related workers.......................................................301 Commercial and industrial designers...................................... 304 Floral designers........................................................................310 Graphic designers.....................................................................312 Interior designers......................................................................314 Workers who also design wearable accessories are: Jewelers and precious stone and metal workers...................... 770 Other common occupations involved with fashion include: Demonstrators and product promoters.................................... 532 Models...................................................................................... 537 Photographers...........................................................................347 Purchasing managers, buyers, and purchasing agents.............. 79 Retail salespersons...................................................................543 Textile, apparel, and furnishings occupations......................... 753  Sources of Additional Information For general information about art and design and a list of ac­ credited college-level programs, contact: V National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasad.arts-accredit.org For general information about careers in fashion design, con­ tact: > Fashion Group International, 8 West 40th St., 7th Floor, New York, NY 10018. Internet: http://www.fgi.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http ://www.bls.gov/ooh/ocos291 .htm  310 Occupational Outlook Handbook  Floral Designers Significant Points • Despite the projected decline in employment, job op­ portunities should be good as many people leave this occupation, due to relatively low wages and limited advancement opportunities. • Floral design is the only design specialty that does not require formal postsecondary training. • Many floral designers work long hours on weekends and holidays, filling orders and setting up decorations for weddings and other events. Nature of the Work Floral designers, or florists, cut live, dried, or silk flowers and other greenery and arrange them into displays of various sizes and shapes. These workers design displays by selecting flow­ ers, containers, and ribbons and arranging them into bouquets, corsages, centerpieces of tables, wreaths, etc. for weddings, funerals, holidays, and other special occasions. Some floral designers also use accessories such as balloons, candles, toys, candy, and gift baskets as part of their displays. Job duties often vary by employment setting. Most floral de­ signers work in small independent floral shops that specialize in custom orders and also handle large orders for weddings, caterers, or interior designers. Floral designers may meet with customers to discuss the arrangement or work from a written order. They note the occasion, the customer’s preferences, the price of the order, the time the floral display or plant is to be ready, and the place to which it is to be delivered. For spe­ cial occasions, floral designers usually will help set up floral decorations. Floral designers also will prearrange a few dis­ plays to have available for walk-in customers or last-minute orders. Some floral designers also assist interior designers in creating live or silk displays for hotels, restaurants, and private residences. A number of floral designers work in the floral departments of grocery stores or for Internet florists, which specialize in cre­ ating prearranged floral decorations and bouquets. These floral retailers also may fill small custom orders for special occasions and funerals, but most grocery store florists do not deliver to clients or handle large custom orders. Florists who work for wholesale flower distributors assist in the selection of different types of flowers and greenery to pur­ chase and sell to retail florists. Wholesale floral designers also select flowers for displays that they use as examples for retail florists. Self-employed floral designers must handle the various as­ pects of running their own businesses, such as selecting and purchasing flowers, hiring and supervising staff, and maintain­ ing financial records. Self-employed designers also may run gift shops or wedding consultation businesses in addition to provid­ ing floral design services. Some conduct design workshops for amateur gardeners or others with an interest in floral design. Work environment. Most floral designers work in comfort­ able well-lit spaces in retail outlets or at home, although Digitized forand FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  working outdoors sometimes is required. Designers also may make frequent short trips delivering flowers, setting up ar­ rangements for special events, and procuring flowers and other supplies. Floral designers have frequent contact with customers and must work to satisfy their demands, including last-minute holi­ day and funeral orders. Because many flowers are perishable, most orders cannot be completed too far in advance. Conse­ quently, some designers work long hours before and during hol­ idays. Some also work nights and weekends to complete large orders for weddings and other special events. Floral designers may suffer back strain from lifting and carrying heavy flower arrangements. Designers also may suf­ fer allergic reactions to certain types of pollen when working with flowers. In addition, they frequently use sharp objects— scissors, knives, and metal wire—that can cause injuries if handled improperly. However, injuries can be mitigated by fol­ lowing proper procedures.  Training, Other Qualifications, and Advancement Floral design is the only design occupation that does not re­ quire formal postsecondary training; most floral designers learn their skills on the job. Employers generally look for high school graduates who have creativity, a flair for arranging flowers, and a desire to learn. Education and training. Most floral designers have a high school diploma or equivalent and learn their skills on the job over the course of a few months. Although typically not required, some private floral schools, vocational schools, and community colleges award certificates in floral design. These programs generally require a high school diploma for admis­ sion and last from several weeks to 1 year. Floral design courses teach the basics of arranging flowers, including the different types of flowers, their color and texture, cutting and taping tech­ niques, tying bows and ribbons, proper handling and care of flowers, floral trends, and pricing. Some floral designers also can earn an associate or bachelor’s degree at a community college or university. Some programs offer formal degrees in floral design, while others offer degrees in floriculture, horticulture, or ornamental horticulture. In ad­ dition to floral design courses, these programs teach courses in  Most floral designers work in small independent floral shops.  Professional and Related Occupations 311  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Floral designers.......................................... 76,100 74,200 -1,900 -3 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  soc  Employment, 2008  tion Included in the Handbook. botany, chemistry, hydrology, microbiology, pesticides, and soil management. Since many floral designers manage their own business, addi­ tional courses in business, accounting, marketing, and computer technology are helpful. Certification and other qualifications. The American Institute of Floral Designers offers an accreditation examina­ tion as an indication of professional achievement in floral de­ sign. The exam consists of a written part covering floral termi­ nology and an onsite floral-arranging part in which candidates have 4 hours to complete five floral designs: funeral tributes, table arrangements, wedding arrangements, wearable flowers, and a category of the candidate’s choosing. Floral designers must be creative, service oriented, and able to communicate their ideas visually and verbally. Because trends in floral design change fairly quickly, designers must be open to new ideas and react quickly to changing trends. Problem­ solving skills and the ability to work independently and under pressure also are important traits. Individuals in this field need self-discipline to budget their time and meet deadlines. Advancement. Many florists gain their initial experience working as cashiers or delivery people in retail floral stores. The completion of formal design training, however, is an asset for floral designers, particularly those interested in advancing to chief floral designer or in opening their own businesses. Advancement in the floral field is limited. After a few years of on-the-job training, designers can either advance to a super­ visory position or open their own floral shop.  Mass merchandisers like grocery stores offer cheaper and simper flower arrangements, at much greater convenience, than small retail florists do. They have become more appealing when it comes to consumer’s daily needs. Specialty floral retail­ ers will continue to be needed for custom orders but are being steadily replaced when it comes to everyday sales. Job prospects. Job opportunities should be good, because many people leave their jobs, particularly in retail florists, due to comparatively low wages and limited opportunities for ad­ vancement. Opportunities should be good in grocery store and Internet floral shops, as sales of floral arrangements from these outlets grow. Prearranged displays and gifts available in these stores appeal to consumers because of the convenience and be­ cause of prices that are lower than can be found in independent floral shops. As mass marketers capture more of the small flower orders, independent floral shops are increasingly finding themselves under pressure to remain profitable. Many independent shops have added online ordering systems to compete with Internet florists. Others are trying to distinguish their services by spe­ cializing in certain areas of floral design or by combining floral design with event planning and interior design services. Some florists also are adding holiday decorating services in which they will set up decorations for businesses and residences. Discretionary spending on flowers and floral products is highly sensitive to the state of the economy, and during eco­ nomic downturns employment may fall off as floral expendi­ tures decline.  Employment  Earnings  Floral designers held about 76,100 jobs in 2008. About 50 percent of all floral designers worked in florist shops. Another 12 percent worked in the floral departments of grocery stores.  Median annual wages for wage and salary floral designers were $23,230 in May 2008. The middle 50 percent earned between $18,690 and $29,330. The lowest 10 percent earned less than $16,210, and the highest 10 percent earned more than $35,010. Median annual wages were $25,160 in grocery stores and $22,710 in florists.  Job Outlook Despite the decline in employment, job opportunities are ex­ pected to be good as many people leave this occupation because of relatively low wages and limited advancement opportunities. Employment change. Employment of floral designers is ex­ pected to decline slowly, by 3 percent, between 2008 and 2018. The need for floral designers will decline as people purchase fewer elaborate floral decorations for their everyday lives. Even though more people will demand fresh flowers in their homes and offices, as competition from grocery stores lowers the cost of flowers and increases the convenience of buying them, these flower arrangements tend to be simpler than those from tradi­ tional retail florists and, therefore, require fewer designers. On the other hand, this decline may be moderated by the continued demand for floral decorations, due to increases in the number Digitizedand for lavishness FRASER of weddings and other special events. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Related Occupations Other art and design occupations include: Page Artists and related workers................................................... 301 Commercial and industrial designers...................................... 304 Fashion designers..................................................................... 307 Graphic designers.....................................................................312 Interior designers...................................................................... 314 Landscape architects................................................................ 154 Other occupations involved directly with plants and flowers include: Agricultural and food scientists...............................................177 Agricultural workers, other......................................................609  312 Occupational Outlook Handbook  Sources of Additional Information For information about careers in floral design, contact: > American Institute of Floral Designers, 720 Light St., Baltimore, MD 21230. Internet: http://www.aifd.org y Society of American Florists, 1601 Duke St., Alexandria, VA 22314. Internet: http://www.safnow.org To learn more about designing flowers for weddings and funerals, see “Jobs in weddings and funerals: Work­ ing with the betrothed and the bereaved,” in the win­ ter 2006 Occupational Outlook Quarterly and online at http://www.bls.gov/opub/ooq/2006/winter/art03.pdf. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos292.htm  Graphic Designers Significant Points • Employment is expected to grow about as fast as the average, with many new jobs associated with interac­ tive media. • A bachelor’s degree in graphic design is usually required. • Jobseekers are expected to face keen competition; individuals with Web site design and animation expe­ rience will have the best opportunities.  Nature of the Work Graphic designers—or graphic artists—plan, analyze, and create visual solutions to communications problems. They find the most effective way to get messages across in print and electronic media using color, type, illustration, photog­ raphy, animation, and various print and layout techniques. Graphic designers develop the overall layout and production design of magazines, newspapers, journals, corporate reports, and other publications. They also produce promotional dis­ plays, packaging, and marketing brochures for products and services, design distinctive logos for products and businesses, and develop signs and signage systems—called environmen­ tal graphics—for business and government. An increasing number of graphic designers also develop material for Inter­ net Web pages, interactive media, and multimedia projects. Graphic designers also may produce the credits that appear before and after television programs and movies. The first step in developing a new design is to determine the needs of the client, the message the design should portray, and its appeal to customers or users. Graphic designers consider cognitive, cultural, physical, and social factors in planning and executing designs for the target audience. Designers gather relevant information by meeting with clients, creative or art directors, and by performing their own research. Identifying the needs of consumers is becoming increasingly important Digitizedfor for graphic FRASER designers as they continue to develop corporate https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  communication strategies in addition to creating designs and layouts. Graphic designers prepare sketches or layouts—by hand or with the aid of a computer—to illustrate their vision for the design. They select colors, sound, artwork, photography, ani­ mation, style of type, and other visual elements for the design. Designers also select the size and arrangement of the different elements on the page or screen. They may create graphs and charts from data for use in publications, and they often con­ sult with copywriters on any text that accompanies the design. Designers then present the completed design to their clients or art or creative director for approval. In printing and publishing firms, graphic designers also may assist the printers by select­ ing the type of paper and ink for the publication and reviewing the mock-up design for errors before final publication. Graphic designers use specialized computer software pack­ ages to help them create layouts and design elements and to program animated graphics. Graphic designers sometimes supervise assistants who fol­ low instructions to complete parts of the design process. De­ signers who run their own businesses also may devote a con­ siderable time to developing new business contacts, choosing equipment, and performing administrative tasks, such as re­ viewing catalogues and ordering samples. The need for up-todate computer and communications equipment is an ongoing consideration for graphic designers. Work environment. Working conditions and places of employment vary. Graphic designers employed by large ad­ vertising, publishing, or design firms generally work regular hours in well-lighted and comfortable settings. Designers in smaller design consulting firms and those who freelance gen­ erally work on a contract, or job, basis. They frequently adjust their workday to suit their clients’ schedules and deadlines. Consultants and self-employed designers tend to work longer hours and in smaller, more congested, environments. Designers may work in their own offices or studios or in clients’ offices. Designers who are paid by the assignment are under pressure to please existing clients and to find new ones to maintain a steady income. All designers sometimes face frustration when their designs are rejected or when their  Graphic designers must be familiar with computer graphics and design software.  Professional and Related Occupations 313  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 2018 Number Percent Graphic designers....................................... 286,100 323,100 13 36,900 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational  Occupational Title  SOC Code  Employment, 2008  Information Included in the Handbook. work is not as creative as they wish. Graphic designers may work evenings or weekends to meet production schedules, es­ pecially in the printing and publishing industries where dead­ lines are shorter and more frequent.  Training, Other Qualifications, and Advancement A bachelor’s degree in graphic design is usually required. Cre­ ativity, communication, and problem-solving skills are impor­ tant, as are a familiarity with computer graphics and design software. Education and training. A bachelor’s degree in graphic design is usually required for most entry-level and advanced graphic design positions. Bachelor’s degree programs in fine arts or graphic design are offered at many colleges, univer­ sities, and private design schools. Most curriculums include studio art, principles of design, computerized design, com­ mercial graphics production, printing techniques, and Web site design. In addition to design courses, a liberal arts educa­ tion that includes courses in art history, writing, psychology, sociology, foreign languages and cultural studies, marketing, and business are useful in helping designers work effectively. Associate degrees and certificates in graphic design also are available from 2-year and 3-year professional schools, and graduates of these programs normally qualify as assis­ tants to graphic designers or for positions requiring technical skills only. Creative individuals who wish to pursue a career in graphic design—and who already possess a bachelor’s degree in another field—can complete a 2-year or 3-year program in graphic design to learn the technical requirements. The National Association of Schools of Art and Design ac­ credits about 300 postsecondary institutions with programs in art and design. Most of these schools award a degree in graphic design. Many schools do not allow formal entry into a bachelor’s degree program until a student has successfully finished a year of basic art and design courses, which can be completed in high school. Applicants may be required to sub­ mit sketches and other examples of their artistic ability. Graphic designers must keep up with new and updated computer graphics and design software, either on their own or through formal software training programs. Other qualifications. In addition to postsecondary train­ ing in graphic design, creativity, communication, and prob­ lem-solving skills are crucial. Graphic designers must be cre­ ative and able to communicate their ideas visually, verbally, and in writing. They also must have an eye for details. Design­ ers show employers these traits by putting together a portfo­ lio—a collection of examples of a person’s best work. A good portfolio often is the deciding factor in getting a job. Because consumer tastes can change fairly quickly, design­ also need to be well read, open to new ideas and influ­ Digitized ers for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  ences, and quick to react to changing trends. The ability to work independently and under pressure are equally important traits. People in this field need self-discipline to start projects on their own, to budget their time, and to meet deadlines and production schedules. Good business sense and sales ability also are important, especially for those who freelance or run their own firms. Advancement. Beginning graphic designers usually need 1 to 3 years of working experience before they can advance to higher positions. Experienced graphic designers in large firms may advance to chief designer, art or creative director, or other supervisory positions. Some designers leave the occupation to become teachers in design schools or in colleges and universi­ ties. Many faculty members continue to consult privately or operate small design studios to complement their classroom activities. Some experienced designers open their own firms or choose to specialize in one area of graphic design.  Employment Graphic designers held about 286,100 jobs in 2008. Most graphic designers worked in specialized design services; adver­ tising and related services; printing and related support activi­ ties; or newspaper, periodical, book, and directory publishers. A small number of designers produced computer graphics for computer systems design firms. Some designers do freelance work—full time or part time— in addition to holding a salaried job in design or in another occupation.  Job Outlook Employment is expected grow about as fast as average. Keen competition for jobs is expected; individuals with Web site design and animation experience will have the best opportuni­ ties. Employment change. Employment of graphic designers is expected to grow 13 percent, as fast as the average for all occupations from 2008 to 2018, as demand for graphic design continues to increase from advertisers and computer design firms. Moreover, graphic designers with Web site design and ani­ mation experience will especially be needed as demand in­ creases for design projects for interactive media—Web sites, mobile phones, and other technology. Demand for graphic de­ signers also will increase as advertising firms create print and Web marketing and promotional materials for a growing num­ ber of products and services. Growth in Internet advertising, in particular, is expected to increase the number of designers. However, growth may be tempered by reduced demand in the print publishing, where many graphic designers are employed. Job prospects. Graphic designers are expected to face keen competition for available positions. Many talented indi-  314 Occupational Outlook Handbook  Sources of Additional Information  viduals are attracted to careers as graphic designers. Individu­ als with Web site design and animation experience will have the best opportunities. Graphic designers with a broad liberal arts education and experience in marketing and business management will be best suited for positions developing communication strategies.  For general information about art and design and a list of ac­ credited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190-5248. Internet: http://nasad.arts-accredit.org  Earnings  For information about various design careers, contact: y American Institute of Graphic Arts, 164 Fifth Ave., New York, NY 10010. Internet: http://www.aiga.org  Median annual wages for graphic designers were $42,400 in May 2008. The middle 50 percent earned between $32,600 and $56,620. The lowest 10 percent earned less than $26,110, and the highest 10 percent earned more than $74,660. May 2008 median annual wages in the industries employing the largest numbers of graphic designers were: Computer systems design and related services....... $47,860 Specialized design services.........................................45,870 Advertising, public relations and related services..... 43,540 Newspaper, periodical, book, and directory publishers....................................................... 36,910  For information on workshops, scholarships, internships, and competitions for graphic design students interested in advertis­ ing careers, contact: > Art Directors Club, 106 West 29th St., New York, NY 10001. Internet: http://www.adcglobal.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos090.htm  Printing and related support activities........................ 36,100 According to the American Institute of Graphic Arts, me­ dian annual cash compensation for entry-level designers was $35,000 in 2008. Staff-level graphic designers earned a me­ dian of $45,000. Senior designers, who may supervise junior staff or have some decision-making authority that reflects their knowledge of graphic design, earned a median of $60,000. Solo designers who freelanced or worked under contract to another company reported median earnings of $57,000. De­ sign directors, the creative heads of design firms or in-house corporate design departments, earned $95,000. Graphic de­ signers with ownership or partnership interests in a firm or who were principals of the firm in some other capacity earned $95,000.  Related Occupations Workers in other occupations in the art and design field include: Page Artists and related workers....................................................... 301 Commercial and industrial designers.......................................304 Fashion designers..................................................................... 307 Floral designers........................................................................ 310 Interior designers...................................................................... 314 Other occupations that require computer-aided design skills include: Computer software engineers and computer programmers........................................................ 134 Desktop publishers................................................................... 579 Drafters..................................................................................... 170 Other occupations involved in the design, layout, and copy of publications include: Advertising, marketing, promotions, public relations, and sales managers..................................... 32 Authors, writers, and editors....................................................333 Photographers........................................................................... 347 technicians and workers.............................................748 DigitizedPrepress for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Interior Designers Significant Points • Keen competition is expected for jobs because many talented individuals are attracted to this occupation. • Self employment is common; many interior designers work in small firms or on a contract basis. • Postsecondary education—either an associate or a bachelor’s degree—is necessary for entry-level positions; some States license interior designers. Nature of the Work Interior designers draw upon many disciplines to enhance the function, safety, and aesthetics of interior spaces. Their main concerns are with how different colors, textures, furniture, light­ ing, and space work together to meet the needs of a building’s occupants. Designers plan interior spaces of almost every type of building, including offices, airport terminals, theaters, shop­ ping malls, restaurants, hotels, schools, hospitals, and private residences. Good design can boost office productivity, increase sales, attract a more affluent clientele, provide a more relaxing hospital stay, or increase a building’s market value. Traditionally, most interior designers focused on decorat­ ing—choosing a style and color palette and then selecting ap­ propriate furniture, floor and window coverings, artwork, and lighting. However, an increasing number of designers are be­ coming involved in architectural detailing, such as crown mold­ ing and built-in bookshelves, and in planning layouts of build­ ings undergoing renovation, including helping to determine the location of windows, stairways, escalators, and walkways. Interior designers must be able to read blueprints, understand building and fire codes, and know how to make space accessible to people who are disabled. Designers frequently collaborate with architects, electricians, and building contractors to ensure that designs are safe and meet construction requirements.  Professional and Related Occupations 315 .  An increasing number of interior designers are involved with architectural detailing. Whatever space they are working on, almost all designers fol­ low the same process. The first step, known as programming, is to determine the client’s needs and wishes. The designer usually meets face-to-face with the client to find out how the space will be used and to get an idea of the client’s preferences and budget. For example, the designer might inquire about a family’s cook­ ing habits if the family is remodeling a kitchen or ask about a store or restaurant’s target customer to pick an appropriate motif. The designer also will visit the space to take inventory of existing furniture and equipment and identify positive attributes of the space and potential problems. After collecting this information, the designer formulates a design plan and estimates costs. Today, designs often are cre­ ated with the use of computer-aided design (CAD) software, which provides more detail and easier corrections than sketches made by hand. Upon completing the design plan, the designer will present it to the client and make revisions based on the cli­ ent’s input. When the design concept is finalized, the designer will be­ gin specifying the materials, finishes, and furnishings required, such as furniture, lighting, flooring, wall covering, and artwork. Depending on the complexity of the project, the designer also might submit drawings for approval by a construction inspec­ tor to ensure that the design meets building codes. If a project requires structural work, the designer works with an architect or engineer for that part of the project. Most designs also require the hiring of contractors to do technical work, such as lighting, plumbing, and electrical wiring. Often designers choose con­ tractors and write work contracts. Finally, the designer develops a timeline for the project, co­ ordinates contractor work schedules, and makes sure work is completed on time. The designer oversees the installation of the design elements, and after the project is complete, the designer, together with the client, pay follow-up visits to the building site to ensure that the client is satisfied. If the client is not satisfied, the designer makes corrections. Designers who work for furniture or home and garden stores sell merchandise in addition to offering design services. In-store designers provide services, such as selecting a style and color scheme that fits the client’s needs or finding suitable accessories Digitizedand for lighting, FRASER similar to those offered by other interior designers. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  However, in-store designers rarely visit clients’ spaces and use only a particular store’s products or catalogs. Interior designers sometimes supervise assistants who carry out their plans and perform administrative tasks, such as re­ viewing catalogues and ordering samples. Designers who run their own businesses also may devote considerable time to developing new business contacts, examining equipment and space needs, and attending to business matters. Although most interior designers do many kinds of projects, some specialize in one area of interior design. Some special­ ize in the type of building space—usually residential or com­ mercial—while others specialize in a certain design element or type of client, such as healthcare facilities. The most common specialties of this kind are lighting, kitchen and bath, and closet designs. However, designers can specialize in almost any area of design, including acoustics and noise abatement, security, electronics and home theaters, home spas, and indoor gardens. Three areas of design that are becoming increasingly popu­ lar are ergonomic design, elder design, and environmental— or green—design. Ergonomic design involves designing work spaces and furniture that emphasize good posture and minimize muscle strain on the body. Elder design involves planning inte­ rior space to aid in the movement of people who are elderly and disabled. Green design involves selecting furniture and carpets that are free of chemicals and hypoallergenic and selecting con­ struction materials that are energy-efficient or are made from renewable resources. Work environment. Working conditions and places of employment vary. Interior designers employed by large corporations or design firms generally work regular hours in well-lighted and comfortable settings. Designers in smaller de­ sign consulting firms or those who freelance generally work on a contract, or job, basis. They frequently adjust their workday to suit their clients’ schedules and deadlines, meeting with clients during evening or weekend hours when necessary. Consultants and self-employed designers tend to work longer hours and in smaller, more congested environments. Interior designers may work under stress to meet deadlines, stay on budget, and please clients. Self-employed designers also are under pressure to find new clients to maintain a steady income. Designers may work in their own offices or studios or in cli­ ents’ homes or offices. They also may travel to other locations, such as showrooms, design centers, clients’ exhibit sites, and manufacturing facilities. With the increased speed and sophis­ tication of computers and advanced communications networks, designers may form international design teams, serve a more geographically dispersed clientele, research design alternatives by using information on the Internet, and purchase supplies electronically.  Training, Other Qualifications, and Advancement An associate or bachelor’s degree is needed for entry-level posi­ tions in interior design. Some States license interior designers. Education and training. Postsecondary education is nec­ essary for entry-level positions in interior design. Training programs are available from professional design schools or from colleges and universities and usually take 2 to 4 years to  316 Occupational Outlook Handbook  complete. Graduates of 2-year or 3-year programs are awarded certificates or associate degrees in interior design and normally qualify as assistants to interior designers upon graduation. Graduates with a bachelor’s degree usually qualify for a formal design apprenticeship program. The National Association of Schools of Art and Design ac­ credits approximately 300 postsecondary institutions with pro­ grams in art and design. Most of these schools award a degree in interior design. Applicants may be required to submit sketches and other examples of their artistic ability. Basic coursework in­ cludes CAD, drawing, perspective, spatial planning, color and fabrics, furniture design, architecture, ergonomics, ethics, and psychology. The Council for Interior Design Accreditation also accredits interior design programs that lead to a bachelor’s or master’s degree. In 2008, there were over 150 accredited programs in interior design in the United States; most are part of schools or departments of art, architecture, and home economics. After the completion of formal training, interior designers can enter a 1-year to 3-year apprenticeship to gain experience before working on their own. Most apprentices work in design or architecture firms under the supervision of an experienced designer. Apprentices also may choose to gain experience working as an in-store designer in furniture stores. The National Council for Interior Design Qualification offers the Interior Design Experience Program, which helps entry-level interior designers gain valuable work experience by supervising their work and offering mentoring services to new designers. Licensure. A number of States register or license interior designers. The National Council for Interior Design Qualifica­ tion administers the licensing exam for interior design qualifica­ tion. To be eligible to take the exam, applicants must have at least 6 years of combined education and experience in interior de­ sign, of which at least 2 years must be postsecondary education. Once candidates have passed the qualifying exam, they are granted the title of Certified, Registered, or Licensed Interior Designer, depending on the State. Continuing education is often required to maintain licensure. Other qualifications. Employers increasingly prefer in­ terior designers who are familiar with computer-aided design software and the basics of architecture and engineering to en­ sure that their designs meet building safety codes. In addition to possessing technical knowledge, interior de­ signers must be creative, imaginative, and persistent and must be able to communicate their ideas visually, verbally, and in writing. Because tastes in style can change fairly quickly, designers need to be well read, open to new ideas and influ­ ences, and quick to react to changing trends. Problem-solving skills and the ability to work independently and under pressure are additional important traits. People in this field need self­ discipline to start projects on their own, to budget their time,  and to meet deadlines and production schedules. Good business sense and sales ability also are important, especially for those who freelance or run their own business. Certification and advancement. Optional certifications in residential kitchen and bath design are available from the Na­ tional Kitchen and Bath Association. The association offers several different levels of certification for kitchen and bath designers, each achieved through training seminars and certi­ fication exams. Beginning interior designers receive on-the-job training and normally need 1 to 3 years of training before they can advance to higher level positions. Experienced designers in large firms may advance to chief designer, design department head, or some other supervisory position. Some experienced designers open their own firms or decide to specialize in one aspect of interior design. Other designers leave the occupation to become teachers in schools of design or in colleges and universities. Many faculty members continue to consult privately or operate small design studios to complement their classroom activities.  Employment Interior designers held about 71,700 jobs in 2008. About 30 percent of interior designers worked in specialized design ser­ vices. Additionally, 14 percent of interior designers provided design services in architectural and landscape architectural ser­ vices and 9 percent worked in furniture and home-furnishing stores. Many interior designers also performed freelance work in addition to holding a salaried job in interior design or another occupation. Job Outlook Employment is expected to grow faster than average; however, keen competition for jobs is expected. Employment change. Employment of interior designers is expected to grow 19 percent from 2008 to 2018, faster than the average for all occupations. An increasing interest in interior design and awareness of its benefits will increase demand for designers. As businesses realize the improvements that can be made to worker and customer satisfaction through good design, they will use interior designers to redesign their offices and stores. Homeowners are increasingly using the services of interior designers when they plan new additions, remodel aging kitch­ ens and bathrooms, and update the general decor of their home. Many homeowners also have requested design help in creating year-round outdoor living spaces and home theater systems. Demand for interior design services from the healthcare in­ dustry is expected to be high because of an anticipated increase in demand for facilities that will accommodate the aging popu­ lation. Designers will be needed to make these facilities as com­ fortable and homelike as possible for patients. There will also  Projections data from the National Employment Matrix Occupational Title  soc  Code  Employment, 2008  Projected Employment, 2018 85,600  Change, 2008-2018 Number Percent 13,900 19  71,700 27-1025 Interior designers................................................................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 317  be demand from businesses in the hospitality industry—hotels, resorts, and restaurants—where good design work can help at­ tract more business. Some interior designers choose to specialize in one design element to create a niche for themselves in an increasingly competitive market. The demand for kitchen and bath design is growing in response to the growing demand for home remodel­ ing. Designs using the latest technology in, for example, home theaters, state-of-the-art conference facilities, and security sys­ tems are expected to be especially popular. In addition, demand for home spas, indoor gardens, and outdoor living space should continue to increase. Extensive knowledge of ergonomics and green design are ex­ pected to be in demand. Ergonomic design has gained in popu­ larity with the growth in the elderly population and workplace safety requirements. The public’s growing awareness of envi­ ronmental quality and the growing number of individuals with allergies and asthma are expected to increase the demand for green design. Job prospects. Interior designers are expected to face keen competition for available positions because many talented in­ dividuals are attracted to this profession. Individuals with little or no formal training in interior design, as well as those lack­ ing creativity and perseverance, will find it very difficult to establish and maintain a career in this occupation. Designers with formal training or experience in green or energy efficientdesign in particular are expected to have better job prospects due to increased interest in this area. As the economy grows, more private businesses and consum­ ers will request the services of interior designers. However, design services are considered a luxury expense and may be subject to fluctuations in the economy. For example, decreases in consumer and business income and spending caused by a slow economy can have a detrimental effect on employment of interior designers.  Earnings Median annual wages for interior designers were $44,950 in May 2008. The middle 50 percent earned between $34,620 and $61,880. The lowest 10 percent earned less than $27,230, and the highest 10 percent earned more than $82,750. Median annual wages in the industries employing the largest numbers of interior designers in May 2008 were: Architectural, engineering, and related services.......$49,290 Specialized design services.......................................... 45,470 Furniture stores............................................................. 41,080 Building material and supplies dealers...................... 40,040 Interior design salaries vary widely with the specialty, type of employer, number of years of experience, and reputation of the individuals. Among salaried interior designers, those in large specialized design and architectural firms tend to earn higher and more stable salaries. Interior designers working in retail stores usually earn a commission, which can be irregular. For residential design projects, self-employed interior design­ ers and those working in smaller firms usually earn a per-hour  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  consulting fee, plus a percentage of the total cost of furniture, lighting, artwork, and other design elements. For commercial projects, they might charge a per-hour consulting fee, charge by the square footage, or charge a flat fee for the whole project. Also, designers who use specialty contractors usually earn a percentage of the contractor’s earnings on the project in return for hiring the contractor. Self-employed designers must provide their own benefits.  Related Occupations Workers in other occupations who design or arrange objects to enhance their appearance and function include: Page Architects, except landscape and naval....................................151 Artists and related workers.......................................................301 Commercial and industrial designers...................................... 304 Fashion designers.....................................................................307 Floral designers........................................................................310 Graphic designers.....................................................................312 Landscape architects................................................................ 154  Sources of Additional Information For information on degrees, continuing education, and licen­ sure programs in interior design and interior design research, contact: V American Society of Interior Designers, 608 Massachusetts Ave. NE„ Washington, DC 20002. Internet: http://www.asid.org For a list of schools with accredited bachelor’s degree pro­ grams in interior design, contact: > Council for Interior Design Accreditation, 206 Granville Ave, Suite 350, Grand Rapids, MI 49503. Internet: http ://www.accredit-id.org For general information about art and design and a list of accredited college-level programs, contact: y National Association of Schools of Art and Design, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasad.arts-accredit.org For information on State licensing requirements and exams, and the Interior Design Experience Program, contact: y National Council for Interior Design Qualification, 1602 L St. NW„ Suite 200, Washington, DC 20036. Internet: http ://www.ncidq.org For information on careers, continuing education, and certi­ fication programs in the interior design specialty of residential kitchen and bath design, contact: > National Kitchen and Bath Association, 687 Willow Grove St., Hackettstown, NJ 07840. Internet: http://www.nkba.org/student The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos293.htm  318 Occupational Outlook Handbook  Entertainers and Performers, Sports and Related Occupations Actors, Producers, and Directors Significant Points • Actors endure long periods of unemployment, in­ tense competition for roles, and frequent rejections in auditions. • Formal training through a university or acting con­ servatory is typical; however, many actors, producers, and directors find work on the basis of their experi­ ence and talent alone. • Because earnings may be erratic, many actors, pro­ ducers, and directors supplement their incomes by holding jobs in other fields. Nature of the Work Actors, producers, and directors express ideas and create images in theater, film, radio, television, and other performing arts media. They interpret a writer’s script to entertain, inform, or instruct an audience. Although many actors, producers, and directors work in New York or Los Angeles, far more work in other places. They perform, direct, and produce in local or regional television stu­ dios, theaters, or film production companies, often creating adver­ tising or training films or small-scale independent movies. Actors perform in stage, radio, television, video, or motion picture productions. They also work in cabarets, nightclubs, and theme parks. Actors portray characters, and, for more complex roles, they research their character’s traits and circumstances so that they can better understand a script. Most actors struggle to find steady work and only a few achieve recognition as stars. Others work as “extras,” with no lines to deliver. Some actors do voiceover and narration work for advertisements, animated features, books on tape, and other electronic media. They also teach in high school or university drama departments, acting conservatories, or public programs. Producers are entrepreneurs who make the business and fi­ nancial decisions involving a motion picture, television show, or stage production. They select scripts, approve the develop­ ment of ideas, arrange financing, and determine the size and cost of the endeavor. Producers hire or approve directors, prin­ cipal cast members, and key production staff members. Large productions often have associate, assistant, or line pro­ ducers who share responsibilities. The number of producers and their specific job duties vary with the size and budget of each production; however, all work is done under the overall direc­ tion of an executive producer. Together the producers coordi­ nate the activities of writers, directors, managers, and agents to ensure that each project stays on schedule and within budget. Directors are responsible for the overall creative decisions of a production. They interpret scripts, audition and select cast members, conduct rehearsals, and direct the work of cast and  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  crew. They approve the design elements of a production, in­ cluding the sets, costumes, choreography, and music. As with producers, large productions often have many levels of direc­ tors working on them. Assistant directors cue the performers and technicians, telling them when to make entrances or light, sound, or set changes. All directors must ultimately answer to the executive producer, who has the final say on all factors re­ lated to the production. Work environment. Actors, producers, and directors work under constant pressure. Many face stress from the continual need to find their next job. To succeed, actors, producers, and directors need patience and commitment to their craft. Actors strive to deliver flawless performances, often while working under undesirable and unpleasant conditions. Producers and directors organize rehearsals and meet with writers, designers, financial backers, and production technicians. They experience stress not only from these activities, but also from the need to adhere to budgets, union work rules, and production schedules. Work assignments typically are short term—ranging from 1 day to a few months—which means that workers frequently experience long periods of unemployment between jobs. The uncertain nature of the work results in unpredictable earnings and intense competition for jobs. Often, actors, producers, and directors must hold other jobs in order to sustain a living. Work hours are often long and irregular—evening and weekend work is a regular part of life in the performing arts. Actors, pro­ ducers, and directors who work in theater may travel with a tour­ ing show across the country, whereas those who work in film may work on location, sometimes under adverse weather conditions. Actors who perform in a television series often appear on camera with little preparation time, because scripts tend to be revised fre­ quently or even written moments before taping. Those who appear live or before a studio audience must be able to handle impromptu situations and calmly ad lib, or substitute, lines when necessary.  mm •  Actors, producers, and directors often work long, irregular hours.  Professional and Related Occupations 319  Actors should be in good physical condition and have the necessary stamina and coordination to move about theater stages and large movie and television studio lots. They also need to maneuver about complex technical sets while staying in character and projecting their voices audibly. Actors must be fit to endure heat from stage or studio lights and the weight of heavy costumes. Producers and directors ensure the safety of actors by conducting extra rehearsals on the set so that the actors can learn the layout of set pieces and props, by allow­ ing time for warm-ups and stretching exercises to guard against physical and vocal injuries, and by providing an adequate num­ ber of breaks to prevent heat exhaustion and dehydration.  Training, Other Qualifications, and Advancement People who become actors, producers, and directors follow many paths to employment. The most important qualities em­ ployers look for are creative instincts, innate talent, and the intellectual capacity to perform. The best way to prepare for a career as an actor, especially in the theater, is through formal dramatic training, preferably obtained as part of a bachelor’s degree program. Producers and especially directors need ex­ perience in the field, either as actors or in other related jobs. Education and training. Formal dramatic training, ei­ ther through an acting conservatory or a university program, generally is necessary for these jobs, but some people suc­ cessfully enter the field without it. Most people studying for a bachelor’s degree take courses in radio and television broad­ casting, communications, film, theater, drama, or dramatic lit­ erature. Many stage actors continue their academic training and receive a Master of Fine Arts (MFA) degree. Advanced curricula may include courses in stage speech and movement, directing, playwriting, and design, as well as intensive acting workshops. The National Association of Schools of Theatre accredits over 150 programs in theater arts. Most aspiring actors participate in high school and college plays, work at college radio or television stations, or perform with local community theater groups. Local and regional the­ ater experience may also help many young actors hone their skills. In television and film, actors and directors typically start in smaller roles or independent movie production com­ panies and then work their way up to larger productions. Ac­ tors, regardless of their level of experience, may pursue work­ shop training through acting conservatories or mentoring by a drama coach. There are no specific training requirements for producers. They come from many different backgrounds. Actors, writ­ ers, film editors, and business managers commonly enter the field. Producers often start in a theatrical management office, working for a press agent, managing director, or business manager. Some start in a performing arts union or service or­ ganization. Others work behind the scenes with successful di­ rectors, serve on the boards of art companies, or promote their own projects. Although there are no formal training programs for producers, a number of colleges and universities offer de­ gree programs in arts management and in managing nonprofit Digitizedorganizations. for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Some directors have experience as actors or writers, while others gain experience in the field by assisting established directors. Many also have formal training in directing. Other qualifications. Actors need talent and creativity that will enable them to portray different characters. Because competition for parts is fierce, versatility and a wide range of related performance skills, such as singing, dancing, skating, juggling, acrobatics, or miming are especially useful. Actors must have poise, stage presence, the ability to affect an audience, and the ability to follow direction. Modeling experience also may be helpful. Physical appearance, such as having certain features and being the specified size and weight, often is a deciding factor in who gets a particular role. Some actors begin as movie extras. To become an extra, one usually must be listed by casting agencies that supply ex­ tras to the major movie studios in Hollywood. Applicants are accepted only when the number of people of a particular type on the list—for example, athletic young women, old men, or small children—falls below what is needed. In recent years, only a very small proportion of applicants have succeeded in being listed. Like actors, directors and producers need talent and creativity. Directors need management ability because they are often in charge of a large number of people in a produc­ tion. Producers need business acumen. Advancement. As the reputations and box-office draw of actors, producers, and directors grow, some of them work on bigger budget productions, on network or syndicated broadcasts, in more prestigious theaters, or in larger markets. Actors may advance to lead roles and receive star billing. A few actors move into acting-related jobs, becoming drama coaches, directors, or producers. Some actors teach drama pri­ vately or in colleges and universities.  Employment In May 2008, actors, producers, and directors held about 155,100 jobs, primarily in the motion picture and video, performing arts, and broadcast industries. This statistic does not capture large number of actors, producers, and directors who were available for work but were between jobs during the month in which data were collected. About 21 percent of ac­ tors, producers, and directors were self-employed. Employment in motion pictures and in films for television is centered in New York and Los Angeles. However, small stu­ dios exist throughout the country. Many films are shot on loca­ tion and may employ local professional and nonprofessional actors. In television, opportunities are concentrated in the net­ work centers of New York and Los Angeles, but cable televi­ sion services and local television stations around the country also employ many actors, producers, and directors. Employment in the theater, and in other performing arts companies, is cyclical—higher in the fall and spring sea­ sons—and concentrated in New York and other major cities with large commercial houses for musicals and touring pro­ ductions. Also, many cities support established professional regional theaters that operate on a seasonal or year-round ba­ sis.  320 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 16,900 172,000 11 155,100 27-2010 Actors, producers, and directors.......................................................... 13 7,200 63,700 27-2011 56,500 Actors.................................................................................................. 9,700 108,300 10 98,600 27-2012 Producers and directors..................................................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  soc  Employment, 2008  tion Included in the Handbook.  Actors, producers, and directors may find work in summer festivals, on cruise lines, and in theme parks. Many smaller, nonprofit professional companies, such as repertory companies, dinner theaters, and theaters affiliated with drama schools, acting conservatories, and universities, pro­ vide employment opportunities for local amateur talent and professional entertainers. Auditions typically are held in New York for many productions across the country and for shows that go on the road. Job Outlook Employment is expected to grow as fast as the average for all occupations. Competition for jobs will be keen. Although a growing number of people aspire to enter these professions, many will leave the field early because the work—when it is available—is hard, the hours are long, and the pay is often low. Employment change. Employment in these occupations is expected to grow 11 percent during the 2008-18 decade, about as fast as the average for all occupations. Expanding cable and satellite television operations and increasing box-office receipts of major studio and independent films will increase the need for workers. Additionally, a rising demand for U.S. films in other countries should create more employment opportunities for actors, producers, and directors. Also fueling job growth is the continued development of interactive media, online movies, and mobile content produced for cell phones or other portable electronic devices. Attendance at live theater performances should continue to be steady, and drive employ­ ment of stage actors, producers and directors. However, sta­ tion consolidation may restrict employment opportunities in the broadcasting industry for producers and directors. Job prospects. Competition for acting jobs is intense, as the number of actors auditioning for roles greatly exceeds the number of parts that become available. Only performers with the most stamina and talent will find regular employment. Venues for live entertainment, such as theaters, touring pro­ ductions, and repertory theaters in many major metropolitan areas, as well as theme parks and resorts, are expected to offer many job opportunities. However, prospects in these venues are variable because they fluctuate with economic conditions.  Earnings Many of the most successful actors, producers, and directors have extraordinarily high earnings, but many more of these professionals, faced with erratic earnings, supplement their income by holding jobs in other fields. Median hourly wages of actors were $16.59 in May 2008. The Digitized for middle FRASER50 percent earned between $9.81 and $29.57. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Median hourly wages were $14.48 in performing arts com­ panies and $28.72 in the motion picture and video industry. Annual wage data for actors were not available because of the wide variation in the number of hours worked by actors and the short-term nature of many jobs, which may last for 1 day or 1 week; it is extremely rare for actors to have guaranteed employment that exceeds 3 to 6 months. Median annual wages of producers and directors were $64,430 in 2008. The middle 50 percent earned between $41,890 and $105,070. Median annual wages were $85,940 in the motion picture and video industry and $55,380 in radio and television broadcasting. Minimum salaries, hours of work, and other conditions of employment are often covered in collective bargaining agreements between the producers and the unions representing workers. While these unions generally determine minimum salaries, any actor or director may negotiate for a salary higher than the minimum. A joint agreement between the Screen Actors Guild (SAG) and the American Federation of Television and Radio Artists (AFTRA) guarantees all unionized motion picture and televi­ sion actors with speaking parts a minimum daily rate of $782 or $2,713 for a 5-day week as of June 2009. Actors also re­ ceive contributions to their health and pension plans and ad­ ditional compensation for reruns and foreign telecasts of the productions in which they appear. Some well-known actors earn well above the minimum; their salaries are many times the figures cited here, creating the false impression that all actors are highly paid. For exam­ ple, of the nearly 100,000 SAG members, only about 50 might fall into this category. The average income that SAG members earn from acting is low because employment is sporadic and most actors must supplement their incomes by holding jobs in other occupations. Actors Equity Association (AEA), which represents stage actors, has negotiated minimum weekly salary requirements for their members. Salaries vary depending on the theater or venue the actor is employed in. Many stage directors be­ long to the Society of Stage Directors and Choreographers (SSDC), and most film and television directors belong to the Directors Guild of America. Earnings of stage directors vary greatly. The SSDC usually negotiates salary contracts which include royalties (additional income based on the number of performances) with smaller theaters. Regional theaters may hire directors for longer periods, increasing compensation ac­ cordingly. The highest paid directors work on Broadway; in addition to their contract fee, they also receive payment in the form of royalties—a negotiated percentage of gross box-office  Professional and Related Occupations 321  receipts—that can exceed the contract fee for long-running box-office successes. Stage producers seldom receive a set fee; instead, they get a percentage of a show’s earnings or ticket sales.  Related Occupations Other performing artists who may need acting skills include: Page Announcers.............................................................................. 331 Dancers and choreographers....................................................325 Musicians, singers, and related workers................................. 328 Others whose jobs are related to film and theater include: Fashion designers..................................................................... 307 Makeup artists, theatrical and performance............................ 526 Set and exhibit designers.......................................................... 825 Producers share many responsibilities with: Top executives............................................................................ 83  Sources of Additional Information For general information about theater arts and a list of accred­ ited college-level programs, contact: y National Association of Schools of Theater, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nast.arts-accredit.org For general information on actors, producers, and directors, contact the following organizations: y Actors’ Equity Association, 165 West 46th St., New York, NY 10036. Internet: http://www.actorsequity.org > Screen Actors Guild, 5757 Wilshire Blvd. 7th floor, Los Angeles, CA 90036-3600. Internet: http://www.sag.org y Producers Guild of America. Internet: http ://www.producersgui!d.org The Occupational Information Network (0**NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos093.htm  Athletes, Coaches, Umpires, and Related Workers Significant Points • These jobs require immense overall knowledge of the game, usually acquired through years of experience at lower levels. • Career-ending injuries are always a risk for athletes. • Job opportunities will be best for part-time coaches, sports instructors, umpires, referees, and sports of­ ficials in high schools, sports clubs, and other set­ tings. • Aspiring professional athletes will continue to face keen competition. Digitized for extremely FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Few people who dream of becoming paid professional athletes, coaches, or sports officials beat the odds and make a full-time living from professional athletics. Professional athletes often have short careers with little job security. Even though the chances of employment as a professional athlete are slim, there are many opportunities for at least a part-time job as a coach, instructor, referee, or umpire in amateur athletics or in high school, college, or university sports. Athletes and sports competitors compete in organized, offici­ ated sports events to entertain spectators. When playing a game, athletes are required to understand the strategies of their game while obeying the rules and regulations of the sport. The events in which they compete include both team sports, such as base­ ball, basketball, football, hockey, and soccer, and individual sports, such as golf, tennis, and bowling. The level of play var­ ies from unpaid high school athletics to professional sports, in which the best from around the world compete in events broad­ cast on international television. Being an athlete involves more than competing in athletic events. Athletes spend many hours each day practicing skills and improving teamwork under the guidance of a coach or a sports instructor. They view videotapes to critique their own performances and techniques and to learn their opponents’ ten­ dencies and weaknesses to gain a competitive advantage. Some athletes work regularly with strength trainers to gain muscle and stamina and to prevent injury. Many athletes push their bodies to the limit during both practice and play, so career­ ending injury always is a risk; even minor injuries may put a player at risk of replacement. Because competition at all lev­ els is extremely intense and job security is always precarious, many athletes train year round to maintain excellent form and technique and peak physical condition. Very little downtime from the sport exists at the professional level. Some athletes must conform to regimented diets to supplement any physical training program. Coaches organize amateur and professional athletes and teach them the fundamental skills of individual and team sports. (In individual sports, instructors sometimes may fill this role.) Coaches train athletes for competition by holding practice ses­ sions to perform drills that improve the athletes’ form, technique, skills, and stamina. Along with refining athletes’ individual skills, coaches are responsible for instilling good sportsman­ ship, a competitive spirit, and teamwork and for managing their teams during both practice sessions and competitions. Before competition, coaches evaluate or scout the opposing team to determine game strategies and practice specific plays. Dur­ ing competition, coaches may call specific plays intended to surprise or overpower the opponent, and they may substitute players for optimum team chemistry and success. Coaches’ additional tasks may include selecting, storing, issuing, and tak­ ing inventory of equipment, materials, and supplies. Many coaches in high schools are primarily teachers of academic subjects who supplement their income by coaching part time. (For more information on high school teachers, see the statement on teachers—kindergarten, elementary, middle, and secondary, elsewhere in the Handbook.) College coaches consider coaching a full-time discipline and may be away from  322 Occupational Outlook Handbook  Coaches organize amateur and professional athletes and teach them the fundamental skills of individual and team sports. home frequently as they travel to competitions and to scout and recruit prospective players. Sports instructors teach professional and nonprofessional athletes individually. They organize, instruct, train, and lead athletes in indoor and outdoor sports such as bowling, tennis, golf, and swimming. Because activities are as diverse as weight lifting, gymnastics, scuba diving, and karate, instructors tend to specialize in one or a few activities. Like coaches, sports instruc­ tors also may hold daily practice sessions and be responsible for any needed equipment and supplies. Using their knowledge of their sport and of physiology, they determine the type and level of difficulty of exercises, prescribe specific drills, and correct athletes’ techniques. Some instructors also teach and demonstrate the use of training apparatus, such as trampolines or weights, for correcting athletes’ weaknesses and enhancing their conditioning. Like coaches, sports instructors evaluate the athlete and the athlete’s opponents to devise a competitive game strategy. Coaches and sports instructors sometimes differ in their approaches to athletes because of the focus of their work. For example, while coaches manage the team during a game to optimize its chance for victory, sports instructors—such as those who work for professional tennis players—often are not permitted to instruct their athletes during competition. Sports instructors spend more of their time with athletes working one-on-one, which permits them to design customized training programs for each individual. Motivating athletes to play hard challenges most coaches and sports instructors but is vital for the athlete’s success. Many coaches and instructors derive great satisfaction working with children or young adults, helping them to learn new physical and social skills, improve their physical condition, and achieve success in their sport. Umpires, referees, and other sports officials officiate at com­ petitive athletic and sporting events. They observe the play and impose penalties for infractions as established by the rules and regulations of the various sports. Umpires, referees, and sports officials anticipate play and position themselves to best see the action, assess the situation, and determine any violations. Some sports officials, such as boxing referees, may work indepen­ dently, while others such as umpires work in groups. Regard­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  less of the sport, the job is highly stressful because officials are often required to make a decision in a split second, sometimes resulting in strong disagreement among competitors, coaches, and spectators. Professional scouts evaluate the skills of both amateur and pro­ fessional athletes to determine talent and potential. As a sports intelligence agent, the scout’s primary duty is to seek out top athletic candidates for the team he or she represents. At the pro­ fessional level, scouts typically work for scouting organizations or as freelance scouts. In locating new talent, scouts perform their work in secrecy so as not to “tip off’ their opponents about their interest in certain players. At the college level, the head scout often is an assistant coach, although freelance scouts may aid colleges by reporting to coaches about exceptional players. Scouts at this level seek talented high school athletes by reading newspapers, contacting high school coaches and alumni, attend­ ing high school games, and studying videotapes of prospects’ performances. They also evaluate potential players’ background and personal characteristics, such as motivation and discipline, by talking to the players’ coaches, parents, and teachers. Work environment. Irregular work hours are common for athletes, coaches, umpires, referees, and other sports officials. They often work Saturdays, Sundays, evenings, and holidays. Athletes and full-time coaches usually work more than 40 hours a week for several months during the sports season, if not most of the year. High school coaches in educational institutions of­ ten coach more than one sport. Athletes, coaches, and sports officials who participate in com­ petitions that are held outdoors may be exposed to all weather conditions of the season. Athletes, coaches, and some sports officials frequently travel to sporting events. Scouts also travel extensively in locating talent. Athletes, coaches, and sports of­ ficials regularly encounter verbal abuse. Officials also face pos­ sible physical assault and, increasingly, lawsuits from injured athletes based on their officiating decisions. Athletes and sports competitors had one of the highest rates of nonfatal on-the-job injuries. Coaches and sports’ officials also face the risk of injury, but the risk is not as great as that faced by athletes and sports competitors.  Training, Other Qualifications, and Advancement Education and training requirements for athletes, coaches, um­ pires, and related workers vary greatly by the level and type of sport. Regardless of the sport or occupation, these jobs require immense overall knowledge of the game, usually acquired through years of experience at lower levels. Education and training. Most athletes, coaches, umpires, and related workers get their training from having played in the sport at some level. All of these sports-related workers need to have an extensive knowledge of the way the sport is played, its rules and regulations, and strategies, which is often acquired by playing the sport in school or recreation center, but also with the help of instructors or coaches, or in a camp that teaches the fun­ damentals of the sport. Athletes get their training in several ways. For most team sports, athletes gain experience by competing in high school and collegiate athletics or on club teams. Although a high school or college degree may not be required to enter the sport, most ath-  letes who get their training this way are often required to main­ tain specific academic standards to remain eligible to play, which often results in earning a degree. Other athletes, in gymnastics or tennis for example, learn their sport by taking private or group lessons. Although there may not be a specific education requirement, head coaches at public secondary schools and sports instruc­ tors at all levels usually must have a bachelor’s degree. For high school coaching and sports instructor jobs, schools usually pre­ fer, and may have to hire teachers willing to take on these part time jobs. If no suitable teacher is found, schools hire someone from outside. College coaches also usually are required to have a bachelor’s degree. Degree programs specifically related to coach­ ing include exercise and sports science, physiology, kinesiology, nutrition and fitness, physical education, and sports medicine. Some entry-level positions for coaches or instructors require only experience derived as a participant in the sport or activity. Each sport has specific requirements for umpires, referees, and other sports officials; some require these officials to pass a test of their knowledge of the sport. Umpires, referees, and other sports officials often begin their careers and gain needed experience by volunteering for intramural, community, and recreational league competitions. They are often required to attend some form of training course or academy. Scouting jobs often requires experience playing a sport at the college or professional level that makes it possible to spot young players who possess athletic ability and skills. Most beginning scouting jobs are as part-time talent spotters in a particular area or region. Licensure and certification. The need for athletes, coaches, umpires, and related workers to be licensed or certified to prac­ tice varies by sport and by locality. For example, in drag racing, drivers need to graduate from approved schools in order to be licensed to compete in the various drag racing series. The govern­ ing body of the sport may revoke licenses and suspend players who do not meet the required performance, education, or train­ ing. In addition, athletes may have their licenses or certification suspended for inappropriate activity. Most public high school coaches need to meet State require­ ments for certification to become a head coach. Certification, however, may not be required for coaching and sports instruc­ tor jobs in private schools. College coaches may be required to be certified. For those interested in becoming scuba, tennis, golf, karate, or other kind of instructor, certification is highly desir­ able and may be required. There are many certifying organiza­ tions specific to the various sports, and their requirements vary. Coaches’ certification often requires that one must be at least 18 years old and certified in cardiopulmonary resuscitation (CPR). Participation in a clinic, camp, or school also usually is required for certification. Part-time workers and those in smaller facilities are less likely to need formal education or training and may not need certification. To officiate at high school athletic events, umpires, referees, and other officials must register with the State agency that over­ sees high school athletics and pass an exam on the rules of the particular game. For college refereeing, candidates must be certi­ fied by an officiating school and be evaluated during a proba­ tionary period. Some larger college sports conferences require  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 323  officials to have certification and other qualifications, such as residence in or near the conference boundaries, along with sev­ eral years of experience officiating at high school, community college, or other college conference games. Other qualifications. Athletes, coaches, umpires, and related workers often direct teams or compete on them. Thus these work­ ers must relate well to others and possess good communication and leadership skills. They may need to pass a background check and applicable drug tests. Athletes who seek to compete profes­ sionally must have extraordinary talent, desire, and dedication to training. Coaches must be resourceful and flexible to success­ fully instruct and motivate individuals and groups of athletes. Officials need good vision, reflexes, and the ability to make deci­ sions quickly. Advancement. For most athletes, turning professional is the biggest advancement. They often begin to compete immediately, although some may spend more time “on the bench”, as a reserve, to gain experience. In some sports, such as baseball, athletes may begin their professional career on a minor league team before moving up to the major leagues. Professional athletes generally advance in their sport by winning and achieving accolades and earning a higher salary. Many coaches begin their careers as assistant coaches to gain the knowledge and experience needed to become a head coach. Flead coaches at large schools and colleges that strive to compete at the highest levels of a sport require substantial experience as a head coach at another school or as an assistant coach. To reach the ranks of professional coaching, a person usually needs years of coaching experience and a winning record in the lower ranks or experience as an athlete in that sport. Standards for umpires and other officials become more stringent as the level of competition advances. A local or State academy may be required to referee a school baseball game. Those seek­ ing to officiate at minor or major league games must attend a professional umpire training school. To advance to umpiring in Major League Baseball, umpires usually need 7 to 10 years of experience in various minor leagues before being considered for major league jobs. Finding talented players is essential for scouts to advance. Hard work and a record of success often lead to full-time jobs and responsibility for scouting in more areas. Some scouts ad­ vance to scouting director jobs or various administrative posi­ tions in sports.  Employment Athletes, coaches, umpires, and related workers held about 258,100 jobs in 2008. Coaches and scouts held 225,700 jobs; athletes and sports competitors, 16,500; and umpires, referees, and other sports officials, 15,900. About half of all athletes, coaches, umpires, and related workers worked part time or main­ tained variable schedules. Many sports officials and coaches receive such small and irregular payments for their services— occasional officiating at club games, for example—that they may not consider themselves employed in these occupations, even part time.  Among those employed in wage and salary jobs, 52 percent held jobs in public and private educational services. About 13 percent worked in amusement, gambling, and recreation in-  324 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 23 59,600 317,700 258,100 27-2020 12 1,900 18,400 16,500 27-2021 25 56,000 281,700 225,700 27-2022 10 1,700 17,600 15,900 27-2023 Umnires. referees, and other sports officials.................................. (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  soc  Occupational Title  tion Included in the Handbook.  Employment, 2008  ____________________________  dustries, including golf and tennis clubs, gymnasiums, health clubs, judo and karate schools, riding stables, swim clubs, and other sports and recreation facilities. Another 6 percent worked in the spectator sports industry. About 16 percent of workers in this occupation were self-em­ ployed, earning prize money or fees for lessons, scouting, or of­ ficiating assignments. Many other coaches and sports officials, although technically not self-employed, have such irregular or tenuous working arrangements that their working conditions re­ semble those of self-employment.  in these sports. The expansion of nontraditional sports may cre­ ate some additional opportunities. Because most professional athletes’ careers last only a few years due to debilitating injuries and age, annual replacement needs for these jobs is high, creat­ ing some job opportunities. However, the talented young men and women who dream of becoming sports superstars greatly  Job Outlook  opportunities and face less competition for positions. Competition is expected for higher paying jobs at the college level and will be even greater for jobs in professional sports. Competition should be keen for paying jobs as scouts, particularly for professional teams, because the number of available positions is limited.  Employment of athletes, coaches, umpires, and related workers is expected to grow much faster than the average for all occupa­ tions through 2018. Very keen competition is expected for jobs at the highest levels of sports with progressively more favorable opportunities in lower levels of competition. Employment change. Employment of athletes, coaches, umpires, and related workers is expected to increase by 23 per­ cent from 2008 to 2018, which is much faster than the average for all occupations. A larger population overall that will continue to participate in organized sports for entertainment, recreation, and physical conditioning will boost demand for these workers, particularly for coaches, umpires, sports instructors, and other related workers. Job growth also will be driven by the increas­ ing number of retirees who are expected to participate more in leisure activities such as golf and tennis, which require instruc­ tion. Additionally, the demand for private sports instruction is expected to grow among young athletes as parents try to help their children reach their full potential. Future expansion of new professional teams and leagues may create additional openings for all of these workers. Additional coaches and instructors are expected to be needed as school and college athletic programs expand. Population growth is expected to cause the construction of additional schools, but funding for athletic programs often is cut first when budgets become tight. Still, the popularity of team sports often enables shortfalls to be offset with the assistance from fundraisers, booster clubs, and parents. In colleges, most of the expansion is expected to be in women’s sports. Job prospects. Persons who are State-certified to teach academic subjects are likely to have the best prospects for obtaining coaching and instructor jobs in schools. The need to replace the many high school coaches will provide most coach­ ing opportunities. Competition for professional athlete jobs will continue to be extremely keen. In major sports, such as basketball and football, only about 1 in 5,000 high school athletes becomes professional   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  outnumber the number of openings. Opportunities should be best for persons seeking part-time umpire, referee, and other sports official jobs at the high school level. Coaches in girls’ and women’s sports may havd better  Earnings Median annual wages of athletes and sports competitors were $40,480 in May 2008. The middle 50 percent earned between $21,760 and $93,710. The highest paid professional athletes earn much more. Median annual wages of umpires and related workers were $23,730 in May 2008. The middle 50 percent earned between $17,410 and $33,150. The lowest paid 10 percent earned less than $15,450, and the highest paid 10 percent earned more than $48,310. In May 2008, median annual wages of coaches and scouts were $28,340. The middle 50 percent earned between $18,220 and $43,440. The lowest paid 10 percent earned less than $15,530, and the highest paid 10 percent earned more than $62,660. How­ ever, the highest paid professional coaches earn much more. Me­ dian annual wages in the industries employing the largest num­ bers of coaches and scouts in May 2008 are shown below: Colleges, universities, and professional schools........$39,550 Other amusement and recreation industries...................28,720 Other schools and instruction............................................25,740 Elementary and secondary schools................................. 22,390  Wages vary by level of education, certification, and geo­ graphic region. Some instructors and coaches are paid a salary, while others may be paid by the hour, per session, or based on the number of participants.  Professional and Related Occupations 325  Related Occupations Other occupations involved with athletes or sports include: Page Dietitians and nutritionists....................................................... 366 Fitness workers......................................................................... 513 Physical therapists.................................................................... 377 Recreation workers................................................................... 522 Recreational therapists............................................................. 389 Other workers who teach and motivate students include: Teachers—kindergarten, elementary, middle, and secondary....................................................................... 288  Sources of Additional Information For information about sports officiating for team and individual sports, contact: y National Association of Sports Officials, 2017 Lathrop Ave., Racine, WI 53405. Internet: http://www.naso.org For additional information related to individual sports, refer to the organization that represents the sport. The Occupational Information Network (0**NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos251.htm  Dancers and Choreographers Significant Points • Many dancers stop performing by their late thirties, but some remain in the field as choreographers, dance teachers, or artistic directors. • Most dancers begin formal training at an early age—between 5 and 15—and many have their first professional audition by age 17 or 18; becoming a choreographer usually requires years of experience. • Dancers and choreographers face intense competi­ tion; only the most talented find regular work.  Choreographers create original dances and develop new interpretations of existing dances. They work in theaters, dance schools, dance and movie studios, and at fashion shows, and are involved in auditioning performers for dance parts. Because few dance routines are written down, choreographers instruct performers at rehearsals to achieve the desired effect, often by demonstrating the exact technique. Choreographers also work with performers other than dancers. For example, the complex martial arts scenes in movies are arranged by choreographers who specialize in the martial arts. Choreographers also may help coordinate costume design and lighting, as well as choose the music and sound effects that convey the intended message. Work environment. Dance is strenuous. In fact, dancers have one of the highest rates of nonfatal on-the-job injury. Many dancers, as a result, stop performing by their late thirties because of the physical demands on the body. Nonetheless, some continue to work in the field as choreographers, artistic directors, and dance teachers and coaches, while a small number may move into administrative positions, such as company managers. A few celebrated dancers, however, continue per­ forming most of their lives. Many dance companies tour for part of the year to supple­ ment a limited performance schedule at home. Dancers who perform in musical productions and other family entertainment spend much of their time on the road; others work in nightclubs or on cruise ships. Most dance performances are in the evening, whereas rehearsals and practice usually take place during the day. As a result, dancers often work very long and late hours. Generally, dancers and choreographers work in modem and temperature-controlled facilities; however, some studios may be older and less comfortable. Training, Other Qualifications, and Advancement Dancers generally need long-term on-the-job training to be successful. Most dancers begin formal training at an early age—between 5 and 15—and many have their first profes­ sional audition by age 17 or 18. Some earn a bachelor’s de­ gree or attend dance school, although neither is required. Becoming a choreographer usually requires years of experi­ ence.  • Earnings from dancing are usually low because em­ ployment is irregular; dancers often supplement their income. Nature of the Work Complex movements and dances on stage and screen do not happen without a lot of hard work. Dancers spend years learning dances and honing skills, as do most choreographers. Together, they then translate those skills into movement that expresses ideas and stories. Dancers perform in a variety of settings, including opera, musical theater, and other musical productions, and may present folk, ethnic, tap, jazz, or other popular kinds of dance. They also perform in television, movies, music videos, and commercials, in which they may sing and act. Dancers most often perform as part of a group, although a few top artists perform solo.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Most dancers begin formal training at an early age and many have theirfirst professional audition by age 17 or 18.  326 Occupational Outlook Handbook  Education and training. Training varies with the type of dance and is a continuous part of all dancers’ careers. Many believe that dancers should start with a good foundation in classical technique before selecting a particular style. Bal­ let training for girls usually begins between the ages of 5 to 8 with a private teacher or through an independent bal­ let school, with more serious training beginning between the ages of 10 and 12. Boys often begin their ballet training between the ages of 10 and 15. Students who demonstrate potential in their early teens may seek out more intensive and advanced professional training. At about this time, students should begin to focus their training on a particular style and decide whether to pursue additional training through a dance company’s school or a college dance program. Lead­ ing dance school companies often have summer training pro­ grams from which they select candidates for admission to their regular full-time training programs. Formal training for modern and culturally specific dances often begins later than training in ballet; however, many folk dance forms are taught to very young children. As a result, a good number of danc­ ers have their first professional auditions by age 17 or 18. Training is an important component of professional danc­ ers’ careers. Dancers normally spend 8 hours a day in class and rehearsal, keeping their bodies in shape and prepar­ ing for performances. Their daily training period usually includes time to warm up and cool down before and after classes and rehearsals. Because of the strenuous and time-consuming training required, some dancers view formal education as second­ ary. However, a broad, general education including music, literature, history, and the visual arts is helpful in the inter­ pretation of dramatic episodes, ideas, and feelings. Danc­ ers sometimes conduct research to learn more about the part they are playing. Many colleges and universities award bachelor’s or mas­ ter’s degrees in dance, typically through departments of dance, theater, or fine arts. The National Association of Schools of Dance is made up of 74 accredited dance pro­ grams. Many programs concentrate on modern dance, but some also offer courses in jazz, culturally specific dance, ballet, or classical techniques. Courses in dance composi­ tion, history and criticism, and movement analysis are also available. A college education is not essential for employment as a professional dancer; however, many dancers obtain degrees in unrelated fields to prepare themselves for careers after dance. The completion of a college program in dance and education is usually essential to qualify to teach dance in college, high school, or elementary school. (See the state­ ment on teachers—postsecondary and teachers—kinder­ garten, elementary, middle, and secondary elsewhere in the Handbook.) Colleges and conservatories sometimes require graduate degrees but may accept performance experience. A college background is not necessary for teaching dance or choreography in local recreational programs. Studio schools prefer teachers to have experience as performers. Choreographers should have a thorough understanding of the dance style that they arrange. This often is gained through   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  years of performing and practicing. Some dance conservato­ ries offer choreography courses. Other qualifications. Because of the rigorous practice schedules of most dancers and choreographers, self-disci­ pline, patience, perseverance, and a devotion to dance are essential for success in the field. Dancers and choreogra­ phers also must possess good problem-solving skills and an ability to work with people. Dancers, above all, must have good health and physical stamina, along with flexibility, agility, coordination, and grace, a sense of rhythm, a feel­ ing for music, and a creative ability to express themselves through movement. Choreographers should possess many of the same attributes while also being able to plan and coordi­ nate activities. Because dancers and choreographers are typically mem­ bers of an ensemble made up of other dancers, musicians, and directors or choreographers, they must be able to func­ tion as part of a team. They also should be highly motivated and prepared to face the anxiety of intermittent employment and rejections when looking for work. Advancement. For dancers, advancement takes the form of a growing reputation, more frequent work, bigger and bet­ ter roles, and higher pay. Some dancers may take on added responsibilities, such as by becoming a dance captain in mu­ sical theater or ballet master/ballet mistress in concert dance companies, by leading rehearsals, or by working with less experienced dancers in the absence of a choreographer. Choreographers typically are experienced dancers with years of practice working in the theater. Through their per­ formance as dancers, they develop reputations that often lead to opportunities to choreograph productions. Employment Professional dancers and choreographers held about 29,200 jobs in 2008. Many others were between engagements; as a result, the total number of people available for work as danc­ ers over the course of the year was greater. Dancers and cho­ reographers worked in a variety of industries, such as public and private educational services, which includes dance stu­ dios and schools, as well as colleges and universities; food services and drinking establishments; performing arts compa­ nies, which include dance, theater, and opera companies; and amusement and recreation venues, such as casinos and theme parks. About 14 percent of dancers and choreographers were self-employed. Most major cities serve as home to major dance companies; however, many smaller communities across the Nation also support home-grown, full-time professional dance companies.  Job Outlook Employment is expected to grow more slowly than the aver­ age. Dancers and choreographers face intense competition for jobs. Only the most talented find regular employment. Employment change. Employment of dancers and chore­ ographers is expected to grow 6 percent during the 2008-18 decade, more slowly than the average for all occupations. The public’s interest in dance will sustain large and mid-size dance companies, but limited funding from public and private orga­ nizations is not expected to allow for additional dance com-  Professional and Related Occupations 327  Projections data from the National Employment Matrix Projected Employment, 2018 30,900 1 'X onn 17,000  Change, 2008-2018 Number Percent Dancers and choreographers........... 27-2030 29.200 1,700 6 Dancers................................ 13,000 / Choreographers.......................... 16.200 900 5 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. Occupational Title  panies. For many small organizations, the result will be fewer performances and more limited employment opportunities. Job prospects. Because many people enjoy dance and would like to make their careers in dance, dancers and cho­ reographers face intense competition for jobs. Only the most talented find regular employment. Although job openings will arise each year because dancers and choreographers retire or leave the occupation for other reasons, the number of applicants will continue to vastly ex­ ceed the number of job openings. National dance companies likely will continue to provide jobs in this field. Opera companies and dance groups affili­ ated with television and motion pictures also will offer some opportunities. Moreover, the growing popularity of dance for recreational and fitness purposes has resulted in increased op­ portunities to teach dance, especially for older dancers who may be transitioning to another field. Musicians will provide a small number of openings for both dancers and choreogra­ phers, and candidates are expected to face keen competition. Amusement parks and cruise ships should also provide some opportunities for dancers and choreographers.  Earnings Median hourly wages of dancers were $12.22 in May 2008. The middle 50 percent earned between $8.03 and $18.82. The lowest 10 percent earned less than $7.28, and the high­ est 10 percent earned more than $27.26. Annual wage data for dancers were not available, because the wide variation in the number of hours worked by dancers and the short­ term nature of many jobs—which may last for 1 day or 1 week—make it rare for dancers to have guaranteed employ­ ment that exceeds a few months. Median hourly wages in the industries employing the largest number of dancers were as follows: Performing arts companies........................................... $15.30 Other amusement and recreation industries................... 11.56 Other schools and instruction......................................... 10.00 Drinking places (alcoholic beverages).............................8.01 Median annual wages of salaried choreographers were $38,520 in May 2008. The middle 50 percent earned be­ tween $25,320 and $55,360. The lowest 10 percent earned less than $17,880, and the highest 10 percent earned more than $67,160. Median annual wages were $37,570 in “other schools and instruction,” the North American Industry Clas­ sification System category that includes dance studios and schools. Dancers who were on tour usually received an additional allowance for room and board, as well as extra compensation   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc Code  Employment, 2008  for overtime. Earnings from dancing are usually low because employment is irregular. Dancers often supplement their in­ come by working as guest artists with other dance compa­ nies, teaching dance, or taking jobs unrelated to the field. Earnings of dancers at some of the largest companies and in commercial settings are governed by union contracts. Some dancers in major opera ballet, classical ballet, and modern dance corps belong to the American Guild of Musi­ cal Artists, Inc. of the AFL-CIO; those who appear on live or videotaped television programs belong to the American Federation of Television and Radio Artists; those who per­ form in films and on television belong to the Screen Actors Guild; and those in musical theater are members of the Ac­ tors’ Equity Association. The unions and producers sign ba­ sic agreements specifying minimum salary rates, hours of work, benefits, and other conditions of employment. How­ ever, the contract each dancer signs with the producer of the show may be more favorable than the basic agreement. Most salaried dancers and choreographers covered by union contracts receive some paid sick leave and various health and pension benefits, including extended sick pay and family-leave benefits provided by their unions. Employers contribute toward these benefits. Dancers and choreogra­ phers not covered by union contracts usually do not enjoy such benefits.  Related Occupations Other occupations that perform before audiences include: Page Actors, producers, and directors.............................................318 Athletes, coaches, umpires, and related workers................... 321 Musicians, singers, and related workers................................ 328 Occupations directly involved in the production of dance pro­ grams include: Barbers, cosmetologists, and other personal appearance workers..............................................................507 Fashion designers.....................................................................307 Set and exhibit designers..........................................................825  Sources of Additional Information For general information about dance and a list of accredited college-level programs, contact: > National Association of Schools of Dance, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http ://nasd.arts-accredit.org For information about dance and dance companies, contact: 'y Dance/USA, 1111 16th St. NW., Suite 300, Washington, DC 20036. Internet: http://www.danceusa.org  328 Occupational Outlook Handbook  The Occupational Information Network (0**NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos094.htm  Musicians, Singers, and Related Workers Significant Points • Part-time schedules—typically at night and on week­ ends—intermittent unemployment, and rejection when auditioning for work are common; many musi­ cians and singers supplement their income with earn­ ings from other sources. • Aspiring musicians and singers begin studying an in­ strument or training their voice at an early age. • Competition for jobs, especially full-time jobs, is keen; talented individuals who can play several in­ struments and perform a wide range of musical styles should enjoy the best job prospects. Nature of the Work Musicians, singers, and related workers play musical instru­ ments, sing, compose or arrange music, or conduct groups in instrumental or vocal performances. They perform solo or as part of a group, mostly in front of live audiences in nightclubs, concert halls, and theaters. They also perform in recording or production studios for radio, TV, film, or video games. Regard­ less of the setting, they spend considerable time practicing alone and with their bands, orchestras, or other musical ensembles. Musicians play one or more musical instruments. Many musicians learn to play several related instruments and can perform equally well in several musical styles. Instrumental musicians, for example, may play in a symphony orchestra, rock group, or jazz combo one night, appear in another ensemble the next, and work in a studio band the following day. Some play a variety of string, brass, woodwind, or percussion instruments or electronic synthesizers. Singers use their knowledge of voice production, melody, and harmony to interpret music and text. They sing character parts or perform in their own individual styles. Singers often are clas­ sified according to their voice range—soprano, contralto, tenor, baritone, or bass—or by the type of music they sing, such as rock, pop, folk, opera, rap, or country. Music directors and conductors conduct, direct, plan, and lead instrumental or vocal performances by musical groups such as orchestras, choirs, and glee clubs. These leaders audition and select musicians, choose the music most appropriate for their talents and abilities, and direct rehearsals and performances. Choral directors lead choirs and glee clubs, sometimes work­ ing with a band or an orchestra conductor. Directors audition and select singers and lead them at rehearsals and performances to achieve harmony, rhythm, tempo, shading, and other desired musical effects.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Composers create original music such as symphonies, op­ eras, sonatas, radio and television jingles, film scores, and pop­ ular songs. They transcribe ideas into musical notation, using harmony, rhythm, melody, and tonal structure. Although most composers and songwriters practice their craft on instruments and transcribe the notes with pen and paper, some use computer software to compose and edit their music. Arrangers transcribe and adapt musical compositions to a par­ ticular style for orchestras, bands, choral groups, or individuals. Components of music—including tempo, volume, and the mix of instruments needed—are arranged to express the composer’s message. Although some arrangers write directly into a musical composition, others use computer software to make changes. Work environment. Musicians typically perform at night and on weekends. They spend much additional time practic­ ing or in rehearsal. Full-time musicians with long-term em­ ployment contracts, such as those with symphony orchestras or television and film production companies, enjoy steady work and less travel. Nightclub, solo, or recital musicians frequently travel to perform in a variety of local settings and may tour na­ tionally or internationally. Because many musicians find only part-time or intermittent work and experience unemployment between engagements, they often supplement their income with other types of jobs. The stress of constantly looking for work leads many musicians to accept permanent full-time jobs in other occupations while working part time as musicians. Most instrumental musicians work closely with a variety of other people, including colleagues, agents, employers, spon­ sors, and audiences. Although they usually work indoors, some perform outdoors for parades, concerts, and festivals. In some nightclubs and restaurants, smoke and odors may be present and lighting and ventilation may be poor.  Training, Other Qualifications, and Advancement Long-term on-the-job training is the most common way people learn to become musicians or singers. Aspiring musicians begin studying an instrument at an early age. They may gain valuable experience playing in a school or community band or orchestra or with a group of friends. Singers usually start training when their voices mature. Participation in school musicals or choirs often provides good early training and experience. Compos-  ,1  Musicians face keen competition, especially forfull-time jobs.  Professional and Related Occupations 329  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Musicians, singers, and related workers......................... ................... 27-2040 240,000 259,600 19,600 8 Music directors and composers.................................... ................... 27-2041 53,600 59,000 5,300 10 Musicians and singers................................................. ................... 27-2042 186,400 200.600 14.200 8 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  soc  Employment, 2008  tion Included in the Handbook.  ers and music directors usually require a bachelor’s degree in a related field. Education and training. Musicians need extensive and pro­ longed training and practice to acquire the skills and knowledge necessary to interpret music at a professional level. Like other artists, musicians and singers continually strive to improve their abilities. Formal training may be obtained through private study with an accomplished musician, in a college or univer­ sity music program, or in a music conservatory. An audition generally is necessary to qualify for university or conservatory study. The National Association of Schools of Music is made up of 615 accredited college-level programs in music. Courses typically include music theory, music interpretation, composi­ tion, conducting, and performance, either with a particular in­ strument or a voice performance. Music directors, composers, conductors, and arrangers need considerable related work expe­ rience or advanced training in these subjects. A master’s or doctoral degree usually is required to teach advanced music courses in colleges and universities; a bach­ elor’s degree may be sufficient to teach basic courses. A degree in music education qualifies graduates for a State certificate to teach music in public elementary or secondary schools. (Infor­ mation related to teachers—postsecondary and teachers—kin­ dergarten, elementary, middle, and secondary can be found elsewhere in the Handbook.) Musicians who do not meet pub­ lic school music education requirements may teach in private schools and recreation associations or instruct individual stu­ dents in private sessions. Other qualifications. Musicians must be knowledge­ able about a broad range of musical styles. Having a broader range of interest, knowledge, and training can help expand employment opportunities and musical abilities. Voice train­ ing and private instrumental lessons, especially when taken at a young age, also help develop technique and enhance one’s performance. Young persons considering careers in music should have musical talent, versatility, creativity, poise, and good stage presence. Self-discipline is vital because producing a quality performance on a consistent basis requires constant study and practice. Musicians who play in concerts or in night­ clubs and those who tour must have physical stamina to endure frequent travel and an irregular performance sched­ ule. Musicians and singers also must be prepared to face the anxiety of intermittent employment and of rejection when auditioning for work. Advancement. Advancement for musicians usually means becoming better known, finding work more easily, and per­ forming for higher earnings. Successful musicians often rely   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  on agents or managers to find them performing engagements, negotiate contracts, and develop their careers.  Employment Musicians, singers, and related workers held about 240,000 jobs in 2008, of which 186,400 were held by musicians and singers; 53,600 were music directors and composers. Around 43 percent worked part time; 50 percent were self-employed. Many found jobs in cities in which entertainment and recording activities are concentrated, such as New York, Los Angeles, Las Vegas, Chicago, and Nashville. Musicians, singers, and related workers are employed in a va­ riety of settings. Of those who earn a wage or salary, 33 percent were employed by religious, grantmaking, civic, professional, and similar organizations and 12 percent by performing arts companies, such as professional orchestras, small chamber mu­ sic groups, opera companies, musical theater companies, and ballet troupes. Musicians and singers also perform in nightclubs and restaurants and for weddings and other events. Well-known musicians and groups may perform in concerts, appear on ra­ dio and television broadcasts, and make recordings and music videos. The U.S. Armed Forces also offer careers in their bands and smaller musical groups. (Information related to job op­ portunities in the armed forces can be found elsewhere in the Handbook.)  Job Outlook Employment is expected to grow as fast as average. Keen competition for jobs, especially full-time jobs, is expected to continue. Talented individuals who are skilled in mul­ tiple instruments and musical styles will have the best job prospects. Employment change. Employment of musicians, singers, and related workers is expected to grow 8 percent during the 2008-18 decade, as fast as the average for all occupations. Most new wage-and-salary jobs for musicians will arise in religious organizations. Slower than average employment growth is expected for self-employed musicians, who gener­ ally perform in nightclubs, concert tours, and other venues. The Internet and other new forms of media may provide in­ dependent musicians and singers alternative methods for dis­ tributing music. Job prospects. Growth in demand for musicians will gen­ erate a number of job opportunities, and many openings also will arise from the need to replace those who leave the field each year because they are unable to make a living solely as musicians or singers, as well as those who leave for other reasons.  330 Occupational Outlook Handbook  Competition for jobs as musicians, singers, and related workers—especially full-time jobs—is expected to be keen. The vast number of people with the desire to perform will continue to greatly exceed the number of openings. New mu­ sicians or singers will have their best chance of landing a job with smaller, community-based performing arts groups or as freelance artists. Instrumentalists should have better opportunities than singers because of a larger pool of work. Talented individuals who are skilled in multiple instruments or musical styles will have the best job prospects. However, talent alone is no guarantee of success: many people start out to become musicians or singers but leave the profession because they find the work difficult, the discipline demand­ ing, and the long periods of intermittent unemployment a hardship.  Earnings Median hourly wages of wage-and-salary musicians and sing­ ers were $21.24 in May 2008. The middle 50 percent earned between $11.49 and $36.36. The lowest 10 percent earned less than $7.64, and the highest 10 percent earned more than $59.92. Median hourly wages were $23.68 in performing arts compa­ nies and $12.50 in religious organizations. Annual wage data for musicians and singers were not available because of the wide variation in the number of hours worked by musicians and singers and the short-term nature of many jobs. It is rare for musicians and singers to have guaranteed employment that exceeds 3 to 6 months. Median annual wages of salaried music directors and com­ posers were $41,270 in May 2008. The middle 50 percent earned between $26,480 and $63,200. The lowest 10 percent earned less than $16,750, and the highest 10 percent earned more than $107,280. For self-employed musicians and singers, earnings typically reflect the number of jobs a freelance musician or singer played or the number of hours and weeks of contract work, in addition to a performer’s professional reputation and setting. Perform­ ers who can fill large concert halls, arenas, or outdoor stadiums generally command higher pay than those who perform in lo­ cal clubs. Soloists or headliners usually receive higher earnings than band members or opening acts. The most successful musi­ cians earn performance or recording fees that far exceed the median earnings. The American Federation of Musicians negotiates minimum contracts for major orchestras during the performing season. Each orchestra works out a separate contract with its local union, but individual musicians may negotiate higher salaries. In regional orchestras, minimum salaries often are less because   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  fewer performances are scheduled. Regional orchestra musi­ cians frequently are paid for their services without any guar­ antee of future employment. Community orchestras often have limited funding and offer salaries that are much lower for sea­ sons of shorter duration. Although musicians employed by some symphony orches­ tras work under master wage agreements, which guarantee a season’s work up to 52 weeks, many other musicians face relatively long periods of unemployment between jobs. Even when employed, many musicians and singers work part time in unrelated occupations. Thus, their earnings for music usu­ ally are lower than earnings in many other occupations. More­ over, because they may not work steadily for one employer, some performers cannot qualify for unemployment compen­ sation and few have typical benefits such as sick leave or paid vacations. For these reasons, many musicians give private les­ sons or take jobs unrelated to music to supplement their earn­ ings as performers. Many musicians belong to a local of the American Fed­ eration of Musicians. Professional singers who perform live often belong to a branch of the American Guild of Musical Artists; those who record for the broadcast industries may belong to the American Federation of Television and Radio Artists.  Related Occupations Other occupations that require a technical knowledge of musical instruments include the following: Musical instrument repairers and tuners................................. 721 Musicians, singers, and related workers are involved in the performing arts, as are the following workers: Actors, producers, and directors............................................. 318 Announcers.............................................................................. 331 Dancers and choreographers....................................................325  Sources of Additional Information For general information about music and music teacher education and a list of accredited college-level programs, contact: y National Association of Schools of Music, 11250 Roger Bacon Dr., Suite 21, Reston, VA 20190. Internet: http://nasm.arts-accredit.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos095.htm  Professional and Related Occupations 331  Media and Communication-Related Occupations Announcers Significant Points • Competition for announcer jobs will continue to be keen. • Jobs at small stations usually have low pay, but offer the best opportunities for inexperienced announcers. • Applicants who have completed internships or have related work experience, and those with more ad­ vanced computer skills, may have an advantage in the job market. • Employment is projected to decline slowly. Nature of the Work Radio and television announcers perform a variety of tasks on and off the air. They announce station program information, such as program schedules and station breaks for commer­ cials, or public-service information, and they introduce and close programs. Announcers read prepared scripts or make ad-lib commentary on the air as they present news, sports, the weather, the time, and commercials. If a written script is required, they may do the research and writing. Announcers also interview guests and moderate panels or discussions. Some provide commentary for the audience during sporting events, at parades, and on other occasions. Announcers often are well known to radio and television audiences and may make promotional appearances and do remote broadcasts for their stations. Announcers at smaller stations may have more off-air duties as well. They may operate the control board, monitor the trans­ mitter, sell commercial time to advertisers, keep a log of the station’s daily programming, and produce advertisements and other recorded material. At many radio stations, announcers do much of the work previously performed by editors and broad­ cast technicians, such as operating the control board, which is used to broadcast programming, commercials, and public-ser­ vice announcements according to the station’s schedule. (See the statement on broadcast and sound engineering technicians and radio operators elsewhere in the Handbook.) Public radio and television announcers also are involved in station fundrais­ ing efforts. Announcers frequently participate in community activities. Sports announcers, for example, may serve as masters of cer­ emony at sports club banquets or may greet customers at open­ ings of sporting-goods stores. Radio announcers who broadcast music often are called disc jockeys (DJs). Some DJs specialize in one kind of music, an­ nouncing selections as they air them. Most DJs do not select much of the music they play (although they often did so in the past); instead, they follow schedules of commercials, talk, and music provided to them by management. While on the air, DJs comment on the music, weather, and traffic. They may take   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  requests from listeners, interview guests, and manage listener contests. Many radio stations now require DJs to update their station Web site. Some DJs announce and play music at clubs, dances, restau­ rants, and weddings. They often have their own equipment with which to play the music. Many are self-employed and rent their services out on a job-by-job basis. Show hosts may specialize in a certain area of interest, such as politics, personal finance, sports, or health. They contribute to the preparation of the program’s content, interview guests, and discuss issues with viewers, listeners, or the studio audience. Public-address system announcers provide information to the audience at sporting, performing arts, and other events. Work environment. Announcers usually work in well-lighted, air-conditioned, soundproof studios. Announcers often work within tight schedules, which can be physically and mentally stressful. For many announcers, the intangible rewards—creative work, many personal contacts, and the satisfaction of becoming widely known—far outweigh the disadvantages of irregular and often unpredictable hours, work pressures, and disrupted personal lives. The broadcast day is long for radio and TV stations—many are on the air 24 hours a day—so announcers can expect to work unusual hours. Many present early-morning shows, when most people are getting ready for work or commuting, while others do late-night programs. The shifts, however, are not as varied as in the past, because new technology has allowed sta­ tions to eliminate most of the overnight hours. Many announc­ ers work part time.  I MIX  Radio announcers who broadcast music often are called disc jockeys, or DJs.  332 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Announcers............................................................................................. Radio and television announcers...................................................... Public address system and other announcers.................................  Projected Employment,  ^  Change, 2008-2018  2018Number Percent 27-3010 67,400 65,000 -2,400 -4 27-3011 55,100 51,700 -3,400 -6 27-301212,30013,3001,0008  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  Training, Other Qualifications, and Advancement Entry into this occupation is highly competitive, and postsec­ ondary education or long-term on-the-job training is common. Trainees usually must have several years of experience in the industry before receiving an opportunity to work on the air. An applicant’s delivery and—in television—appearance and style are important. Education and training. Formal training in broadcasting from college or a technical school is valuable. These programs prepare students to work with the computer equipment and software to which they might otherwise not have access. In radio, many announcers will also need Web site editing skills. It is common for announcers to have a bachelor’s degree in a subject such as communications, broadcasting, or journalism. High school and college courses in English, public speaking, drama, foreign languages, and computer science are valuable, and hobbies such as sports and music are additional assets. There are many broadcast programs available and they have varying reputations. Individuals considering enrolling in a broadcasting school should contact personnel managers of radio and television stations, as well as broadcasting trade organizations, to determine the school’s reputation for produc­ ing suitably trained candidates. Announcers are often required to complete long-term on-thejob training. This can be accomplished at campus radio or TV facilities and at commercial stations while students serve as in­ terns. Work experience at college or high school radio or TV stations is very valuable. Oftentimes, even for entry-level posi­ tions, employees need to have experience, which students can acquire at these stations. Paid or unpaid internships also provide students with hands-on training and the chance to establish con­ tacts in the industry. Unpaid interns frequently receive college credit and are allowed to observe and assist station employees. This experience sometimes leads to paid internships which are valuable because interns may do work ordinarily performed by regular employees. Once hired by a television station, an employee usually starts out as a production assistant, researcher, or reporter and is given a chance to move into announcing if he or she shows an aptitude for “on-air” work. A beginner’s chance of landing an on-air job is remote. The best chances for an on-air job for inexperienced announcers may be as a substitute for a familiar announcer at a small radio station. In radio, newcomers usually start out taping interviews and operating equipment. Other qualifications. Announcers must have a pleasant and well-controlled voice, good timing, excellent pronunciation, and correct grammar. College broadcasting programs offer courses, such as voice and diction, to help students improve their qualities. Television announcers need a neat, pleas­ Digitized forvocal FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  ing appearance as well. Knowledge of theater, sports, music, business, politics, and other subjects likely to be covered in broadcasts improves one’s chances for success. Announcers, especially those seeking radio careers, should have good infor­ mation technology skills and be capable of using computers, editing equipment, and other broadcast-related devices because new advances in technology have made these abilities impor­ tant. Announcers also need strong writing skills, because they normally write their own material. In addition, they should be able to ad lib all or part of a show and to work under tight dead­ lines. The most successful announcers attract a large audience by combining a pleasing personality and voice with an appeal­ ing style. Advancement. Announcers usually begin at a station in a small community and, if they are qualified, may move to a bet­ ter paying job in a large city. They also may advance by hosting a regular program as a disc jockey, sportscaster, or other spe­ cialist. Competition for employment by networks is particularly intense, and employees will need a college degree with at least several years of successful announcing experience if they wish to advance.  Employment Announcers held about 67,400 jobs in 2008. About 51 percent were employed in radio and television broadcasting. Many other announcers were self-employed freelance announcers, who sold their services to networks and stations, advertising agencies, other independent producers, or to sponsors of local events.  Job Outlook Competition for jobs as announcers will be keen because the broadcasting field attracts many more jobseekers than there are jobs. Furthermore, employment of announcers is projected to decline slowly. In some cases, announcers leave the field be­ cause they cannot advance to better paying jobs. Changes in station ownership, format, and ratings frequently cause periods of unemployment for many announcers. Employment change. Employment of announcers is expected to decline by 4 percent from 2008 to 2018. Im­ proving technology continues to increase the productivity of announcers, reducing the time required to edit material or perform other off-air technical and production work. The ability of radio announcers to broadcast a program live and record a show for another time has eliminated most late-night shifts and allowed multiple stations to use material from the same announcer. Increasing consolidation among broadcast­ ing companies also may contribute to the increased use of syndicated programming and programs originating outside a station’s viewing or listening area. The growth of alternative  Professional and Related Occupations 333  media sources, such as satellite radio, may contribute to the expected decline. A possible positive area for radio announcers is hybrid digital (HD) radio, which broadcasters hope will increase in the coming years. HD radio offers more channels and could result in higher demand for on-air personalities. There will always be some demand for this occupation, because the public continues to desire local radio and television broad­ casting and announcers play a necessary role in bringing it to them. Job prospects. Some job openings will arise from the need to replace those who transfer to other kinds of work or leave the labor force. Nevertheless, competition for jobs as announc­ ers will be keen because the broadcasting field attracts many more jobseekers than there are jobs. Small radio stations are more inclined to hire beginners, but the pay is low. Applicants who have completed internships and those with related work experience usually receive preference for available positions. Jobseekers with good computer and technical skills also will have an advantage. Large stations will seek announcers who have proven that they can attract and retain a sizable audience, because competition for ratings is so intense in major metropol­ itan areas. Announcers who are knowledgeable about business, consumer, and health news also may have an advantage over others. Although subject-matter specialization is more common at large stations and the networks, many small stations also en­ courage it. There will be some opportunities for self-employed DJs who provide music at clubs and special events, but most of these jobs will be part time.  Earnings Salaries in broadcasting vary widely, but generally are rela­ tively low, except for announcers who work for large stations in major markets or for networks. Earnings are higher in tele­ vision than in radio and higher in commercial broadcasting than in public broadcasting. Median hourly wages of radio and television announcers in May 2008 were $12.95. The middle 50 percent earned be­ tween $9.05 and $20.31. The lowest 10 percent earned less than $7.45, and the highest 10 percent earned more than $36.42. Median hourly wages of announcers in the radio and television broadcasting industry were $12.61. Median hourly wages of public address and other system announcers in May 2008 were $13.18. The middle 50 per­ cent earned between $8.82 and $21.04. The lowest 10 percent earned less than $7.51 and the highest 10 percent earned more than $33.58.  Related Occupations The success of announcers depends upon how well they commu­ nicate. Others who must be skilled at oral communication include: Page Interpreters and translators....................................................... 340 News analysts, reporters, and correspondents......................... 344 Public relations specialists.......................................................350 and related workers, all other Digitized Sales for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Many announcers also must entertain their audience, so their work is similar to that of other entertainment-related occupa­ tions, such as: Actors, producers, and directors............................................. 318 Musicians, singers, and related workers................................. 328 Some announcers write their own material, as do: Writers and authors..................................................................333 Announcers perform a variety of duties, including some tech­ nical operations similar to those performed by: Broadcast and sound engineering technicians and radio operators..............................................................337  Sources of Additional Information General information on the broadcasting industry, in which many announcers are employed, is available from: y National Association of Broadcasters, 1771 N St. NW., Washington, DC 20036. Internet: http://www.nab.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos087.htm  Authors, Writers, and Editors Significant Points • Most jobs require a college degree, preferably in communications, journalism, or English. • Keen competition is expected for writing and editing jobs as many people are attracted to this occupation. • Online publications and services are growing in num­ ber and sophistication, spurring the demand for writ­ ers and editors with Web or multimedia experience. Nature of the Work Authors, writers and editors produce a wide variety of written materials in an increasing number of ways. They develop con­ tent using any number of multimedia formats that can be read, listened to, or viewed onscreen. Although many people write as part of their primary job, or on online chats or blogs, only writers and editors who are paid to primarily write or edit are included in this occupation. (News analysts, reporters and cor­ respondents, who gather information and prepare stories about newsworthy events, and technical writers, who help explain highly technical information to less technical audiences, are de­ scribed elsewhere in the Handbook.) Writers and authors develop original written materials for books, magazines, trade journals, online publications, company newsletters, and advertisements. Their works are classified broadly as either fiction or nonfiction and writers often are iden­ tified by the type of writing they do—for example, novelists, playwrights, biographers, and textbook writers. Writers such as songwriters, screenwriters, or scriptwriters, produce content for radio and television broadcasts, motion pictures, and other types of performance. An increasing number of writers are pro­  334 Occupational Outlook Handbook  ducing scripted material directly for the Web and other com­ munication devices. Copy writers prepare advertising copy for use in publications or for broadcasting and they write other materials to promote the sale of a good or service. They often must work with the client to produce advertising themes or slogans and may be in­ volved in the marketing of the product or service. All writers conduct research on their topics, which they gather through personal observation, library and Internet re­ search, and interviews. Some staff writers who work in the newspaper or magazine publishing industry are news ana­ lysts, reporters, and correspondents and like most writers are typically assigned articles to write by editors and publishers, and may propose their own story ideas. Writers, especially of nonfiction, are expected to establish their credibility with editors and readers through strong research and the use of appropriate sources and citations. Writers and authors then select the material they want to use, organize it, and use the written word to express story lines, ideas, or to convey infor­ mation. With help from editors, they may revise or rewrite sections, searching for the best organization or the right phrasing. Most writers and editors use desktop or electronic publish­ ing software, scanners, and other electronic communications equipment in the production of their material. In addition, be­ cause many writers today prepare material directly for the In­ ternet, such as online newspapers and text for video games, they should be knowledgeable about graphic design, page layout, and multimedia software. In addition, they should be familiar with interactive technologies of the Web so that they can blend text, graphics, and sound together. Some writers maintain blogs or issue text messages as a way of keeping in touch with read­ ers or providing information to them quickly, but only those who are paid to write their blogs or send text messages may be considered writers. An increasing number of writers today are freelance writ­ ers—that is, they are self-employed and make their living by selling their written content to book and magazine publishers, news organizations, advertising agencies, or movie, theater, or television producers or by working under contract with an organization. Some writers may be commissioned by a spon­ sor to write a script; others to write a book on the basis of a proposal in the form of a draft or an outline. Many freelance writers are hired to complete specific short-term or recurring assignments, such as contributing a column or a series of ar­ ticles on a specific topic to a news agency or for an organiza­ tion’s newsletter. Editors review, rewrite, and edit the work of writers. They also may do original writing. An editor’s responsibilities vary with the employer and type and level of editorial position held. Editorial duties may include planning the content of books, journals, magazines, and other general-interest publications. Editors also review story ideas proposed by staff and free­ lance writers then decide what material will appeal to readers. They review and edit drafts of books and articles, offer com­ ments to improve the work, and suggest possible titles. In ad­ dition, they may oversee the production of publications. In the book-publishing industry, an editor’s primary responsibility is  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Authors, writers, and editors check their sources and facts for accuracy. to review proposals for books and decide whether to buy the publication rights from the author. Most editors begin work as writers. Those who are particu­ larly adept at identifying stories, recognizing writing talent, and interacting with writers, may be interested in editing jobs. Major newspapers and newsmagazines usually employ sev­ eral types of editors. The executive editor oversees assistant editors, and generally has the final say about what stories are published and how they are covered. Assistant editors have re­ sponsibility for particular subjects, such as local news, inter­ national news, feature stories, or sports. The managing editor usually is responsible for the daily operation of the news depart­ ment. Assignment editors determine which reporters will cover a given story. In smaller organizations—such as small daily or weekly newspapers—a single editor may do everything or share responsibility with only a few other people. Executive and managing editors typically hire writers, reporters, and other employees. They also plan budgets and negotiate contracts with freelance writers, sometimes called “stringers” in the news industry. Copy editors, review copy for errors in grammar, punctuation, and spelling and check the copy for readability, style, and agreement with editorial policy. They suggest revisions, such as changing words and rearranging sentences and paragraphs, to improve clarity or accuracy. They may also carry out research and confirm sources for writers and verify facts, dates, and statistics. In addition, they may arrange page layouts of articles, photographs, and advertising; compose headlines; and prepare copy for printing. Editors often employ others, such as interns, fact checkers, or editorial assistants, for some entry-level positions. While gaining practical experience in a newsroom, they may carry out research and verify facts, dates, and statistics for other writ­ ers. In addition, they may arrange page layouts of articles,  Professional and Related Occupations 335  photographs, and advertising; compose headlines; and prepare copy for printing. Publication assistants who work for book publishing houses may read and evaluate manuscripts submit­ ted by freelance writers, proofread printers’ galleys, and answer inquiries about published material. Assistants on small newspa­ pers or in smaller media markets may compile articles available from wire services or the Internet, answer phones, and proof­ read articles. Work environment. Advances in electronic communications have changed the work environment for many writers. Laptop computers and wireless communications technologies allow growing numbers of writers and authors to work from home and on the road. The ability to send e-mail or text messages, transmit and download stories, perform research, or review ma­ terials using the Internet allows writers and editors greater flex­ ibility in where and how they complete assignments. Still, some writers and authors work in offices and many travel to conduct on-site research on their topic. Some writers keep regular office hours, either to maintain contact with sources and editors or to establish a writing rou­ tine, but most writers set their own hours. Many writers—es­ pecially freelance writers—are paid per assignment; therefore, they work any number of hours necessary to meet a deadline. As a result, writers must be willing to work evenings, nights, or weekends to produce a piece acceptable to an editor or client by the deadline. While many freelance writers enjoy running their own busi­ nesses and the advantages of working flexible hours, most routinely face the pressures of juggling multiple projects with competing demands and the continual need to find new work. Deadline pressures and long, erratic work hours—often part of the daily routine in these jobs—may cause stress, fatigue, or burnout. In addition, the use of computers for extended periods may cause some individuals to experience back pain, eyestrain, or fatigue. Editors’ schedules generally are determined by the produc­ tion schedule and the type of editorial position. Most sala­ ried editors work in busy offices much of the time and have to deal with production deadline pressures and the stresses of ensuring that the information they publish is accurate. As a result, editors often work long hours, especially at those times leading up to a publication deadline, which can be daily or even more frequently when editing material for the Internet or for a live broadcast. Overseeing and coordinating multiple writing projects simultaneously is common in these jobs, which may lead to stress, fatigue, or other chronic prob­ lems. Freelance editors face the added pressures of finding work on an ongoing basis and continually adjusting to new work environments.  Training, Other Qualifications, and Advancement A college degree generally is required for a position as an au­ thor, writer, or editor. Good facility with computers and com­ munications equipment is necessary in order to stay in touch with sources, editors, and other writers while working on as­ signments, whether from home, an office, or while traveling. Education and training. A bachelor’s degree or higher is typically needed for a job as an author, writer, or editor. Be­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  cause writing skills are essential in this occupation, many em­ ployers like to hire people with degrees in communications, journalism, or English, but those with other backgrounds and who can demonstrate good writing skills may also find jobs as writers. Writers who want to focus on writing about a par­ ticular topic may need formal training or experience related to that topic. For example, textbook writers and fashion editors may need expertise in their subject areas that they acquired either through formal academic training or work experience. The Internet and other media allow some people to gain writ­ ing experience through blog posts, text messages, or self­ publishing software. Some of this writing may lead to paid assignments based upon the quality of the writing, unique per­ spective, or the size of the potential audience, without regard to the absence of a degree. Training and experience for author, writer, and editor jobs can be obtained by working on high school and college newspapers, community newspapers, and radio and television stations and submissions to literary magazines. College theater and music programs offer playwrights and songwriters an opportunity for them to have their work performed. Many magazines, newspa­ pers, and broadcast stations also have internships for students. Interns may write stories, conduct research and interviews, and learn about the publishing or broadcasting business. Other qualifications. Authors, writers and editors must be able to express ideas clearly and logically and should enjoy writing. Creativity, curiosity, a broad range of knowledge, self-motivation, and perseverance are also valuable. Authors, writers, and editors must demonstrate good judgment and a strong sense of ethics in deciding what material to publish. In addition, the ability to concentrate and to work under pressure is essential. Editors also need tact and the ability to guide and encourage others in their work. Familiarity with electronic publishing, graphics, Web de­ sign, and multimedia production increasingly is needed. Use of electronic and wireless communications equipment to send e-mail, transmit work, and review copy often is necessary. On­ line publications require knowledge of computer software and editing tools used to combine text with graphics, audio, video, and animation. Advancement. Writers and authors generally advance by building a reputation, taking on more complex writing assign­ ments, and getting published in more prestigious markets and publications. Examples of previously published work form the best route to advancement. Establishing a track record for meet­ ing deadlines also makes it easier to get future assignments. Writing for smaller businesses, local newspapers, advertising agencies, or not-for-profit organizations either as a staff writer or on a freelance basis, allows beginning writers and authors to begin writing right away and take credit for their work. Opportunities for advancement within these organizations may be limited, because they either do not have enough regular work or do not need more advanced writing. In larger businesses, jobs and promotions usually are more formally structured. Beginners often read submissions, do re­ search, fact check articles, or copy edit drafts, and advance to writing and editing more substantive stories and articles.  336 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 8 22,100 303,300 281,300 Authors, writers, and editors................................................................. 0 -400 129,200 129,600 27-3041 Editors........................................................................................... ..... 15 22,500 174,100 151,700 27-3043 Writers and authors........................................................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa lion Included in the Handbook. ______________________________________ _  Occupational Title  Most editors begin work as writers. Those who are particu­ larly adept at identifying stories, recognizing writing talent, and interacting with writers, may be interested in editing jobs. Except for copy editors, most editors hold management posi­ tions and must also enjoy making decisions related to running a business. For them, advancement generally means moving up the corporate ladder or to publications with larger circulation or greater prestige. Copy editors may move into original writing or substantive editing positions or become freelancers.  Employment Authors, writers and editors held about 281,300 jobs in 2008. Writers and authors held about 151,700 jobs and editors held about 129,600 jobs. About 70 percent of writers and authors were self-employed, while 12 percent of editors were selfemployed. Among the 30 percent of salaried writers and authors, about half work in the professional, scientific, and technical services and in publishing (except Internet) industries. These industries include advertising, public relations and related services and newspaper, periodical, book, and directory publishers, respec­ tively. Other salaried writers and authors work in broadcasting, professional and social organizations, and the motion picture and video industries. While 51 percent of salaried editors worked in the publish­ ing, except Internet industry (half of those for newspapers), a large number of editors were also employed in other industries. Business, professional and social organizations, information services, and educational institutions employed editors to work on their publications or Web content. Jobs are somewhat concentrated in major media and enter­ tainment markets—Boston, Chicago, Los Angeles, New York, and Washington, DC—but improved communications and In­ ternet capabilities allow writers to work from almost anywhere. Many prefer to work outside these cities and travel regularly to meet with publishers and clients and to do research or conduct interviews in person. As a result, job location is less of a require­ ment for many writing or editing positions than it once was. Job Outlook Employment is expected to grow about as fast as average. Keen competition is expected for writing and editing jobs as many people are attracted to this occupation. At the same time, many employers are downsizing. Employment change. Employment of authors, writers, and editors is expected to grow 8 percent, about as fast as the average for all occupations, from 2008 to 2018. Employment in salaried writing and editing positions is expected to in­ slightly as jobs become more prevalent throughout the Digitizedcrease for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  economy. Companies in a wide array of industries are using newer multimedia technologies and online media to reach a more technology friendly consumer and meet the growing de­ mand for Web-based information. Online publications and ser­ vices are growing in number and sophistication, spurring the demand for authors, writers, and editors, especially those with Web or multimedia experience. Businesses and organizations are adding text messaging services to expanded newsletters and Web sites as a way of attracting new customers. They may hire writers or editors on either a salaried or freelance basis to con­ tribute additional content. Some publishing companies however, especially those that rely on advertising revenues and sales re­ ceipts to support large staffs of writers, will employ fewer writ­ ers and editors. But many experienced writers and editors will find work with nonprofit organizations and associations in their public relations offices, or in the public affairs departments of large companies or agencies. Others will find freelance work for newspaper, magazine, or journal publishers; some will write books. Job prospects. Competition is expected for writing and editing jobs as many people are attracted to this occupation. Competition for jobs with established newspaper and magazines will be particularly keen as many organizations move their publication focus from a print to an online presence and as the publishing industry continues to contract. Writers and editors who have adapted to the new media and are comfortable writing for and working with a variety of electronic and digital tools will have an advantage in finding new work. The declining costs of self-publishing and the growing popularity of electronic books and book readers will allow many freelancers to get their work published. Some job openings will arise as experienced workers retire, transfer to other occupations, or leave the labor force.  Earnings Median annual wages for salaried writers and authors were $53,070 in May 2008. The middle 50 percent earned between $38,150 and $75,060. The lowest 10 percent earned less than $28,020, and the highest 10 percent earned more than $106,630. Median annual wages were $58,740 for those working in advertising, public relations, and related services and $43,450 for those working for in newspaper, periodical, book and directory publishers. Median annual wages for salaried editors were $49,990 in May 2008. The middle 50 percent earned between $36,690 and $69,140. The lowest 10 percent earned less than $28,090, and the highest 10 percent earned more than $95,490. Median an­ nual wages of those working for newspaper, periodical, book, and directory publishers were $49,280.  Professional and Related Occupations 337  Freelance writers earn income from their articles, books, and less commonly, television and movie scripts. While most work on an individual project basis for multiple publishers, many support themselves with income derived from other sources. Unless gotten from another job, freelancers generally have to provide for their own health insurance and pension.  Related Occupations Writers and editors communicate ideas and information. Other communications occupations include: Page Announcers.............................................................................. 331 Interpreters and translators.......................................................340 News analysts, reporters, and correspondents......................... 344 Technical writers...................................................................... 353  Sources of Additional Information For information about freelance writing careers, contact: y American Society of Journalists and Authors, 1501 Broadway, Suite 302, New York, NY 10036. Internet: http ://www.asja.org For information about accredited creative writing programs and creative writing conferences, contact: y The Association of Writers and Writing Programs, George Mason University; MS 1E3, Fairfax, VA 22030-4444. Internet: http://www.awpwriter.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos320.htm  Broadcast and Sound Engineering Technicians and Radio Operators Significant Points  • Job applicants will face keen competition for jobs in major metropolitan areas, where pay generally is higher; prospects are expected to be better in small cities and towns. • Technical school, community college, or college training in broadcast technology, electronics, or com­ puter networking provides the best preparation. • About 29 percent of these workers are in broadcast­ ing, mainly in radio and television stations, and 15 percent work in the motion picture, video, and sound recording industries. • Evening, weekend, and holiday work is common. Nature of the Work Broadcast and sound engineering technicians and radio opera­ tors perform a wide variety of tasks. Their duties include setting and maintaining the electrical equipment used in nearly all Digitized up for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  radio and television broadcasts, concerts, plays, sound record­ ings, and movies. There are many specialized occupations in this field. Audio and video equipment technicians set up and operate audio and video equipment, including microphones, speakers, video screens, projectors, video monitors, and recording equip­ ment. They also connect wires and cables and set up and oper­ ate sound and mixing boards and related electronic equipment for concerts, sports events, meetings and conventions, presen­ tations, and news conferences. They may set up and operate associated spotlights and other custom lighting systems. They also are needed to install and maintain equipment in many large businesses and universities that are upgrading their facilities with audio and video equipment. Broadcast technicians set up, operate, and maintain equip­ ment that regulates the signal strength, the clarity, and the ranges of sounds and colors of radio or television broadcasts. These technicians also operate control panels to select the source of the material. Technicians may switch from one camera or studio to another, from film to live programming, or from network to local programming. Sound engineering technicians operate machines and equip­ ment to record, synchronize, mix, or reproduce music, voices, or sound effects in recording studios, sporting arenas, theater productions, or movie and video productions. Broadcast and sound engineering technicians and radio op­ erators perform a variety of duties at small stations. At large stations and at the networks, technicians are more specialized, although job assignments may change from day to day. The terms “operator,” “engineer,” and “technician” often are used interchangeably to describe these workers. They may monitor and log outgoing signals and operate transmitters; set up, ad­ just, service, and repair electronic broadcasting equipment; and regulate fidelity, brightness, contrast, volume, and sound qual­ ity of television broadcasts. Technicians also work in program production. Recording en­ gineers operate and maintain video and sound recording equip­ ment. They may operate equipment designed to produce special effects, such as the illusion of a bolt of lightning or a police si­ ren. Sound mixers or re-recording mixers produce soundtracks for movies or television programs. After filming or recording is complete, these workers may use a process called “dubbing” to insert sounds. Field technicians set up and operate portable transmission equipment outside the studio. Because television news coverage requires so much electronic equipment and the technology is changing so rapidly, many stations assign techni­ cians exclusively to news. Chief engineers, transmission engi­ neers, and broadcast field supervisors oversee other technicians and maintain broadcasting equipment. Radio operators mainly receive and transmit communica­ tions using a variety of tools. These workers also repair equip­ ment, using such devices as electronic testing equipment, hand tools, and power tools. One of their major duties is to help en­ sure communication systems remain in good condition. Work environment. Broadcast and sound engineering tech­ nicians and radio operators generally work indoors in pleasant surroundings. However, those who broadcast news and other programs from locations outside the studio may work outdoors  338 Occupational Outlook Handbook  in all types of weather or in other dangerous conditions. Tech­ nicians doing maintenance may climb poles or antenna towers, and those setting up equipment do heavy lifting. Technicians at large stations and the networks usually work a 40-hour week under great pressure to meet broadcast deadlines, and may occasionally work overtime. Technicians at small stations routinely work more than 40 hours a week. Evening, weekend, and holiday work is usual because most stations are on the air 18 to 24 hours a day, 7 days a week. Some technicians need to be available on call whenever the station is broadcast­ ing; technicians must handle any problems that occur during this time. Technicians who work on motion pictures may be on a tight schedule and may work long hours to meet contractual deadlines.  mmm lllfilifllilflfit  wall i  Training, Other Qualifications, and Advancement Broadcast and sound engineering technicians, as well as audio and video equipment technicians, should have some kind of formal training related to their field. Radio operators do not need an education beyond high school and can usually learn their jobs through several months of on-the-job training. Education and training. Audio and video equipment tech­ nicians should complete a technical-training program related to the field, which may take several months to a year to complete. Many recent entrants to the field have also received an asso­ ciate degree or bachelor’s degree, although it is generally not required for entry-level positions. In addition to coursework, experience in high school or college audiovisual clubs can pro­ vide a student with good training for this occupation. Working as an assistant is a useful way to gain experience and knowledge for an entry-level employee. For broadcast technicians an associate degree in broadcast technology, electronics, computer networking, or a related field is generally recommended. Because of the competitiveness of the broadcast industry, many jobs require a bachelor’s degree. A four-year degree also gives employees much better prospects for advancement in the field. Most entry-level employees find jobs in small markets or with small stations in big markets and can transfer to larger, better paying stations after gaining experience and learning the necessary skills. Small stations usually value more general skills since they have fewer employees doing less specialized work. Large stations almost never hire someone without previ­ ous experience, and they value more specialized skills. Working at a college radio or television station can be very advantageous for prospective employees. Sound engineering technicians usually complete a vocational program, which can take about a year, although there are shorter programs. Prospective technicians should take high school courses in math, physics, and electronics. Technicians need to have excellent computer training to be successful in this field. Radio operators are not usually required to complete any formal training. This is an entry-level position that generally requires on-the-job training. In the motion picture industry, people are hired as appren­ tice editorial assistants and work their way up to jobs requir­ ingfor higher level skills. Employers in the motion picture industry Digitized FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Broadcast technicians set up, operate, and maintain electrical equipment. usually hire experienced freelance technicians on a picture-by­ picture basis. Reputation and perseverance are important in get­ ting jobs. Continuing education to become familiar with emerging technologies is recommended for all broadcast and sound engi­ neering technicians and radio operators. Other qualifications. Broadcast and sound engineering tech­ nicians and radio operators need skills in information technol­ ogy and electronics since most recording, editing, and broad­ casting are done on computers. Prospective technicians must have manual dexterity and an aptitude for working with electri­ cal, electronic, and mechanical systems and equipment. Certification and advancement. Licensing is not required for broadcast technicians. However, certification by the Soci­ ety of Broadcast Engineers is issued to experienced technicians who pass an examination, and the certification may help with advancement. Experienced technicians can become supervisory technicians or chief engineers. A college degree in engineering is needed to become chief engineer at large television stations.  Employment Broadcast and sound engineering technicians and radio opera­ tors held about 114,600 jobs in 2008. Their employment was distributed among the following detailed occupations: Audio and video equipment technicians......................55,400 Broadcast technicians................................................... 38,800 Sound engineering technicians..................................... 19,500 Radio operators...............................................................1,000 About 29 percent of broadcast and sound engineering techni­ cians and radio operators worked in broadcasting (except Inter­ net broadcasting), and 15 percent worked in the motion picture, video, and sound recording industries. About 13 percent were  Professional and Related Occupations 339  Projections data from the National Employment Matrix Occupational Title  soc  Employment,  Code  2008  Projected Employment,  Change, 2008-2018  2018 Number Percent 27-4010 114,600 123,600 9,000 8 27-4011 55,400 62,400 7,000 13 27-4012 38,800 39,400 700 2 27-4013 1,000 1,100 100 9 27-4014 19,500 20.700 1.200 6 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  Broadcast and sound engineering technicians and radio operators .. Audio and video equipment technicians............................... Broadcast technicians........................................................... Radio operators........................................................ Sound engineering technicians............................................... tion Included in the Handbook.  self-employed. Television stations employ, on average, many more technicians than radio stations. Some technicians are em­ ployed in other industries, producing employee communica­ tions, sales, and training programs. Technician jobs in television and radio are located in virtually all U.S. cities; jobs in radio also are found in many small towns. The highest paying and most specialized jobs are concentrated in New York City, Los Ange­ les, Chicago, and Washington, DC—the headquarters of most network and news programs. Motion picture production jobs are concentrated in Los Angeles and New York City.  An area in which technicians will be in increasing demand over the next several years is mobile broadcasting. Job prospects. People seeking entry-level jobs as broadcast technicians are expected to face keen competition because of the large number of people attracted by the glamour of working in television or radio. Competition will be stronger in large met­ ropolitan areas where pay is generally higher and the number of job seekers usually exceeds the number of openings. Prospects for entry-level positions are expected to be better in small cities and towns, provided that the jobseeker has appropriate training.  Job Outlook  Earnings  Employment is expected to grow about as fast as the average through 2018. But people seeking entry-level jobs as techni­ cians in broadcasting are expected to face keen competition in major metropolitan areas. Prospects are expected to be better in small cities and towns. Employment change. Overall employment of broadcast and sound engineering technicians and radio operators is expected to grow by 8 percent over the 2008-18 decade, which is about as fast as the average of all occupations. Projected job growth varies among detailed occupations in this field. Employment of audio and video equipment technicians is expected to grow 13 percent, about as fast as average. Audio and video equip­ ment is in heavy demand in many new buildings, especially new schools, and in existing schools as well. Many new technicians will be needed, not only to install, but to maintain and repair the equipment as well. A growing number of companies will plan permanent departments employing audio and video techni­ cians. An increase in the use of digital signage will also lead to higher demand for audio and video equipment technicians. In the motion picture industry, employment for these workers will grow because they are needed to install digital movie screens. Employment of broadcast technicians is expected to grow by 2 percent, signifying little or no change, and employment of sound engineering technicians is expected to grow by 6 per­ cent, which is slower than average. Advancements in technol­ ogy will enhance the capabilities of technicians to produce higher quality radio and television programming; however, this improved technology will also increase the productivity of technicians, which may hold down employment growth. Jobs in radio and television broadcasting will also be limited by further consolidation of stations and by labor-saving ad­ vances, such as computer-controlled programming. In the ca­ ble and pay portion of the broadcasting industry, employment is expected to grow as the range of products and services ex­ including cable Internet access and video-on-demand. Digitizedpands, for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Television stations usually pay higher salaries than radio sta­ tions, commercial broadcasting usually pays more than non­ commercial broadcasting, and stations in large markets pay more than those in small markets. Median annual wages of audio and video equipment techni­ cians in May 2008 were $38,050. The middle 50 percent earned between $28,130 and $51,780. The lowest 10 percent earned less than $21,500, and the highest 10 percent earned more than $66,030. Median annual wages in motion picture and video in­ dustries, which employed the largest number of audio and video equipment technicians, were $39,410. Median annual wages of broadcast technicians in May 2008 were $32,900. The middle 50 percent earned between $22,900 and $49,340. The lowest 10 percent earned less than $17,510, and the highest 10 percent earned more than $66,550. Median annual wages in radio and television broadcasting, which employed the largest number of broadcast technicians, were $29,220. Median annual wages of sound engineering technicians in May 2008 were $47,490. The middle 50 percent earned be­ tween $32,770 and $69,700. The lowest 10 percent earned less than $23,790, and the highest 10 percent earned more than $92,700. Median annual wages of radio operators in May 2008 were $37,120. The middle 50 percent earned between $27,890 and $48,200. The lowest 10 percent earned less than $19,240, and the highest 10 percent earned more than $61,290.  Related Occupations Other occupations that need the electronics training necessary to operate technical equipment include: Page Electrical and electronics installers and repairers..................675 Engineering technicians........................................................... 173 Science technicians..................................................................230  340 Occupational Outlook Handbook  Broadcast and sound engineering technicians also may oper­ ate computer networks, as do: Computer support specialists.................................................. 138 Other occupations that screen incoming calls on some live radio and television programs are: Communications equipment operators....................................588  Sources of Additional Information For career information and links to employment resources, contact: V National Association of Broadcasters, 1771 N St. NW., Washington, DC 20036. Internet: http://www.nab.org For information on certification and links to employment in­ formation, contact: y Society of Broadcast Engineers, 9102 North Meridian St., Suite 150, Indianapolis, IN 46260. Internet:  http://www.sbe.org For information on audio and video equipment technicians, contact: V InfoComm International, 11242 Waples Mill Rd., Suite 200, Fairfax, VA 22030. Internet: http://www.infocomm.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at  http://www.bls.gov/ooh/ocosl09.htm  Interpreters and Translators Significant Points  • About 26 percent of interpreters and translators are self-employed; many freelance and work in this oc­ cupation only sporadically. • In addition to needing fluency in at least two lan­ guages, many interpreters and translators need a bachelor’s degree. • Employment is expected to grow much faster than average. • Job prospects vary by specialty and language. Nature of the Work Interpreters and translators facilitate the cross-cultural com­ munication necessary in today’s society by converting one language into another. However, these language specialists do more than simply translate words—they relay concepts and ideas between languages. They must thoroughly understand the subject matter in which they work in order to accurately convey information from one language into another. In addition, they must be sensitive to the cultures associated with their languages of expertise. Although some people do both, interpreting and translation are different professions. Interpreters deal with spoken words, with written words. Each task requires a distinct set Digitizedtranslators for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  of skills and aptitudes, and most people are better suited for one or the other. While interpreters often interpret into and from both languages, translators generally translate only into their native language. Interpreters convert one spoken language into another—or, in the case of sign-language interpreters, between spoken com­ munication and sign language. Interpreting requires that one pay attention carefully, understand what is communicated in both languages, and express thoughts and ideas clearly. Strong research and analytical skills, mental dexterity, and an excep­ tional memory also are important. There are two modes of interpreting: simultaneous, and con­ secutive. Simultaneous interpreting requires interpreters to listen and speak (or sign) at the same time someone is speak­ ing or signing. Ideally, simultaneous interpreters should be so familiar with a subject that they are able to anticipate the end of the speaker’s sentence. Because they need a high degree of concentration, simultaneous interpreters work in pairs, with each interpreting for 20-minute to 30-minute periods. This type of interpreting is required at international conferences and is sometimes used in the courts. In contrast to the immediacy of simultaneous interpreting, consecutive interpreting begins only after the speaker has ver­ balized a group of words or sentences. Consecutive interpreters often take notes while listening to the speakers, so they must develop some type of note-taking or shorthand system. This form of interpreting is used most often for person-to-person communication, during which the interpreter is positioned near both parties. Translators convert written materials from one language into another. They must have excellent writing and analytical ability, and because the translations that they produce must be accurate, they also need good editing skills. Translating involves more than replacing a word with its equivalent in another language; sentences and ideas must be ma­ nipulated to flow with the same coherence as those in the source document so that the translation reads as though it originated in the target language. Translators also must bear in mind any cul­ tural references that may need to be explained to the intended audience, such as colloquialisms, slang, and other expressions that do not translate literally. Some subjects may be more dif­ ficult than others to translate because words or passages may have multiple meanings that make several translations possible. Not surprisingly, translated work often goes through multiple revisions before final text is submitted. Nearly all translation work is done on a computer, and most assignments are received and submitted electronically. This enables translators to work from almost anywhere, and a large percentage of them work from home. The Internet pro­ vides advanced research capabilities and valuable language resources, such as specialized dictionaries and glossaries. In some cases, use of computer-assisted translation—in­ cluding memory tools that provide comparisons of previous translations with current work—helps save time and reduce repetition. The services of interpreters and translators are needed in a number of subject areas. While these workers may not com­ pletely specialize in a particular field or industry, many do fo-  Professional and Related Occupations 341  mm M Interpreters and translators must have a thorough understand­ ing of various languages. cus on one area of expertise. Some of the most common areas are described below; however, interpreters and translators may work in a variety of other areas also, including business, educa­ tion, social services, and entertainment. Judiciary interpreters and translators facilitate communi­ cation for people with limited English proficiency who find it challenging to communicate in a legal setting. Legal translators must be thoroughly familiar with the language and functions of the U.S. judicial system, as well as other countries’ legal systems. Court interpreters work in a variety of legal settings, such as attorney-client meetings, preliminary hearings, arraign­ ments, depositions, and trials. Success as a court interpreter requires an understanding of both legal terminology and collo­ quial language. In addition to interpreting what is said, court in­ terpreters also may be required to read written documents aloud in a language other than that in which they were written, a task known as sight translation. Medical interpreters and translator, sometimes referred to as healthcare interpreters and translators, provide language ser­ vices to healthcare patients with limited English proficiency. Medical interpreters help patients to communicate with doc­ tors, nurses, and other medical staff. Translators working in this specialty primarily convert patient materials and informa­ tional brochures issued by hospitals and medical facilities into the desired language. Interpreters in this field need a strong grasp of medical and colloquial terminology in both languages, along with cultural sensitivity to help the patient receive the information. Sign-language interpreters facilitate communication be­ tween people who are deaf or hard of hearing and people who can hear. Sign-language interpreters must be fluent in English and in American Sign Language (ASL), which combines sign­ ing, finger spelling, and specific body language. Most signlanguage interpreters either interpret, aiding communication between English and ASL, or transliterate, facilitating com­ munication between English and contact signing—a form of signing that uses a more English language-based word order. Some interpreters specialize in oral interpreting for people who are deaf or hard of hearing and lip-read instead of sign. Other specialties include tactile signing, which is interpreting forFRASER people who are blind as well as deaf by making manual Digitized for https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  signs into their hands, using cued speech, and signing exact English. Conference interpreters work at conferences that have nonEnglish-speaking attendees. The work is often in the field of international business or diplomacy, although conference in­ terpreters can interpret for any organization that works with speakers of foreign languages. Employers prefer high-level interpreters who have the ability to translate from at least two languages into one native language—for example, the ability to interpret from Spanish and French into English. For some positions, such as those with the United Nations, this qualifica­ tion is mandatory. Guide or escort interpreters accompany either U.S. visitors abroad or foreign visitors in the United States to ensure that they are able to communicate during their stay. These specialists interpret on a variety of subjects, both on an informal basis and on a professional level. Most of their interpreting is consecutive, and work is generally shared by two interpreters when the assignment requires more than an 8-hour day. Frequent travel, often for days or weeks at a time, is common, and it is an aspect of the job that some find particularly appealing. Literary translators adapt written literature from one language into another. They may translate any number of documents, in­ cluding journal articles, books, poetry, and short stories. Liter­ ary translation is related to creative writing; literary translators must create a new text in the target language that reproduces the content and style of the original. Whenever possible, liter­ ary translators work closely with authors to best capture their intended meanings and literary characteristics. Localization translators completely adapt a product or service for use in a different language and culture. The goal of these specialists is to make it appear as though a product originated in the country where it will be sold and supported. At its earlier stages, this work dealt primarily with software localization, but the specialty has expanded to include the adaptation of Internet sites, marketing, publications, and products and services in manufacturing and other business sectors. Work environment. Interpreters work in a wide variety of settings, such as schools, hospitals, courtrooms, and confer­ ence centers. Translators usually work alone, and they must frequently perform under pressure of deadlines and tight sched­ ules. Technology allows translators to work from almost any­ where, and many choose to work from home. Because many interpreters and translators freelance, their schedules often vary, with periods of limited work interspersed with periods requiring long, irregular hours. For those who free­ lance, a significant amount of time must be dedicated to looking for jobs. Interpreters who work over the telephone or through videoconferencing generally work in call centers in urban areas and keep to a standard 5-day, 40-hour workweek.  Training, Other Qualifications, and Advancement Interpreters and translators must be fluent in at least two lan­ guages. Their educational backgrounds may vary widely, but many need a bachelor’s degree. Many also complete jobspecific training programs. Education and training. The educational backgrounds of interpreters and translators vary. Knowing at least two lan-  342 Occupational Outlook Handbook  guages is essential. Although it is not necessary to have been raised bilingual to succeed, many interpreters and translators grew up speaking two languages. In high school, students can prepare for these careers by taking a broad range of courses that include English writing and comprehension, foreign languages, and basic computer proficiency. Other helpful pursuits include spending time abroad, engaging in direct contact with foreign cultures, and reading extensively on a variety of subjects in English and at least one other language. Beyond high school, there are many educational options. Although a bachelor’s degree is often required for jobs, ma­ joring in a language is not always necessary. An educational background in a particular field of study can provide a natural area of subject-matter expertise. However, specialized train­ ing in how to do the work is generally required. Formal pro­ grams in interpreting and translation are available at colleges nationwide and through nonuniversity training programs, con­ ferences, and courses. Many people who work as conference interpreters or in more technical areas—such as localization, engineering, or finance—have master’s degrees, while those working in the community as court or medical interpreters or translators are more likely to complete job-specific training programs. Other qualifications. Experience is an essential part of a successful career in either interpreting or translation. In fact, many agencies or companies use only the services of people who have worked in the field for 3 to 5 years or who have a degree in translation studies, or both. A good way for translators to learn firsthand about the profes­ sion is to start out working in-house for a translation company; however, such jobs are not very numerous. People seeking to enter interpreter or translator jobs should begin by getting expe­ rience whatever way possible—even if it means doing informal or volunteer work. Volunteer opportunities are available through community or­ ganizations, hospitals, and sporting events, such as marathons, that involve international competitors. The American Transla­ tors Association works with the Red Cross to provide volunteer interpreters in crisis situations. Any translation can be used as an example for potential clients, even translation done as practice. Paid or unpaid internships and apprenticeships are other ways for interpreters and translators to get started. Escort inter­ preting may offer an opportunity for inexperienced candidates to work alongside a more seasoned interpreter. Interpreters might also find it easier to break into areas with particularly high demand for language services, such as court or medical interpreting. Whatever path of entry they pursue, new interpreters and translators should establish mentoring relationships to build their skills, confidence, and professional network. Mentoring  may be formal, such as through a professional association, or informal with a coworker or an acquaintance who has experi­ ence as an interpreter or translator. Both the American Transla­ tors Association and the Registry of Interpreters for the Deaf offer formal mentoring programs. Translators working in localization need a solid grasp of the languages to be translated, a thorough understanding of technical concepts and vocabulary, and a high degree of knowledge about the intended target audience or users of the product. Because software often is involved, it is not uncommon for people who work in this area of translation to have a strong background in computer science or to have computer-related work experience. Self-employed and freelance interpreters and translators need general business skills to successfully manage their finances and careers. They must set prices for their work, bill customers, keep financial records, and market their services to attract new business and build their client base. Certification and advancement. There is currently no universal form of certification required of interpreters and translators in the United States. However there are a variety of different tests that workers can take to demonstrate proficiency, which may be helpful in gaining employment. For example, the American Translators Association provides certification in 24 language combinations involving English for its members. Federal courts have certification for Spanish, Navajo, and Haitian Creole interpreters, and many State and municipal courts offer their own forms of certification. The National As­ sociation of Judiciary Interpreters and Translators also offers certification for court interpreting. The U.S. Department of State has a three-test series for pro­ spective interpreters—one test in simple consecutive interpreting (for escort work), another in simultaneous interpreting (for court or seminar work), and a third in conference-level interpreting (for international conferences)—as well as a test for prospec­ tive translators. These tests are not considered a credential, but successful completion indicates that a person has a significant level of skill in the field. Additionally, the International Associa­ tion of Conference Interpreters offers certification for conference interpreters The National Association of the Deaf and the Registry of Interpreters for the Deaf (RID) jointly offer certification for general sign interpreters. In addition, the registry offers spe­ cialty tests in legal interpreting, speech reading, and deaf-todeaf interpreting—which includes interpreting among deaf speakers with different native languages and from ASL to tactile signing. Once interpreters and translators have gained sufficient expe­ rience, they may then move up to more difficult or prestigious assignments, may seek certification, may be given editorial respon­ sibility, or may eventually manage or start a translation agency.  Projections data from the National Employment Matrix Occupational Title Interpreters and translators............................................................  „„„ SOC C0de 27-3091  _ , Employment, 2008 50,900  Projected £m , 2018 62,200  Change, 2008-2018 Number Percent 11,300  22  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 343  Many self-employed interpreters and translators start busi­ nesses by submitting resumes and samples to many different translation and interpreting agencies and then wait to be con­ tacted when an agency matches their skills with a job. Work is often acquired by word of mouth or through referrals from existing clients.  Employment Interpreters and translators held about 50,900 jobs in 2008. However, the actual number of interpreters and translators is probably significantly higher because many work in the occupation only sporadically. Interpreters and translators are employed in a variety of industries, reflecting the diversity of employment options in the field. About 28 percent worked in public and private educational institutions, such as schools, colleges, and universities. About 13 percent worked in health care and social assistance, many of whom worked for hospitals. Another 9 percent worked in other areas of government, such as Federal, State, and local courts. Other employers of interpreters and translators include interpreting and translation agencies, publishing companies, telephone companies, and airlines. About 26 percent of interpreters and translators are selfemployed. Many who freelance in the occupation work only part time, relying on other sources of income to supplement earnings from interpreting or translation.  Job Outlook Interpreters and translators can expect much faster than aver­ age employment growth. Job prospects vary by specialty and language. Employment change. Employment of interpreters and translators is projected to increase 22 percent over the 2008-18 decade, which is much faster than the average for all occupa­ tions. Higher demand for interpreters and translators results directly from the broadening of international ties and the large increases in the number of non-English speaking people in the United States. Both of these trends are expected to continue throughout the projections period, contributing to relatively rapid growth in the number of jobs for interpreters and transla­ tors across all industries in the economy. Demand will remain strong for translators of frequently translated languages, such as Portuguese, French, Italian, Ger­ man, and Spanish. Demand should also be strong for translators of Arabic and other Middle Eastern languages and for the prin­ cipal East Asian languages—Chinese, Japanese, and Korean. Demand for American Sign Language interpreters will grow rapidly, driven by the increasing use of video relay services, which allow individuals to conduct video calls using a sign lan­ guage interpreter over an Internet connection. Technology has made the work of interpreters and transla­ tors easier. However, technology is not likely to have a negative impact on employment of interpreters and translators because such innovations are incapable of producing work comparable with work produced by these professionals. Job prospects. Urban areas, especially Washington, DC, New York, and cities in California, provide the largest numbers of employment possibilities, especially for interpreters; how­ ever, as the immigrant population spreads into more rural areas, Digitizedjobs for FRASER in smaller communities will become more widely available. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Job prospects for interpreters and translators vary by spe­ cialty and language. For example, interpreters and translators of Spanish should have good job opportunities because of expected increases in the Hispanic population in the United States. Demand is expected to be strong for interpreters and transla­ tors specializing in healthcare and law because it is critical that information be fully understood among all parties in these areas. Additionally, there should be demand for specialists in localiza­ tion, driven by the globalization of business and the expansion of the Internet; however, demand may be dampened somewhat by outsourcing of localization work to other countries. Given the shortage of interpreters and translators meeting the desired skill level of employers, interpreters for the deaf will continue to have favorable employment prospects. On the other hand, competition can be expected for both conference interpreter and literary translator positions because of the small number of job opportunities in these specialties.  Earnings Wage and salary interpreters and translators had median hourly wages of $38,850 in May 2008. The middle 50 percent earned between $28,940 and $52,240. The lowest 10 percent earned less than $22,170, and the highest 10 percent earned more than $69,190. Individuals classified as language specialists in the Federal Government earned an average of $79,865 annually in March 2009. Earnings depend on language, subject matter, skill, ex­ perience, education, certification, and type of employer, and salaries of interpreters and translators can vary widely. Interpreters and translators who know languages for which there is a greater demand, or which relatively few people can translate, often have higher earnings, as do those who perform services requiring a high level of skill, such as conference interpreters. For those who are not salaried, earnings typically fluctuate, depending on the availability of work. Freelance interpreters usually earn an hourly rate, whereas translators who freelance typically earn a rate per word or per hour.  Related Occupations Interpreters and translators use their multilingual skills, as do teachers of languages. These include: Page Teachers—adult literacy and remedial education................... 279 Teachers—kindergarten, elementary, middle, and secondary.......................................................................288 Teachers—postsecondary........................................................ 282 Teachers—self-enrichment education..................................... 292 Teachers—special education................................................... 294 Translators prepare texts for publicationor dissemination; other workers involved in this process include: Authors, writers, and editors....................................................333 Interpreters or translators working in a legal or healthcare environment are required to have a knowledge of terms and concepts that is similar to that of other workers in these fields,  such as: Court reporters....................................................................250 Medical transcriptionists..................................................... 457  344 Occupational Outlook Handbook  Sources of Additional Information Organizations dedicated to these professions can provide valu­ able advice and guidance to people interested in learning more about interpreting and translation. The language services divi­ sion of local hospitals or courthouses also may have informa­ tion about available opportunities. For general career information, contact: V American Translators Association, 225 Reinekers Ln., Suite 590, Alexandria, VA 22314. Internet: http://www.atanet.org For more detailed information by specialty, contact the as­ sociation affiliated with the subject area in question. See, for example, the following: y American Literary Translators Association, University of Texas at Dallas, 800 W. Campbell Rd., Mail Station J051, Richardson, TX 75080-3021. Internet: http://www.utdallas.edu/alta > International Medical Interpreters Association, 800 Washington Street, Box 271, Boston, MA 02111-1845. Internet: http://www.imiaweb.org > Localization Industry Standards Association, Domaine en Prael, CH-1323 RomainmUtier, Switzerland. Internet: http ://www.Iisa.org > National Association of Judiciary Interpreters and Translators, 1707 L St. NW., Suite 570, Washington, DC 20036. Internet: http://www.najit.org y National Council on Interpreting in Health Care, 5505 Connecticut Ave. NW., Suite 119, Washington, DC 20015. Internet: http://www.ncihc.org y Registry of Interpreters for the Deaf, 333 Commerce St., Alexandria, VA 22314. Internet: http://www.rid.org For information about testing to become a contract interpreter or translator with the U.S. State Department, contact: y U.S. Department of State, Office of Language Services, 2401 E St. NW., SA-1, Room H1400, Washington, DC 20522. Internet: http://languageservices.state.gov Information on obtaining a position as an interpreter and translator with the Federal Government is available from the Office of Personnel Management through USAJOBS, the Federal Government’s official employment informa­ tion system. This resource for locating and applying for job opportunities can be accessed through the Internet at http://www.usajobs.opm.gov or through an interactive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not toll free, and charges may result. For advice on how to find and apply for Fed­ eral jobs, see the Occupational Outlook Quarterly article “How to get a job in the Federal Government,” online at http://www.bls.gov/opub/ooq/2004/summer/art01.pdf. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl75.htm  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  News Analysts, Reporters, and Correspondents Significant Points  • Competition will be keen for jobs at large metropoli­ tan and national newspapers, broadcast stations, and magazines; small publications and broadcast stations and online newspapers and magazines should provide the best opportunities. • Most employers prefer individuals with a bachelor’s degree in journalism or mass communications and ex­ perience gained at school newspapers or broadcasting stations or through internships with news organiza­ tions. • Jobs often involve long, irregular hours and pressure to meet deadlines. Nature of the Work News analysts, reporters, and correspondents gather infor­ mation, prepare stories, and make broadcasts that inform the public about local, State, national, and international events; present points of view on current issues; and report on the actions of public officials, corporate executives, interest groups, and others who exercise power. News analysts—also called newscasters or news anchors— examine, interpret, and broadcast news received from various sources. News anchors present news stories and introduce vid­ eotaped news or live transmissions from on-the-scene reporters. News correspondents report on news occurring in the large U.S. and foreign cities where they are stationed. In covering a story, reporters, sometimes referred to as journalists, investigate leads and news tips, look at documents, observe events at the scene, and interview people. Reporters take notes and also may take photographs or shoot videos. At their office, they organize the material, determine the focus or emphasis, write their stories, and edit accompanying video material. Many reporters enter information or write stories on laptop computers and electronically submit the material to their offices from remote locations. Increasingly, reporters are asked to maintain and produce material for a newspaper’s Web site. In some cases, newswriters write a story from information col­ lected and submitted by reporters. Radio and television report­ ers often compose stories and report “live” from the scene. At times, they later tape an introduction to or commentary on their story in the studio. Some journalists also interpret the news or offer opinions to readers, viewers, or listeners. In this role, they are called commentators or columnists. Newscasters at large stations and networks usually special­ ize in a particular type of news, such as sports or weather. Weathercasters, also called weather reporters, report current and forecasted weather conditions. They gather information from national satellite weather services, wire services, and local and regional weather bureaus. Some weathercasters are trained meteorologists and can develop their own weather fore­ casts. (See the statement on atmospheric scientists elsewhere in  Professional and Related Occupations 345  ers work in large rooms filled with the sound of keyboards and computer printers, as well as the voices of other reporters. Curi­ ous onlookers, police, or other emergency workers can distract those reporting from the scene for radio and television. Cover­ ing wars, political uprisings, fires, floods, and similar events can be dangerous; however, the rate of injuries for reporters and correspondents is relatively low. Work hours vary. Reporters on morning papers often work from late afternoon until midnight. Radio and television report­ ers usually are assigned to a day or evening shift. Magazine reporters usually work during the day. Reporters sometimes have to change their work hours to meet a deadline or to follow late-breaking developments. Their work may require long hours, irregular schedules, and some travel. Because many stations and networks are on the air 24 hours a day, newscasters can expect to work unusual hours. mu**"* ] * ** |  Television reporters often compose stories and report "live” from the scene. the Handbook.) Sportscasters select, write, and deliver sports news, which may include interviews with sports personalities and coverage of games and other sporting events. General-assignment reporters write about newsworthy oc­ currences—such as accidents, political rallies, visits of celebri­ ties, or business closings—as assigned. Large newspapers and radio and television stations assign reporters to gather news about specific topics—for example, crime or education. Some reporters specialize in fields such as health, politics, foreign af­ fairs, sports, theater, consumer affairs, social events, science, business, or religion. Investigative reporters cover stories that may take many days or weeks of information gathering. Some publications use teams of reporters instead of assign­ ing each reporter one specific topic. As a member of a team, a reporter can cover a greater variety of stories. News teams may include reporters, editors, graphic artists, and photographers working together to complete a story. Reporters on small publications cover all aspects of the news. They take photographs, write headlines, lay out pages, edit wire-service stories, and write editorials. Some also solicit advertisements, sell subscriptions, and perform general office work. Work environment. The work of news analysts, reporters, and correspondents is usually hectic. They are under great pres­ sure to meet deadlines. Broadcasts sometimes are aired with little or no time for preparation. Some news analysts, reporters, Digitizedand for FRASER correspondents work in comfortable, private offices; oth­ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Training, Other Qualifications, and Advancement Most employers prefer individuals with a bachelor’s degree in journalism or mass communications, but some hire graduates with other majors. They look for experience at school newspa­ pers or broadcasting stations, and internships with news orga­ nizations. Large-city newspapers and stations also may prefer candidates with a degree in a subject-matter specialty such as economics, political science, or business. Some large newspa­ pers and broadcasters may hire only experienced reporters. Education and training. More than 1,500 institutions offer programs in communications, journalism, and related programs. In 2008, more than 100 of these were accredited by the Accrediting Council on Education in Journalism and Mass Communications. Most of the courses in a typical curriculum are in liberal arts; the remaining courses are in journalism. The most important skills for journalism students to learn are writing and communication. Students planning a career in broadcasting take courses in radio and television news and production. Those planning newspaper or magazine careers usually specialize in more specific forms of writing. To create stories for online media, they need to learn to use computer software to combine online story text with audio and video elements and graphics. Some schools also offer a master’s or Ph.D. degree in jour­ nalism. Some graduate programs are intended primarily as preparation for news careers, while others prepare journalism teachers, researchers and theorists, and advertising and publicrelations workers. High school courses in English, journalism, and social stud­ ies provide a good foundation for college programs. Useful col­ lege liberal arts courses include English, with an emphasis on writing; sociology; political science; economics; history; and psychology. Courses in computer science, business, and speech are useful as well. Fluency in a foreign language is necessary in some jobs. Employers report that practical experience is the most im­ portant part of education and training. Upon graduation, many students already have gained much practical experience through part-time or summer jobs or through internships with news organizations. Most newspapers, magazines, and broadcast news organizations offer reporting and editing internships. Work on high school and college newspapers, at broadcast-  346 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title  soc  Code  Employment, 2008  Projected Employment, 2018 64,900 8,000 56,900  Change, 2008-2018 Number Percent -4,400 -6 300 4 -8 -4,700  69,300 27-3020 News analysts, reporters and correspondents..................... ............... 27-3021 7,700 Broadcast news analysts.................................................... ............... 61,600 27-3022 Reporters and correspondents.......................................... ............... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaHon Included in the Handbook.  ing stations, or on community papers also provides practical training. In addition, journalism scholarships, fellowships, and assistantships awarded to college journalism students by univer­ sities, newspapers, foundations, and professional organizations are helpful. Experience as a freelancer or stringer—a part-time reporter who is paid only for stories printed—is advantageous. Other qualifications. Reporters typically need more than good word-processing skills. Computer graphics and desk­ top-publishing skills are essential as well. Students should be completely proficient in all forms of multimedia. Computerassisted reporting involves the use of computers to analyze data in search of a story. This technique and the interpretation of the results require computer skills and familiarity with databases. Knowledge of news photography also is valuable for entry-level positions, which sometimes combine the responsibilities of a reporter with those of a camera operator or photographer. Reporters should be dedicated to providing accurate and impartial news. Accuracy is important both to serve the public and because untrue or libelous statements can lead to lawsuits. A nose for news, persistence, initiative, poise, resourcefulness, a good memory, and physical stamina are important, as is the emotional stability to deal with pressing deadlines, irregular hours, and dangerous assignments. Broadcast reporters and news analysts must be comfortable on camera. All report­ ers must be at ease in unfamiliar places and with a variety of people. Positions involving on-air work require a pleasant voice and appearance. Advancement. Most reporters start at small publications or broadcast stations as general assignment reporters or copy editors. They are usually assigned to cover court proceedings and civic and club meetings, summarize speeches, and write obituaries. With experience, they report more difficult assign­ ments or specialize in a particular field. Large publications and stations generally require new reporters to have several years of experience. Some news analysts and reporters can advance by moving to larger newspapers or stations. A few experienced reporters become columnists, correspondents, writers, announcers, or public-relations specialists. Others become editors in print journalism or program managers in broadcast journalism, supervising reporters. Some eventually become broadcasting or publishing industry managers.  Employment News analysts, reporters, and correspondents held about 69,300 jobs in 2008. About 53 percent worked for newspaper, periodical, book, and directory publishers. Another 21 percent worked in radio and television broadcasting. About 19 percent  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  of news analysts, reporters, and correspondents were selfemployed (freelancers or stringers).  Job Outlook Employment is expected to decline moderately through 2018. Competition will continue to be keen for jobs on large metropolitan and national newspapers, broadcast stations and networks, and magazines. Small broadcast stations and publications and online newspapers and magazines should provide the best opportunities. Talented writers who can handle highly specialized scientific or technical subjects will have an advantage. Employment change. Employment of news analysts, reporters, and correspondents is expected to decline 6 percent between 2008 and 2018. Many factors will contribute to the decline in this occupation. Consolidation and convergence should continue in the publishing and broadcasting industries. As a result, companies will be better able to allocate their news analysts, reporters, and correspondents to cover news stories. Since broadcasting and newspapers—the two industries employing most of these workers—are dependent on advertising revenue, employment growth will suffer during an economic downturn. Improving technology may eventually lead to more employment growth in this occupation by opening up new areas of work, such as online or mobile news divisions. The contin­ ued demand for news will create some job opportunities. Job openings also will result from the need to replace workers who leave their occupations permanently; some news analysts, re­ porters, and correspondents find the work too stressful and hec­ tic or do not like the lifestyle, and transfer to other occupations. Job prospects. Competition will continue to be keen for jobs at large metropolitan and national newspapers, broadcast stations and networks, and magazines. Job opportunities will be best for applicants in the expanding world of new media, such as online newspapers or magazines. Small local papers and news stations also will provide greater job prospects for potential reporters and news analysts. For beginning newspaper reporters, freelancing will supply more opportunities for em­ ployment as well. Students with a background in journalism as well as another subject, such as politics, economics, or biol­ ogy, will have an advantage over those without additional back­ ground knowledge in moving beyond an entry-level position. Journalism graduates have the background for work in closely related fields such as advertising and public relations or communications, and many take jobs in these fields. Other graduates accept sales, managerial, or other nonmedia positions.  Professional and Related Occupations 347  Earnings Salaries for news analysts, reporters, and correspondents vary widely. Median annual wages of reporters and correspondents were $34,850 in May 2008. The middle 50 percent earned between $25,760 and $52,160. The lowest 10 percent earned less than $20,180, and the highest 10 percent earned more than $77,480. Median annual wages of reporters and correspondents were $33,430 in newspaper, periodical, book, and directory publishing, and $37,710 in radio and television broadcasting. Median annual wages of broadcast news analysts were $51,260 in May 2008. The middle 50 percent earned between $32,000 and $88,630. The lowest 10 percent earned less than $23,470, and the highest 10 percent earned more than $156,200. Median annual wages of broadcast news analysts were $51,890 in radio and television broadcasting.  Related Occupations News analysts, reporters, and correspondents must write clearly and effectively to succeed in their profession. Others for whom good writing ability is essential include: Page Authors, writers, and editors...................................................333 Public relations specialists......................................................350 Many news analysts, reporters, and correspondents also must communicate information orally. Others for whom oral com­ munication skills are important are: Announcers.............................................................................. 331 Interpreters and translators....................................................... 340 Retail salespersons................................................................... 543 Teachers—kindergarten, elementary, middle, and secondary..........................................................288 Teachers—postsecondary.........................................................282  Sources of Additional Information For information on broadcasting education and scholarship resources, contact: y National Association of Broadcasters, 1771 N St. NW, Washington, DC 20036. Internet: http://www.nab.org Information on careers in journalism, colleges and universi­ ties offering degree programs in journalism or communications, and journalism scholarships and internships may be obtained from: > Dow Jones Newspaper Fund, Inc., P.O. Box 300, Princeton, NJ 08543-0300. Internet: https://www.newspaperfund.org For a list of schools with accredited programs in journal­ ism and mass communications, send a stamped, self-addressed envelope to: V Accrediting Council on Education in Journalism and Mass Communications, University of Kansas School of Journalism and Mass Communications, Stauffer-Flint Hall, 1435 Jayhawk Blvd., Lawrence, KS 66045. Internet: http://www.ku.edu/~acejmc/STUDENT/STUDENT.SHTML Names and locations of newspapers and a list of schools and departments of journalism are published in the Editor and Publisher International Year Book, available in most public and newspaper offices. Digitizedlibraries for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos088.htm  Photographers Significant Points  • Competition for jobs is expected to be keen because the work is attractive to many people. • Technical expertise, a “good eye,” and creativity, are essential, and some photographers need a college de­ gree. • More than half of all photographers are self-employed, a much higher proportion than for most occupations. Nature of the Work Photographers produce and preserve images that paint a picture, tell a story, or record an event. To create commer­ cial-quality photographs, photographers need technical expertise, creativity, and the appropriate professional equip­ ment. Producing a successful picture requires choosing and presenting a subject to achieve a particular effect, and select­ ing the right cameras and other photographic enhancing tools. For example, photographers may enhance the subject’s ap­ pearance with natural or artificial light, shoot the subject from an interesting angle, draw attention to a particular aspect of the subject by blurring the background, or use various lenses to produce desired levels of detail at various distances from the subject. Today, most photographers use digital cameras instead of traditional silver-halide film cameras, although some photog­ raphers use both types, depending on their own preference and the nature of the assignment. Regardless of the camera they use, photographers also employ an array of other equip­ ment—from lenses, filters, and tripods to flash attachments and specially constructed lighting equipment—to improve the quality of their work. Digital cameras capture images electronically, allowing them to be edited on a computer. Images can be stored on por­ table memory devices such as compact disks, memory cards, and flash drives. Once the raw image has been transferred to a computer, photographers can use processing software to crop or modify the image and enhance it through color correc­ tion and other specialized effects. As soon as a photographer has finished editing the image, it can be sent anywhere in the world over the Internet. Photographers also can create electronic portfolios of their work and display them on their own webpage, allowing them to reach prospective customers directly. Digital technology also allows the production of larger, more colorful, and more accurate prints or images for use in advertising, photographic art, and scientific research. Photographers who process their own digital images need to be proficient in the use of comput­ ers, high-quality printers, and editing software.  348 Occupational Outlook Handbook  Photographers who use cameras with silver-halide film of­ ten send their film to laboratories for processing. Color film requires expensive equipment and exacting conditions for correct processing and printing. (See the statement on pho­ tographic process workers and processing machine operators elsewhere in the Handbook.) Other photographers, especially those using black and white film or creating special effects, develop and print their own photographs using their own fully equipped darkrooms,. Photographers who develop their own film must invest in additional developing and printing equip­ ment and acquire the technical skills to operate it. Some photographers specialize in areas such as portrait, commercial and industrial, scientific, news, or fine arts pho­ tography. Portrait photographers take pictures of individuals or groups of people and usually work in their own studios. Some specialize in weddings, religious ceremonies, or school photographs and they may work on location. Portrait photog­ raphers who own and operate their own business have many responsibilities in addition to taking pictures. They must ar­ range for advertising, schedule appointments, set and adjust equipment, purchase supplies, keep records, bill customers, pay bills, and—if they have employees—hire, train, and direct their workers. Many also process their own images, design albums, and mount and frame the finished photographs. Commercial and industrial photographers take pictures of various subjects, such as buildings, models, merchandise, artifacts, and landscapes. These photographs are used in a variety of media, including books, reports, advertisements, and catalogs. Industrial photographers often take pictures of equipment, machinery, products, workers, and company officials. The pictures are used for various purposes—for example, analysis of engineering projects, publicity, or re­ cords of equipment development or deployment. This photog­ raphy frequently is done on location. Scientific photographers take images of a variety of sub­ jects to record scientific or medical data or phenomena, using knowledge of scientific procedures. They typically possess additional knowledge in areas such as engineering, medicine, biology, or chemistry. News photographers, also called photojournalists, photo­ graph newsworthy people, places, and sporting, political, and community events for newspapers, journals, magazines, or television. Fine arts photographers sell their photographs as fine art­ work. In addition to technical proficiency, fine arts photogra­ phers need artistic talent and creativity. Self-employed, or freelance, photographers usually spe­ cialize in one of the above fields. In addition to carrying out assignments under direct contract with clients, they may li­ cense the use of their photographs through stock-photo agen­ cies or market their work directly to the public. Stock-photo agencies sell magazines and other customers the right to use photographs, and pay the photographer a commission. These agencies require an application from the photographer and a sizable portfolio of pictures. Once accepted, photographers usually are required to submit a large number of new pho­  tographs each year. Self-employed photographers must also https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  have a thorough understanding of copyright laws in order to protect their work. Most photographers spend only a small portion of their work schedule actually taking photographs. Their most common activities are editing images on a computer—if they use a digital camera—and looking for new business—if they are self-employed. Work environment. Working conditions for photographers vary considerably. Some photographers may work a 5-day, 40hour week. News photographers, however, often work long, irregular hours and must be available to work on short notice. Many photographers work part time or on variable schedules. Portrait photographers usually work in their own studios but also may travel to take photographs at the client’s location, such as a school, a company office, or a private home. News and commercial photographers frequently travel locally, stay overnight on assignments, or travel to distant places for long periods. Some photographers work in uncomfortable or even dan­ gerous surroundings, especially news photographers covering accidents, natural disasters, civil unrest, or military conflicts. Many photographers must wait long hours in all kinds of weather for an event to take place and stand or walk for long  •r  Portrait photographers take pictures of individuals or groups of people and often work out of their own studios.  Professional and Related Occupations 349  periods while carrying heavy equipment. News photographers often work under strict deadlines. Self-employment allows for greater autonomy, freedom of expression, and flexible scheduling. However, income can be uncertain and the continuous, time-consuming search for new clients can be stressful. Some self-employed photographers hire assistants who help seek out new business.  Training, Other Qualifications, and Advancement Employers usually seek applicants with a “good eye,” imagina­ tion, and creativity, as well as a good technical understanding of photography. Photojournalists or industrial or scientific photog­ raphers generally need a college degree. Freelance and portrait photographers need technical proficiency, gained through a de­ gree, training program, or experience. Education and training. Entry-level positions in photojour­ nalism or in industrial or scientific photography generally re­ quire a college degree in photography or in a field related to the industry in which the photographer seeks employment. Entrylevel freelance or portrait photographers need technical profi­ ciency. Some complete a college degree or vocational training programs. Photography courses are offered by many universities, com­ munity and junior colleges, vocational-technical institutes, and private trade and technical schools. Basic courses in photogra­ phy cover equipment, processes, and techniques. Learning good business and marketing skills is important and some bachelor’s degree programs offer courses focusing on them. Art schools offer useful training in photographic design and composition. Photographers may start out as assistants to experienced pho­ tographers. Assistants acquire the technical knowledge needed to be a successful photographer and also learn other skills nec­ essary to run a portrait or commercial photography business. Individuals interested in a career in photography should try to develop contacts in the field by subscribing to photographic newsletters and magazines, joining camera clubs, and seeking summer or part-time employment in camera stores, newspa­ pers, or photo studios. Other qualifications. Photographers need good eyesight, ar­ tistic ability, and good hand-eye coordination. They should be patient, accurate, and detail-oriented and should be able to work well with others, as they frequently deal with clients, graphic designers, and advertising and publishing specialists. Photog­ raphers need to know how to use computer software programs and applications that allow them to prepare and edit images, and those who market directly to clients should know how to use the Internet to display their work. Portrait photographers need the ability to help people relax in front of the camera. Commercial and fine arts photographers must be imaginative and original. News photographers must not only be good with a camera, but also understand the story be­  hind an event so that their pictures match the story. They must be decisive in recognizing a potentially good photograph and act quickly to capture it. Many photographers have websites which highlight an online portfolio that they use to attract work from magazines or adver­ tising agencies. For freelance photographers, maintaining their website is essential. Photographers who operate their own business, or freelance, need business skills as well as talent. These individuals must know how to prepare a business plan; submit bids; write con­ tracts; keep financial records; market their work; hire models, if needed; get permission to shoot on locations that normally are not open to the public; obtain releases to use photographs of people; license and price photographs; and secure copyright protection for their work. To protect their rights and their work, self-employed photographers require basic knowledge of li­ censing and copyright laws, as well as knowledge of contracts and negotiation procedures. Freelance photographers also should develop an individual style of photography to differentiate themselves from the com­ petition. Advancement. After several years of experience, magazine and news photographers may advance to photography or pic­ ture editor positions. Some photographers teach at technical schools, film schools, or universities.  Employment Photographers held about 152,000 jobs in 2008. More than half were self-employed, a much higher proportion than for most occupations. Some self-employed photographers have con­ tracts with advertising agencies, magazine publishers, or other businesses to do individual projects for a set fee, while others operate portrait studios or provide photographs to stock-photo agencies. Most salaried photographers work in portrait or commercial photography studios; most of the others work for newspapers, magazines, and advertising agencies. Photographers work in all areas of the country, but most are employed in metropolitan areas.  Job Outlook Employment is expected to grow as fast as the average for all occupations. Photographers can expect keen competition for job openings because the work is attractive to many people. Employment change. Employment of photographers is ex­ pected to grow 12 percent over the 2008-18 period, about as fast as the average for all occupations. Demand for portrait photographers should increase as the population grows. More­ over, growth of Internet versions of magazines, journals, and newspapers will require increasing numbers of commercial photographers to provide digital images. The Internet and im-  Projections data from the National Employment Matrix Projected Employment,  Change, 2008-2018 2018 Number Percent Photographers........................................................................................ 27-4021 152,000 169,500 17,500 12 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  SOC Code  Employment, 2008  350 Occupational Outlook Handbook  proved data management programs also should make it easier for freelancers to market directly to their customers, increasing opportunities for self-employment and decreasing reliance on stock photo agencies. Job growth, however, will be constrained somewhat by the widespread use of digital photography and the falling price of digital equipment. Improvements in digital technology reduce barriers of entry into this profession and allow more individual consumers and businesses to produce, store, and access photo­ graphic images on their own. News and commercial photog­ raphers may be the most adversely affected by this increase in amateur photographers and non-copyrighted photos. Declines in the newspaper industry also will reduce demand for news photographers to provide still images for print. Job prospects. Photographers can expect keen competition for job openings because the work is attractive to many people. The number of individuals interested in positions as commer­ cial and news photographers is usually much greater than the number of openings. Salaried jobs in particular may be difficult to find as more companies contract with freelancers rather than hire their own photographers. Those who succeed in landing a salaried job or attracting enough work to earn a living by free­ lancing are likely to be adept at operating a business and to be among the most creative. They will be able to find and exploit the new opportunities available from rapidly changing technol­ ogies. Related work experience, job-related training, or some unique skill or talent—such as a background in computers or electronics or knowledge of a second language—also improve a photographer’s job prospects.  Earnings Median annual wages of salaried photographers were $29,440 in May 2008. The middle 50 percent earned between $20,620 and $43,530. The lowest 10 percent earned less than $16,920, and the highest 10 percent earned more than $62,430. Median annual wages in the photographic services industry, which em­ ployed the largest numbers of salaried photographers, were $26,160. Salaried photographers—most of whom work full time—tend to earn more than those who are self-employed. Because most freelance and portrait photographers purchase their own equip­ ment, they incur considerable expense acquiring and maintain­ ing cameras and accessories. Unlike news and commercial pho­ tographers, few fine arts photographers are successful enough to support themselves solely through their art.  Related Occupations Other occupations requiring artistic talent and creativity in­ clude: Page Architects, except landscape and naval....................................151 Artists and related workers.......................................................301 Commercial and industrial designers......................................304 Fashion designers..................................................................... 307 Graphic designers..................................................................... 312 Television, video, and motion picture camera Digitized foroperators FRASER and editors...........................................................356 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Photojoumalists are often required to cover news stories much the same as: News analysts, reporters, and correspondents......................... 344 The processing work that photographers do on computers is similar to the work of: Desktop publishers................................................................... 579 Prepress technicians and workers............................................ 748  Sources of Additional Information Career information on photography is available from: y Professional Photographers of America, Inc., 229 Peachtree St. NE, Suite 2200, Atlanta, GA 30303. Internet: http://www.ppa.com > National Press Photographers Association, Inc., 3200 Croasdaile Dr., Suite 306, Durham, NC 27705. Internet: http://www.nppa.org > American Society of Media Photographers, Inc., 150 North Second St., Philadelphia, PA 19106. Internet: http://www.asmp.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos264.htm  Public Relations Specialists Significant Points  • Although employment is projected to grow much faster than average, keen competition is expected for entry-level jobs. • Opportunities should be best for college graduates who combine a degree in public relations, journalism, or another communications-related field with a public relations internship or other related work experience. • Strong communication skills are essential. Nature of the Work An organization’s reputation, profitability, and its continued existence can depend on the degree to which its targeted public supports its goals and policies. Public relations special­ ists—also referred to as communications specialists and media specialists, among other titles—serve as advocates for clients seeking to build and maintain positive relationships with the public. Their clients include businesses, nonprofit associations, universities, hospitals, and other organizations, and build and maintain positive relationships with the public. As managers recognize the link between good public relations and the suc­ cess of their organizations, they increasingly rely on public re­ lations specialists for advice on the strategy and policy of their communications. Public relations specialists handle organizational functions, such as media, community, consumer, industry, and govern­ mental relations; political campaigns; interest-group represen­  Professional and Related Occupations 351  tation; conflict mediation; and employee and investor relations. Public relations specialists must understand the attitudes and concerns of community, consumer, employee, and public inter­ est groups to establish and maintain cooperative relationships between them and representatives from print and broadcast journalism. Public relations specialists draft press releases and contact people in the media who might print or broadcast their material. Many radio or television special reports, newspaper stories, and magazine articles start at the desks of public relations special­ ists. Sometimes, the subject of a press release is an organization and its policies toward employees or its role in the community. For example, a press release might describe a public issue, such as health, energy, or the environment, and what an organization does to advance that issue. Public relations specialists also arrange and conduct pro­ grams to maintain contact between organization representatives and the public. For example, public relations specialists set up speaking engagements and prepare speeches for officials. These media specialists represent employers at community projects; make film, slide, and other visual presentations for meetings and school assemblies; and plan conventions. In government, public relations specialists may be called press secretaries. They keep the public informed about the ac­ tivities of agencies and officials. For example, public affairs specialists in the U.S. Department of State alert the public of travel advisories and of U.S. positions on foreign issues. A press secretary for a member of Congress informs constituents of the representative’s accomplishments. In large organizations, the key public relations executive, who often is a vice president, may develop overall plans and policies with other executives. In addition, public relations de­ partments employ public relations specialists to write, research, prepare materials, maintain contacts, and respond to inquiries. People who handle publicity for an individual or who direct public relations for a small organization may deal with all as­ pects of the job. These public relations specialists contact peo­ ple, plan and research, and prepare materials for distribution. They also may handle advertising or sales promotion work to support marketing efforts. Work environment. Public relations specialists work in busy offices. The pressures of deadlines and tight work schedules can be stressful. Some public relations specialists work a standard 35- to 40hour week, but overtime is common, and work schedules can be irregular and are frequently interrupted. Occasionally, they must be at the job or on call around the clock, especially if there is an emergency or crisis. Schedules often have to be rearranged so workers can meet deadlines, deliver speeches, attend meet­ ings and community activities, and travel.  Training, Other Qualifications, and Advancement A bachelor’s degree in a communications-related field com­ bined with public relations experience is excellent preparation for a person interested in public relations work. Education and training. Many entry-level public relations specialists have a college degree in public relations, journalism, marketing, or communications. Some firms seek college gradu https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  T V m  I—"¥£.  A.f managers recognize the importance of good public rela­ tions, they increasingly rely on the advice of public relations specialists. ates who have worked in electronic or print journalism. Other employers seek applicants with demonstrated communication skills and training or experience in a field related to the firm’s business—information technology, health care, science, engi­ neering, sales, or finance, for example. Many colleges and universities offer bachelor’s and postsec­ ondary programs leading to a degree in public relations, usually in a journalism or communications department. In addition, many other colleges offer courses in this field. Courses in ad­ vertising, business administration, finance, political science, psychology, sociology, and creative writing also are helpful. Specialties may be offered in public relations for business, gov­ ernment, and nonprofit organizations. Internships in public relations provide students with valuable experience and training and are the best route to finding entrylevel employment. Membership in local chapters of the Public Relations Student Society of America (affiliated with the Pub­ lic Relations Society of America) or in student chapters of the International Association of Business Communicators provides an opportunity for students to exchange views with public re­ lations specialists and to make professional contacts that may help them to find a full-time job after graduation. Some organizations, particularly those with large public relations staffs, have formal training programs for new em­ ployees. In smaller organizations, new employees work under the guidance of experienced staff members. Entry-level work­ ers often maintain files of material about company activities, skim newspapers and magazines for appropriate articles to clip, and assemble information for speeches and pamphlets. New workers also may answer calls from the press and the public, prepare invitation lists and details for press conferences, or escort visitors and clients. After gaining experience, they write news releases, speeches, and articles for publication or plan and  352 Occupational Outlook Handbook  carry out public relations programs. Public relations specialists in smaller firms usually get well-rounded experience, whereas those in larger firms become more specialized. Other qualifications. In addition to the ability to commu­ nicate thoughts clearly and simply, public relations specialists must show creativity, initiative, and good judgment. Decision­ making, problem-solving, and research skills also are impor­ tant. People who choose public relations as a career should have an outgoing personality, self-confidence, an understanding of human psychology, and an enthusiasm for motivating people. They should be assertive but able to participate as part of a team and be open to new ideas. Certification and advancement. The Universal Accredi­ tation Board accredits public relations specialists who are members of the Public Relations Society of America and who participate in the Examination for Accreditation in Public Rela­ tions process. This process includes both a readiness review and an examination, which are designed for candidates who have at least 5 years of full-time work or teaching experience in public relations and who have earned a bachelor’s degree in a communications-related field. The readiness review includes a written submission by each candidate, a portfolio review, and dialogue between the candidate and a three-member panel. Candidates who successfully advance through readiness review and pass the computer-based examination earn the Accredited in Public Relations (APR) designation. The International Association of Business Communicators (IABC) also has an accreditation program for professionals in the communications field, including public relations specialists. Those who meet all the requirements of the pro­ gram earn the Accredited Business Communicator (ABC) designation. Candidates must have at least 5 years of experi­ ence and a bachelor’s degree in a communications field and must pass written and oral examinations. They also must submit a portfolio of work samples that demonstrate involvement in a range of communications projects and a thorough understand­ ing of communications planning. Employers may consider professional recognition through accreditation as a sign of competence in this field, and such designations could be especially helpful in a competitive job market. Public relations specialists who show that they can handle more demanding assignments are more likely to be promoted to supervisory jobs than those who are unable to do so. In public relations firms, an entry-level worker might be hired as a junior account executive and be promoted over the course of a career to account executive, senior account executive, account man­ ager, and, eventually, vice president. Specialists in corporate public relations follow a similar career path, although the job titles may differ.  Some experienced public relations specialists start their own consulting firms. (For more information on public relations managers, see the Handbook statement on advertising, market­ ing, promotions, public relations, and sales managers.)  Employment Public relations specialists held about 275,200 jobs in 2008. They are concentrated in service-providing industries, such as advertising and related services; health care and social assis­ tance; educational services; and government. Others work for communications firms, financial institutions, and government agencies. Public relations specialists are concentrated in large cities, where press services and other communications facilities are readily available and where many businesses and trade associa­ tions have their headquarters. Many public relations consulting firms, for example, are in New York, Los Angeles, San Fran­ cisco, Chicago, and Washington, D.C. There is a trend, how­ ever, toward public relations jobs to be dispersed throughout the Nation, closer to clients.  Job Outlook Employment is projected to grow much faster than average; however, keen competition is expected for entry-level jobs. Employment change. Employment of public relations specialists is expected to grow 24 percent from 2008 to 2018, much faster than the average for all occupations. The need for good public relations in an increasingly competitive and global business environment should spur demand for these workers, especially those with specialized knowledge or international experience. Employees who possess additional language capabilities also are in great demand. The recent emergence of social media in the public rela­ tions is expected to increase job growth as well. Many public relations firms are expanding their use of these tools, and spe­ cialists with skills in them will be needed. Employment in public relations firms is expected to grow as firms hire contractors to provide public relations services, rather than support more full-time staff when additional work is needed. Among detailed industries, the largest job growth will con­ tinue to be in advertising and related services. Job prospects. Keen competition likely will continue for en­ try-level public relations jobs, as the number of qualified appli­ cants is expected to exceed the number of job openings. Many people are attracted to this profession because of the high-pro­ file nature of the work. Opportunities should be best for college graduates who combine a degree in journalism, public relations, or another communications-related field with a public relations internship or other related work experience. Applicants who do  Projections data from the National Employment Matrix Occupational Title Public relations specialists...................................... .............................  soc  Code 27-3031  Employment, 2008 275,200  Projected Employment, 2018 341,300  Change, 2008-2018 Number Percent 66,200 24  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 353  not have the appropriate educational background or work expe­ rience will face the toughest obstacles. Additional job opportunities should result from the need to replace public relations specialists who retire or leave the oc­ cupation for other reasons.  Earnings Median annual wages for salaried public relations specialists were $51,280 in May 2008. The middle 50 percent earned be­ tween $38,400 and $71,670; the lowest 10 percent earned less than $30,140, and the top 10 percent earned more than $97,910. Median annual wages in the industries employing the largest numbers of public relations specialists in May 2008 were: Management of companies and enterprises...............$55,530 Business, professional, labor, political, and similar organizations.......................................... 55,460 Advertising, public relations and related services........55,290 Local government......................................................... 51,340 Colleges, universities, and professional schools......... 46,660  Related Occupations Public relations specialists create favorable attitudes among various organizations, interest groups, and the public through effective communication. Other workers with similar jobs in­ clude: Page Advertising, marketing, promotions, public relations, and sales managers......................................32 Demonstrators and product promoters.................................... 532 Lawyers.............................................................................................. 257  Market and survey researchers.................................................212 News analysts, reporters, and correspondents......................... 344 Sales representatives, wholesale and manufacturing.............. 547  Sources of Additional Information A comprehensive directory of schools offering degree pro­ grams, a sequence of study in public relations, a brochure on careers in public relations, and an online brochure entitled Where Shall I Go to Study Advertising and Public Relations? are available from: y Public Relations Society of America, Inc., 33 Maiden Lane, New York, NY 10038-5150. Internet: http://www.prsa.org For information on accreditation for public relations profes­ sionals and the IABC Student Web site, contact: y International Association of Business Communicators, 601 Montgomery St. Suite 1900, San Francisco, CA 94111. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos086.htm   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Technical Writers Significant Points  • Most jobs in this occupation require a college de­ gree—preferably in communications, journalism, or English—but a degree in a technical subject may be useful. • Job prospects for most technical writing jobs are expected to be good, particularly for those with Web or multimedia experience. • Excellent communications skills, curiosity, and atten­ tion to detail are highly desired traits. Nature of the Work Technical writers, also called technical communicators, put technical information into easily understandable language. They work primarily in information-technology-related industries, coordinating the development and dissemination of technical content for a variety of users; however, a growing number of technical communicators are using technical content to resolve business communications problems in a diversifying number of industries. Included in their products are operating instructions, how-to manuals, assembly instructions, and other documenta­ tion needed for online help and by technical support staff, con­ sumers, and other users within the company or industry. Techni­ cal writers also develop documentation for computer programs and set up communications systems with consumers to assess customer satisfaction and quality control matters. In addition, they commonly work in engineering, scientific, healthcare, and other areas in which highly specialized material needs to be explained to a diverse audience, often of laypersons. Technical writers often work with engineers, scientists, com­ puter specialists, and software developers to manage the flow of information among project workgroups during development and testing. They also may work with product liability specialists and customer service or call center managers to improve the quality of product support and end-user assistance. Technical writers also oversee the preparation of illustrations, photographs, diagrams, and charts. Technical writers increasingly are using a variety of multimedia formats to convey information in such a way that complex concepts can be understood easily by users of the information. Applying their knowledge of the user of the product, technical writers may serve as part of a team conducting usability studies to help improve the design of a product that is in the prototype stage. Technical writers may conduct research on their topics through personal observation, library and Internet research, and discussions with technical specialists. They also are expected to demonstrate their understanding of the subject matter and establish their credibility with their colleagues. Technical writers use computers and other electronic com­ munications equipment extensively in performing their work. They also work regularly with desktop and other electronic publishing software and prepare material directly for the In­ ternet. Technical writers may work with graphic design, page layout, and multimedia software; increasingly, they are prepar-  354 Occupational Outlook Handbook  mg documents by using the interactive technologies of the Web to blend text, graphics, multidimensional images, and sound. Some technical writers work on a freelance or contract basis. They either are self-employed or work for a technical consult­ ing firm and may be hired to complete specific short-term or recurring assignments, such as writing about a new product or coordinating the work and communications of different units to keep a project on track. Whether a project is to be coordinated among an organization’s departments or among autonomous companies, technical writers ensure that the different entities share information and mediate differences in favor of the end user in order to bring a product to market sooner. Work environment. Advances in computer and communica­ tions technologies make it possible for technical writers to work from almost anywhere. Laptop computers and wireless commu­ nications permit technical writers to work from home, an office, or on the road. The ability to use the Internet to e-mail, transmit, and download information and assignments, conduct research, or review materials allows them greater flexibility in where and how they complete assignments. Many technical writers work with people located around the world and with specialists in highly technical fields, such as sci­ ence and engineering. As a result, they must be able to assimi­ late complex information quickly and be comfortable working with people from diverse professional and cultural backgrounds. Although most technical writers are employed directly by the companies that use their services, many freelance writers are paid on a project basis and routinely face the pressures of jug­ gling multiple projects and the continual need to find new work. Technical writers may be expected to work evenings, nights, or weekends to coordinate with those in other time zones, meet deadlines, or produce information that complies with project requirements and is acceptable to the client.  Training, Other Qualifications, and Advancement A college degree is required for a position as a technical writer. In addition, knowledge in a technical subject, as well as experi­ ence in Web design and computer graphics, is important. Education and training. Employers look for candidates with a bachelor’s degree, often preferring those with a major in  communications, journalism, or English. Some technical writ­ ing jobs may require both experience and either a degree or knowledge in a specialized field—for example, engineering, medicine, or one of the sciences; others have broader require­ ments, such as a background in liberal arts. Knowledge of a second language is helpful for some positions. Experience in Web design and computer graphics also is helpful, because of the growing use of online technical documentation. Other qualifications. Technical writers must have excellent writing and communication skills and be able to express ideas clearly and logically in a variety of media. Increasingly, techni­ cal writers need familiarity with electronic publishing, graph­ ics, and sound and video production. Also needed is knowledge of computer software for combining online text with graphics, audio, video, and animation, as well as the ability to manage large, complex, and interconnected files. Technical writers must be detail oriented, curious, persistent in solving problems, self-motivated, and able to understand complex material and explain it clearly. Technical writers also must demonstrate good working relationships and sensitivity toward others, especially those from different backgrounds. In addition, the ability to work under pressure and in a variety of work settings is essential. Advancement. Some technical writers begin their careers not as writers, but as specialists in a technical field or as re­ search assistants or trainees in a technical information depart­ ment. By transferring or developing technical communication skills, they eventually assume primary responsibilities for tech­ nical writing. In small firms, beginning technical writers may work on projects right away; in larger companies with more standard procedures, beginners may observe experienced tech­ nical writers and interact with specialists before being assigned projects. Prospects for advancement generally include working on more complex projects, leading or training junior staff, and getting enough work to make it as a freelancer. Many firms and freelancers provide technical writing services on a contract basis, often to small or not-for-profit organizations that do not have enough regular work to employ technical writ­ ers full time. Building a reputation and establishing a record for meeting deadlines also makes it easier to get future assign­ ments. An experienced, credible, and reliable freelance techni­ cal writer or editor often is able to establish long-term dealings with the same companies.  Employment  ; * ... Technical writers use computer and communications technolo­ gies extensively, which allows them to workfrom home or wher­ ever their work takes them.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Technical writers held about 48,900 jobs in 2008. There are technical writers in almost every industry, but they are concen­ trated in industries related to computer systems and software, publishing (except Internet), science, and engineering. The in­ dustry that employed the most technical writers in 2008 was the computer systems design industry, which had 18 percent of these workers. The second-largest employer was the computer and electronic manufacturing industry, with 8 percent of work­ ers. Software publishers; architectural, engineering, and related services; management, scientific, and technical consulting ser­ vices; and scientific research and development services indus­ tries also employed a sizeable number of technical writers. Two percent of technical writers were self-employed in 2008.  Professional and Related Occupations 355  Projections data from the National Employment Matrix Occupational Title  soc  Code  Employment, 2008  Technical writers.........................................  48,900  Projected Employment, 2018 57,800  Change, 2008-2018 Number Percent 8,900 18  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  Jobs usually are concentrated in areas with high informa­ tion technology or scientific and technical research industry employment, such as San Francisco and San Jose, CA; Bos­ ton, MA; and Washington, DC. However, technology permits technical writers to work in one location while communicating with clients and colleagues in another. As a result, geographic concentration is less of a requirement than it once was.  ing positions with more desirable companies and for workers who are new to the occupation. In addition to job openings created by employment growth, some openings will arise as experienced workers retire, trans­ fer to other occupations, or leave the labor force. Also, many freelancers may not earn enough money by freelancing to re­ main in the occupation, thus generating additional job open­  Job Outlook Employment of technical writers is expected to grow faster than the average for all occupations as the need to explain a grow­ ing number of electronic and scientific products increases. Job prospects are expected to be good for those with solid writing and communications skills and a technical background. Employment change. Employment of technical writers is expected to grow 18 percent, or faster than the average for all occupations, from 2008 to 2018. Demand over this decade is expected to increase because of the continuing expansion of scientific and technical information and the growing pres­ ence of customer service and Web-based product support net­ works. Legal, scientific, and technological developments and discoveries will generate demand for people who can interpret technical information for a general audience. Rapid growth and change in the high-technology and electronics industries will result in a greater need for people who can write users’ guides, instruction manuals, and training materials in a vari­ ety of formats and communicate information clearly to others. This occupation requires workers who are both skilled writers and effective communicators and familiar with a specialized subject area. Increasing acceptance of interactive media to provide nearly real-time information will create employment opportu­ nities for technical writers because of the need to revise online information. Businesses and organizations are making more material available online often in formats that permit greater scrutiny and comparison of detailed information. The growing amount and complexity of information available on the Web will spur demand for technical writers. Professional, scien­ tific, and technical services firms will continue to grow and should be a good source of new jobs even as the occupation finds acceptance in a broader range of industries, including data processing, hosting, and related services and educational services. Job prospects. Job prospects, especially for applicants with solid communication and technical skills, are expected to be good. The growing reliance on technologically sophisti­ cated products in the home and the workplace and the increas­ ing complexity of medical or scientific information needed for daily living will create many new job opportunities for techni­ cal writers. However, competition will exist for technical writ­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  ings.  Earnings Median annual wages for salaried technical writers were $61,620 in May 2008. The middle 50 percent earned between $47,100 and $78,910. The lowest 10 percent earned less than $36,500, and the highest 10 percent earned more than $97,460. Median annual wages in the industries employing the largest number of technical writers were: Software publishers.................................................... $71,640 Computer systems design and related services........... 64,380 Management, scientific, and technical consulting services................................................... 62,920 Employment services................................................... 61,810 Architectural, engineering, and related services......... 60,140  Related Occupations Technical writers communicate ideas and information. Other occupations requiring good communications skills include the following: Page Announcers.............................................................................. 331 Authors, writers, and editors....................................................333 Interpreters and translators.......................................................340 Public relations specialists.......................................................350  Sources of Additional Information For information on careers in technical writing, contact: y Society for Technical Communication, Inc., 9401 Lee Highway, Suite 300, Fairfax, VA 22031. Internet:  http ://www.stc.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at  http://www.bls.gov/ooh/ocos319.htm  356 Occupational Outlook Handbook  Television, Video, and Motion Picture Camera Operators and Editors Significant Points • Keen competition for jobs is expected due to the large number of people who wish to enter the broadcasting and motion picture industries. • Opportunities will be best for those with a bachelor’s degree or postsecondary training. Nature of the Work Television, video, and motion picture camera operators pro­ duce images that tell a story, inform or entertain an audience, or record an event. Film and video editors edit soundtracks, film, and video for the motion picture, cable, and broadcast televi­ sion industries. Some camera operators do their own editing. Camera operators use television, video, or motion picture cameras to shoot a wide range of material, including televi­ sion series, studio programs, news and sporting events, music videos, motion pictures, documentaries, and training sessions. This material is constmcted from many different shots by film and video editors. With the increase in digital technology, the editing work is now done on a computer. Many camera opera­ tors and editors are employed by independent television sta­ tions; local affiliate stations of television networks; large cable and television networks; or smaller, independent production companies. Making commercial-quality movies and video programs re­ quires technical expertise and creativity. Producing successful images requires choosing and presenting interesting material, selecting appropriate equipment, and applying a steady hand to ensure smooth, natural movement of the camera. Videographers film or videotape private ceremonies and spe­ cial events, such as weddings. Some record and post short vid­ eos on Web sites for businesses. Studio camera operators work in a broadcast studio and usually videotape their subjects from a fixed position. News camera operators, also called electronic news-gathering (ENG) operators, work as part of a reporting team, following newsworthy events as they unfold. To capture live events, they must anticipate the action and act quickly. ENG operators sometimes edit raw footage on the spot for relay to a television affiliate for broadcast. Camera operators employed in the entertainment field use motion picture cameras to film movies, television programs, and commercials. Those who film motion pictures also are known as cinematographers. Some specialize in filming car­ toons or special effects. Cinematographers may be an integral part of the action, using cameras in any of several different mounts. For example, the camera can be stationary and shoot whatever passes in front of the lens, or it can be mounted on a track, with the camera operator responsible for shooting the scene from different angles or directions. Wider use of digital cameras has enhanced the number of angles and the clarity that a camera operator can provide. Other camera operators sit on cranes and follow the action while crane operators move them into position. Steadicam operators mount a harness and carry   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  the camera on their shoulders to provide a clear picture while they move about the action. Camera operators who work in the entertainment field often meet with a director of photography to discuss ways of filming, editing, and improving scenes. Work environment. ENG operators and those who cover major events, such as conventions or sporting events, frequently travel locally and stay overnight or travel to distant places for longer periods. Camera operators filming television programs or motion pictures may travel to film on location. Some camera operators—especially ENG operators covering accidents, natural disasters, civil unrest, or military conflicts— work in uncomfortable or even dangerous surroundings; how­ ever the occupation as a whole does not tend to suffer more work related injuries than other occupations. Many camera operators must wait long hours in all kinds of weather for an event to take place and must stand or walk for long periods while carrying heavy equipment. ENG operators often work under strict deadlines. Hours of work and working schedules for camera operators and editors vary considerably. Those employed by television and cable networks or advertising agencies may work long hours to meet production schedules. ENG operators often work long, irregular hours and must be available to work on short notice. Camera operators and editors working in motion picture production also may work long, irregular hours.  Training, Other Qualifications, and Advancement Television, video, and motion picture camera operators and edi­ tors usually acquire their skills through formal postsecondary training at film schools, colleges, universities, or photographic institutes. A bachelor’s degree is required for most positions. Employers usually seek applicants with a good eye, imagina­ tion, and creativity, as well as a good technical understanding of how the camera operates. Education and training. Many universities, community and junior colleges, and private trade and technical schools offer courses in camera operation and videography. Basic courses cover equipment, processes, and techniques. It is very impor­ tant for camera operators to have a good understanding of com­ puter technology and knowledge of digital cameras. Bachelor’s degree programs, especially those including business courses,  Film and video editors edit soundtracks, film, and video for the motion picture and cable and broadcast television industries.  Professional and Related Occupations 357  Projections data from the National Employment Matrix Occupational Title Television, video, and motion picture camera operators and editors Camera operators, television, video, and motion picture............ Film and video editors........................................................  SOC Code 27-4030 27-4031 27-4032  Employment, 2008 51,900 26,300 25,500  Projected Employment, 2018 57,300 28,800 28,600  Change, 2008-2018 Number Percent 5,400 11 2,400 9 3,000 12  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa tion Included in the Handbook.  provide a well-rounded education. Film schools also may provide training on the artistic aspects of filmmaking. Individuals interested in camera operations should subscribe to videographic newsletters and magazines, join audio-video clubs, and seek summer or part-time employment in cable and television networks, motion picture studios, or camera and video stores. To enter the occupation, many camera operators first become production assistants, to learn how film and video production works. In entry-level jobs they learn to set up lights, cameras, and other equipment. They also may receive routine assign­ ments requiring adjustments to their cameras or decisions on what subject matter to capture. Camera operators in the film and television industries usually are hired for a project on the basis of recommendations from individuals such as producers, directors of photography, and camera assistants from previous projects or through interviews with the producer. A good pro­ fessional reputation is important in finding employment. ENG and studio camera operators who work for television affiliates usually start in small markets to gain experience. Other qualifications. Camera operators need good eyesight, artistic ability, and hand-eye coordination. They should be patient, accurate, and detail oriented. Camera operators also should have good communication skills and, if needed, the ability to hold a camera by hand for extended periods. Camera operators who run their own businesses or do freelance work need business skills as well as talent. These individuals must know how to submit bids, write contracts, get permission to shoot on locations that normally are not open to the public, obtain legal permission to use film or tape of people, price their services, secure copyright protection for their work, and keep financial records. Advancement. With experience, operators may advance to more demanding assignments or to positions with larger or network television stations. Advancement for ENG operators may mean moving to larger media markets. Other camera operators and editors may become directors of photography for movie studios, advertising agencies, or television programs. Some teach at technical schools, film schools, or universities.  Employment Television, video, and motion picture camera operators and edi­ tors held about 51,900 jobs in 2008. About 26,300 were camera operators, and film and video editors held about 25,500 jobs. Many are employed by independent television stations, local affiliate stations of television networks or broadcast groups, large cable and television networks, or smaller, independent production companies. There also are a large number of self em­ ployed camera operators and film editors. Some self-employed   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  camera operators contract with television networks, documen­ tary or independent filmmakers, advertising agencies, or trade show or convention sponsors to work on individual projects for a set fee, often at a daily rate. Most of the salaried camera operators and editors were em­ ployed by television broadcasting stations or motion picture studios. 37 percent of the salaried camera operators and editors worked for motion picture and video industry while 18 percent worked in television broadcasting. Most camera operators and editors worked in large metropolitan areas.  Job Outlook Keen competition for jobs is expected due to the large num­ ber of people who wish to enter the broadcasting and motion picture industries, in which many camera operators and editors are employed. Those with the most experience and the most advanced computer skills will have the best job opportunities. Employment is expected to grow about as fast as the average for all occupations. Employment change. Employment of camera operators and editors is expected to grow 11 percent over the 2008-18 decade, which is as fast as the average for all occupations through 2018. As the motion picture industry expands, demand for camera op­ erators and editors will expand also. Camera operators will be needed to film made-for-Internet broadcasts, such as music vid­ eos, digital movies, sports features, and general entertainment programming. As the market for professional Internet video grows, camera operators may see increases in employment. Growth will be tempered, however, by the increased offshore production of motion pictures. Job growth for studio camera operators in television broadcasting will be slowed by the use of automated cameras under the control of a single person work­ ing either on the studio floor or in a director’s booth. For ENG camera operators and editors, growth may be tempered by the combination of roles and other cost-cutting measures at broad­ cast stations. For videographers, computer and Internet services will provide new outlets for interactive productions. Job prospects. Television, video, and motion picture camera operators and editors can expect keen competition for job open­ ings because of the large number of people who wish to enter the broadcasting and motion picture industries, in which many of these workers are employed. The number of individuals in­ terested in positions as videographers and movie camera opera­ tors usually is much greater than the number of openings. Those who succeed in landing a salaried job or attracting enough work to earn a living by freelancing are likely to be the most creative and highly motivated people, able to adapt to rapidly changing technologies and adept at operating a business. The change to digital cameras has increased the importance of strong com­  358 Occupational Outlook Handbook  puter skills. Those with the most experience and the most ad­ vanced computer skills will have the best job opportunities.  Earnings Median annual wages for television, video, and motion picture camera operators were $41,670 in May 2008. The middle 50 percent earned between $29,020 and $59,970. The lowest 10 percent earned less than $21,710, and the highest 10 percent earned more than $79,440. Median annual wages were $40,910 in the motion picture and video industries and $36,250 in radio and television broadcasting. Median annual wages for film and video editors were $50,560 in May 2008. The middle 50 percent earned between $33,060 and $77,700. The lowest 10 percent earned less than $24,640, and the highest 10 percent earned more than $112,410. Median annual wages were $56,170 in the motion picture and video in­ dustries, which employed the largest numbers of film and video editors. Freelance camera operators’ earnings tend to fluctuate each year. Because most freelance camera operators purchase their own equipment, they incur considerable expense acquiring and maintaining cameras and accessories. Some camera operators belong to unions, including the International Alliance of Theat­ rical Stage Employees and the National Association of Broad­ cast Employees and Technicians.  Related Occupations Related arts and media occupations include: Page Artists and related workers.......................................................301 Broadcast and sound engineering technicians and radio operators...............................................................337 Graphic designers..................................................................... 312 Photographers........................................................................... 347  Sources of Additional Information For information about careers as a camera operator, contact: y International Cinematographer’s Guild, 80 Eighth Ave., 14th Floor, New York, NY 10011. y National Association of Broadcast Employees and Technicians, 501 Third St. NW., 6th floor, Washington, DC 20001. Internet: http://www.nabetcwa.org Information about career and employment opportunities for camera operators and film and video editors also is available from local offices of State employment service agencies, local offices of the relevant trade unions, and local television and film production companies that employ these workers. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the Inter­ net version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos091.htm  Health Diagnosing and Treating Practitioners Audiologists Significant Points • About 64 percent worked in health care facilities; many others were employed by educational services. • All States regulate licensure of audiologists; require­ ments vary by State. • A master’s degree in audiology (hearing) is the standard level of education required; however, a doc­ toral degree is becoming more common for new en­ trants. • Job prospects will be favorable for those possessing the doctoral (Au.D.) degree. Nature of the Work Audiologists work with people who have hearing, balance, and related ear problems. They examine individuals of all ages and identify those with the symptoms of hearing loss and other auditory, balance, and related sensory and neural prob­ lems. They then assess the nature and extent of the problems and help the individuals manage them. Using audiometers, computers, and other testing devices, they measure the loudness   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  at which a person begins to hear sounds, the ability to distin­ guish between sounds, and the impact of hearing loss on an individual’s daily life. In addition, audiologists use computer equipment to evaluate and diagnose balance disorders. Audi­ ologists interpret these results and may coordinate them with medical, educational, and psychological information to make a diagnosis and determine a course of treatment. Hearing disorders can result from a variety of causes including trauma at birth, viral infections, genetic disorders, exposure to loud noise, certain medications, or aging. Treatment may include examining and cleaning the ear canal, fitting and dispensing hearing aids, and fitting and programming cochlear implants. Audiologic treatment also includes counseling on adjusting to hearing loss, training on the use of hearing instruments, and teaching communication strategies for use in a variety of environments. For example, they may provide instruction in listening strategies. Audiologists also may recommend, fit, and dispense personal or large-area amplification systems and alerting devices. In audiology clinics, audiologists may independently develop and carry out treatment programs. They keep records on the initial evaluation, progress, and discharge of patients. In other settings, audiologists may work with other health and education providers as part of a team in planning and implementing services for children and adults. Audiologists who diagnose and  Professional and Related Occupations 359  treat balance disorders often work in collaboration with physi­ cians, and physical and occupational therapists. Some audiologists specialize in work with the elderly, children, or hearing-impaired individuals who need special treatment programs. Others develop and implement ways to protect workers’ hearing from on-the-job injuries. They measure noise levels in workplaces and conduct hearing protection programs in factories and in schools and communities. Audiologists who work in private practice also manage the business aspects of running an office, such as developing a patient base, hiring employees, keeping records, and ordering equipment and supplies. Some audiologists conduct research on types of, and treatment for, hearing, balance, and related disorders. Others design and develop equipment or techniques for diagnosing and treating these disorders. Work environment. Audiologists usually work at a desk or table in clean, comfortable surroundings. The job is not physically demanding but does require attention to detail and intense concentration. The emotional needs of patients and their families may be demanding. Most full-time audiologists work about 40 hours per week, which may include weekends and evenings to meet the needs of patients. Those who work on a contract basis may spend a substantial amount of time traveling between facilities.  Training, Other Qualifications, and Advancement All States regulate licensure of audiologists; requirements vary by State. At least a master’s degree in audiology is required, but a doctoral degree is increasingly necessary. Education and training. Individuals pursuing a career will need to earn a doctoral degree. In 2009, 18 States required a doctoral degree or its equivalent for new applicants to prac­ tice audiology. The doctoral degree in audiology is a graduate program typically lasting 4 years and resulting in the Au.D. designation. The Council on Academic Accreditation (CAA) is an entity of the American Speech-Language-Hearing Association (ASHA) that accredits education programs in audiology. In 2009, the CAA accredited 70 doctoral programs in audiology. Graduation  from an accredited program may be required to obtain a license in some States and professional credentialing. Requirements for admission to programs in audiology include courses in English, mathematics, physics, chemistry, biology, psychology, and communication. Graduate coursework in audiology includes anatomy; physiology; physics; genetics; normal and abnormal communication development; auditory, balance, and neural systems assessment and treat­ ment; diagnosis and treatment; pharmacology; and ethics. Graduate curriculums also include supervised clinical practicum and externships. Licensure and certification. Audiologists are regulated by licensure in all 50 States. Eighteen of those States require a doctoral degree for licensure. Some States regulate the practice of audiology and the dispensing of hearing aids separately, meaning some States will require an additional license called a Hearing Aid Dispenser license. Many States require that audi­ ologists complete continuing education for license renewal. Eli­ gibility requirements, hearing aid dispensing requirements, and continuing education requirements vary from State to State. For specific requirements, contact your State’s medical or health board. Audiologists can earn the Certificate of Clinical Compe­ tence in Audiology (CCC-A) offered by the American SpeechLanguage-Hearing Association; they may also be credentialed through the American Board of Audiology. Professional cre­ dentialing may satisfy some or all of the requirements for State licensure. Other qualifications. Audiologists should be able to ef­ fectively communicate diagnostic test results, diagnoses, and proposed treatments in a manner easily understood by their patients. They must be able to approach problems objectively and provide support to patients and their families. Because a patient’s progress may be slow, patience, compassion, and good listening skills are necessary. It is important for audiologists to be aware of new diagnos­ tic and treatment technologies. Most audiologists participate in continuing education courses to learn new methods and technologies. Advancement. With experience, audiologists can advance to open their own private practice. Audiologists working in hos­ pitals and clinics can advance to management or supervisory positions.  Employment Audiologists held about 12,800 jobs in 2008. About 64 percent of all jobs were in healthcare facilities—offices of physicians or other health practitioners, including audiologists; hospitals; and outpatient care centers. About 14 percent of jobs were in educational services. Other jobs for audiologists were in health and personal care stores and in State and local governments.  V A.'” Audiologists examine individuals and identify symptoms of hearing loss and other auditory, balance, and related sensory and neural problems.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Job Outlook Much faster than average employment growth is projected. However, because of the small size of the occupation, few job openings are expected. Job prospects will be favorable for those possessing the Au.D. degree. Employment change. Employment of audiologists is ex­ pected to grow 25 percent from 2008 to 2018, much faster than  360 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Audiologists................................................ .................................  soc Code 29-1121  Projected Employment, 2018 16,000  Employment, 2008 12,800  Change, 2008-2018 Number Percent 3,200 25  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ____  average for all occupations. Hearing loss is strongly associated with aging, so increased growth in older population groups will cause the number of people with hearing and balance impair­ ments to increase markedly. Medical advances also are improving the survival rate of pre­ mature infants and trauma victims, who then need assessment and sometimes treatment. Greater awareness of the importance of early identification and diagnosis of hearing disorders in infants also will increase employment. In addition to medical advances, technological advances in hearing aids may drive de­ mand. Digital hearing aids have become smaller in size and also have quality improving technologies like reducing feedback. Demand may be spurred by those who switch from analog to digital hearing aids, as well as those who will desire new or first-time hearing aids because they are becoming less visible. Employment in educational services will increase along with growth in elementary and secondary school enrollments, in­ cluding enrollment of special education students. Growth in employment of audiologists will be moderated by limitations on reimbursements made by third-party payers for the tests and services they provide. Job prospects. Job prospects will be favorable for those possessing the Au.D. degree. Only a few job openings for au­ diologists will arise from the need to replace those who leave the occupation, because the occupation is relatively small and workers tend to stay in this occupation until they retire. De­ mand may be greater in areas with large numbers of retirees, so audiologists who are willing to relocate may have the best job prospects.  Earnings Median annual wages of audiologists were $62,030 in May 2008. The middle 50 percent earned between $50,470 and $78,380. The lowest 10 percent earned less than $40,360, and the highest 10 percent earned more than $98,880. Some em­ ployers may pay for continuing education courses. About 15 percent of audiologists were union members or covered under union contracts in 2008.  Related Occupations Audiologists specialize in the prevention, diagnosis, and treat­ ment of hearing problems. Workers who treat other problems related to physical or mental health include: Page Occupational therapists............................................................ 369 Optometrists............................................................................. 371 Physical therapists.................................................................... 377 Psychologists............................................................................ 215 Speech-language pathologists..................................................399   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Sources of Additional Information State licensing boards can provide information on licensure requirements. State departments of education can supply in­ formation on certification requirements for those who wish to work in public schools. For information on the specific requirements of your State, contact that State’s licensing board. Career information, a de­ scription of the CCC-A credential, and information on State li­ censure is available from: y American Speech-Language-Hearing Association, 2200 Research Blvd., Rockville, MD 20850. Internet: http://www.asha.org For information on the Au.D. degree, contact: V Audiology Foundation of America, 8 N. 3rd St., Suite 301, Lafayette, IN 47901. Internet: http://www.audfound.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos085.htm  Chiropractors Significant Points • Job prospects should be good. • Chiropractors must be licensed, requiring 2 to 4 years of undergraduate education, the completion of a 4-year chiropractic college course, and passing scores on national and State examinations. • About 44 percent of chiropractors are self-employed. • Earnings typically are relatively low in the beginning but increase as the practice grows. Nature of the Work Chiropractors, also known as doctors of chiropractic or chi­ ropractic physicians, diagnose and treat patients with health problems of the musculoskeletal system and treat the effects of those problems on the nervous system and on general health. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine. Chiropractic is based on the principle that spinal joint misalignments interfere with the nervous system and can result in lower resistance to disease and many different conditions of diminished health. The chiropractic approach to healthcare focuses on the pa­ tient’s overall health. Chiropractors provide natural, drugless, nonsurgical health treatments, relying on the body’s inherent recuperative abilities. They also recognize that many factors  Professional and Related Occupations 361  In addition to general chiropractic practice, some chiroprac­ tors specialize in sports injuries, neurology, orthopedics, pe­ diatrics, nutrition, internal disorders, or diagnostic imaging. Many chiropractors are solo or group practitioners who also have the administrative responsibilities of running a practice. In larger offices, chiropractors delegate these tasks to office managers and chiropractic assistants. Chiropractors in private practice are responsible for developing a patient base, hiring employees, and keeping records. Work environment. Chiropractors work in clean, comfort­ able offices. Like other health practitioners, chiropractors are sometimes on their feet for long periods. Chiropractors who take X rays must employ appropriate precautions against the dangers of repeated exposure to radiation. Chiropractors work, on average, about 40 hours per week, although longer hours are not uncommon. Solo practitioners set their own hours but may work evenings or weekends to accommodate patients. Like other healthcare practitioners, chiropractors in a group practice will sometimes be on call or treat patients of other chiropractors in the group.  Training, Other Qualifications, and Advancement  Chiropractors analyze the patient’s posture and spine and may manually adjust the spinal column. affect health, including exercise, diet, rest, environment, and heredity. Chiropractors recommend changes in lifestyle that affect those factors. In some situations, chiropractors refer pa­ tients to or consult with other health practitioners. Like other health practitioners, chiropractors follow a stan­ dard routine to get information needed to diagnose and treat patients. They take the patient’s health history; conduct physi­ cal, neurological, and orthopedic examinations; and may or­ der laboratory tests. X rays and other diagnostic images are important tools because of the chiropractor’s emphasis on the spine and its proper function. Chiropractors also analyze the patient’s posture and spine using a specialized technique. For patients whose health problems can be traced to the muscu­ loskeletal system, chiropractors manually adjust the spinal column. Some chiropractors use additional procedures in their prac­ tices, including therapies using heat, water, light, massage, ul­ trasound, electric currents, and acupuncture . They may apply supports such as straps, tape, braces, or shoe inserts. Chiro­ practors often counsel patients about health concepts such as nutrition, exercise, changes in lifestyle, and stress manage­ ment, but chiropractors do not prescribe drugs or perform sur­ gery.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Chiropractors must be licensed, which requires 2 to 4 years of undergraduate education, the completion of a 4-year chiro­ practic college course, and passing scores on national and State examinations. Education and training. In 2009, 16 chiropractic programs in the United States were accredited by the Council on Chiro­ practic Education. Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor’s de­ gree, including courses in English, the social sciences or hu­ manities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor’s degree, which may eventually become the minimum entry requirement. Sev­ eral chiropractic colleges offer prechiropractic study, as well as a bachelor’s degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the States. Chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. Dur­ ing the first 2 years, most chiropractic programs emphasize classroom and laboratory work in sciences such as anatomy, physiology, public health, microbiology, pathology, and bio­ chemistry. The last 2 years focus on courses in manipulation and spinal adjustment and provide clinical experience in physi­ cal and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and insti­ tutions grant the degree of Doctor of Chiropractic (D.C.). Chiropractic colleges also offer postdoctoral training in or­ thopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences. Once such training is complete, chiropractors may take specialty exams leading to “diplomate” status in a given specialty. Exams are administered by chiro­ practic specialty boards. Licensure. All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet the educational and examination requirements estab-  362 Occupational Outlook Handbook  Projections data from the National Employment Matrix Occupational Title Chiropractors............................................... .................................  soc  Code  Employment, 2008  29-1011  49,100  Projected Employment, 2018 58,700  Change, 2008-2018 Number Percent 9,600 20  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  lished by the State. Chiropractors can practice only in States where they are licensed. Some States have agreements permit­ ting chiropractors licensed in one State to obtain a license in another without further examination, provided that their educa­ tional, examination, and practice credentials meet State speci­ fications. Most State licensing boards require at least 2 years of under­ graduate education, but an increasing number are requiring a 4-year bachelor’s degree. All boards require the completion of a 4-year program at an accredited chiropractic college leading to the Doctor of Chiropractic degree. For licensure, most State boards recognize either all or part of the four-part test administered by the National Board of Chiro­ practic Examiners. State examinations may supplement the Na­ tional Board tests, depending on State requirements. All States except New Jersey require the completion of a specified number of hours of continuing education each year in order to maintain licensure. Chiropractic associations and accredited chiropractic programs and institutions offer continuing education programs. Other qualifications. Chiropractic requires keen observa­ tion to detect physical abnormalities. It also takes considerable manual dexterity, but not unusual strength or endurance, to per­ form adjustments. Chiropractors should be able to work inde­ pendently and handle responsibility. As in other health-related occupations, empathy, understanding, and the desire to help others are good qualities for dealing effectively with patients. Advancement. Newly licensed chiropractors can set up a new practice, purchase an established one, or enter into partner­ ship with an established practitioner. They also may take a sala­ ried position with an established chiropractor, a group practice, or a healthcare facility.  Employment Chiropractors held about 49,100 jobs in 2008. Most chiroprac­ tors work in a solo practice, although some are in group practice or work for other chiropractors. A small number teach, conduct research at chiropractic institutions, or work in hospitals and clinics. Approximately 44 percent of chiropractors were selfemployed. Many chiropractors are located in small communities. How­ ever, the distribution of chiropractors is not geographically uniform. This occurs primarily because new chiropractors fre­ quently establish their practices in close proximity to one of the few chiropractic educational institutions. Job Outlook Employment is projected to grow much faster than average. Job prospects should be good. Employment change. Employment of chiropractors is ex­ pected to increase 20 percent between 2008 and 2018, much faster than the average for all occupations. Projected job growth   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  stems from increasing consumer demand for alternative health care. Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform sur­ gery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremi­ ties, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive healthcare practices. Chiropractors who specialize in pediatric care will be in demand as chiropractic spinal treatment is very gentle and children enjoy subsequent visits. The rapidly expanding older population, with its increased likelihood of mechanical and structural problems, also will increase demand for chiroprac­ tors. Demand for chiropractic treatment, however, is related to the ability of patients to pay, either directly or through health insur­ ance. Although more insurance plans now cover chiropractic services, the extent of such coverage varies among plans. Chi­ ropractors must educate communities about the benefits of chi­ ropractic care in order to establish a successful practice. Job prospects for new chiropractors are Job prospects. expected to be good, especially for those who enter a multidisciplined practice, consisting of, for example, a chiropractor, physical therapist, and medical doctor. Multi-disciplined prac­ tices are cost effective and allow patients to remain in-house. Should a patient be referred to a medical doctor, they may use the “in-house” doctor or one of their own choosing. Chiroprac­ tors usually remain in the occupation until they retire and few transfer to other occupations, so replacement needs arise almost entirely from retirements. Establishing a new practice will be easiest in areas with a low concentration of chiropractors.  Earnings Median annual wages of salaried chiropractors were $66,490 in May 2008. The middle 50 percent earned between $45,540 and $96,700 a year. In 2009, the mean salary for chiropractors was $94,454 ac­ cording to a survey conducted by Chiropractic Economics magazine. In chiropractic, as in other types of independent practice, earnings are relatively low in the beginning and increase as the practice grows. Geographic location and the characteristics and qualifications of the practitioner also may influence earnings. Salaried chiropractors typically receive heath insurance and retirement benefits from their employers, whereas self-em­ ployed chiropractors must provide for their own health insur­ ance and retirement.  Professional and Related Occupations 363  Related Occupations  Nature of the Work  Chiropractors treat patients and work to prevent bodily disor­ ders and injuries. So do:  Dentists diagnose and treat problems with teeth and tissues in the mouth, along with giving advice and administering care to help prevent future problems. They provide instruction on diet, brushing, flossing, the use of fluorides, and other aspects of dental care. They remove tooth decay, fill cavities, exam­ ine x rays, place protective plastic sealants on children’s teeth, straighten teeth, and repair fractured teeth. They also perform corrective surgery on gums and supporting bones to treat gum diseases. Dentists extract teeth and make models and measure­ ments for dentures to replace missing teeth. They also adminis­ ter anesthetics and write prescriptions for antibiotics and other medications. Dentists use a variety of equipment, including x-ray ma­ chines, drills, mouth mirrors, probes, forceps, bmshes, and scalpels. Lasers, digital scanners, and other computer technolo­ gies also may be used. Dentists wear masks, gloves, and safety glasses to protect themselves and their patients from infectious diseases. Dentists in private practice oversee a variety of administrative tasks, including bookkeeping and the buying of equipment and supplies. They may employ and supervise dental hygienists, dental assistants, dental laboratory technicians, and reception-  Page Athletic trainers........................................................................ 405 Massage therapists................................................................... 452 Occupational therapists............................................................ 369 Physical therapists.................................................................... 377 Physicians and surgeons........................................................... 381 Podiatrists................................................................................. 385 Veterinarians............................................................................. 402  Sources of Additional Information General information on a career as a chiropractor is available from the following organizations: >■ American Chiropractic Association, 1701 Clarendon Blvd., Arlington, VA 22209. Internet: http://www.acatoday.org >• International Chiropractors Association, 1110 North Glebe Rd„ Suite 650, Arlington, VA 22201. Internet: http ://www.chiropractic.org y World Chiropractic Alliance, 2950 N. Dobson Rd., Suite 3, Chandler, AZ 85224. For a list of chiropractic programs and institutions, as well as general information on chiropractic education, contact: >• Council on Chiropractic Education, 8049 North 85th Way, Scottsdale, AZ 85258-4321. Internet: http://www.cce-usa.org For information on State education and licensure require­ ments, contact: V Federation of Chiropractic Licensing Boards, 5401 W. 10th St., Suite 101, Greeley, CO 80634-4400. Internet: http ://www.fclb.org For more information on the national chiropractic licensing exam, contact: y National Board of Chiropractic Examiners, 901 54th Ave., Greeley, CO 80634. Internet: http://www.nbce.org For information on admission requirements to a specific chi­ ropractic college, as well as scholarship and loan information, contact the college’s admissions office. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos071 .htm  Dentists Significant Points • About 3 out of 4 dentists are solo practitioners. • Dentists must graduate from an accredited dental school and pass written and practical examinations; competition for admission to dental school is keen. • Faster than average employment growth is projected. • Job prospects should be good, reflecting the need to replace the large number of dentists expected to retire.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Jw i&rzprztSTt  Dentists remove tooth decay, fill cavities, and repair fractu red teeth.  364 Occupational Outlook Handbook  ists. (These occupations are described elsewhere in the Hand­ book.) Most dentists are general practitioners, handling a variety of dental needs. Other dentists practice in any of nine specialty areas. Orthodontists, the largest group of specialists, straighten teeth by applying pressure to the teeth with braces or other ap­ pliances. The next largest group, oral and maxillofacial sur­ geons, operates on the mouth, jaws, teeth, gums, neck, and head. The remainder may specialize as pediatric dentists (focusing on dentistry for children and special-needs patients); periodontists (treating gums and bone supporting the teeth); prosthodon­ tists (replacing missing teeth with permanent fixtures, such as crowns and bridges, or with removable fixtures such as den­ tures); endodontists (performing root-canal therapy); oral pa­ thologists (diagnosing oral diseases); oral and maxillofacial radiologists (diagnosing diseases in the head and neck through the use of imaging technologies); or dental public health spe­ cialists (promoting good dental health and preventing dental diseases within the community). Work environment. Most dentists are solo practitioners, meaning that they own their own businesses and work alone or with a small staff. Some dentists have partners, and a few work for other dentists as associate dentists. Most dentists work 4 or 5 days a week. Some work eve­ nings and weekends to meet their patients’ needs. The number of hours worked varies greatly among dentists. Most full-time dentists work between 35 and 40 hours a week. However, oth­ ers, especially those who are trying to establish a new practice, work more. Also, experienced dentists often work fewer hours. It is common for dentists to continue in part-time practice well beyond the usual retirement age. Dentists usually work in the safety of an office environment. However, work-related injuries can occur, such as those result­ ing from the use of hand-held tools when performing dental work on patients.  Training, Other Qualifications, and Advancement All 50 States and the District of Columbia require dentists to be licensed. To qualify for a license in most States, candidates must graduate from an accredited dental school and pass writ­ ten and practical examinations. Education and training. In 2008, there were 57 dental schools in the United States accredited by the American Dental Association’s (ADA’s) Commission on Dental Accreditation. Dental schools require a minimum of 2 years of college-level predental education prior to admittance. Most dental students  have at least a bachelor’s degree before entering dental school, although a few applicants are accepted to dental school after 2 or 3 years of college and complete their bachelor’s degree while attending dental school. According to the ADA, 85 percent of dental students had a bachelor’s degree prior to beginning their dental program in the 2006-07 academic year. High school and college students who want to become den­ tists should take courses in biology, chemistry, physics, health, and mathematics. College undergraduates planning on applying to dental school are required to take many science courses. Be­ cause of this, some choose a major in a science, such as biology or chemistry, whereas others take the required science coursework while pursuing a major in another subject. All dental schools require applicants to take the Dental Ad­ missions Test (DAT). When selecting students, schools consider scores earned on the DAT, applicants’ grade point averages, and information gathered through recommendations and interviews. Competition for admission to dental school is keen. Dental school usually lasts 4 academic years. Studies begin with classroom instruction and laboratory work in science, in­ cluding anatomy, microbiology, biochemistry, and physiology. Beginning courses in clinical sciences, including laboratory techniques, are also completed. During the last 2 years, students treat patients, usually in dental clinics, under the supervision of licensed dentists. Most dental schools award the degree of Doctor of Dental Surgery (DDS). Others award an equivalent degree, Doctor of Dental Medicine (DMD). Licensure. Licensing is required to practice as a dentist. In most States, licensure requires passing written and practi­ cal examinations in addition to having a degree from an ac­ credited dental school. Candidates may fulfill the written part of the State licensing requirements by passing the National Board Dental Examinations. Individual States or regional test­ ing agencies administer the written or practical examinations. Individuals can be licensed to practice any of the 9 recog­ nized specialties in all 50 States and the District of Columbia. Requirements include 2 to 4 years of postgraduate education and, in some cases, the completion of a special State examina­ tion. A postgraduate residency term also may be required, usu­ ally lasting up to 2 years. Most State licenses permit dentists to engage in both general and specialized practice. Other qualifications. Dentistry requires diagnostic ability and manual skills. Dentists should have good visual memory; excellent judgment regarding space, shape, and color; a high degree of manual dexterity; and scientific ability. Good busi-  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, 2018 Number Percent 164,000 22,100 16 29-1020 141,900 Dentists.......................................................................... ........................ 15 138,600 18,400 29-1021 120,200 Dentists, general........................................................ ........................ 15 29-1022 6,700 7,700 1,000 Oral and maxillofacial surgeons............................. ........................ 20 7,700 9,200 1,500 29-1023 Orthodontists............................................................. ........................ 28 700 100 29-1024 500 Prosthodontists.......................................................... ........................ 7,900 1,000 15 29-1029 6,900 Dentists, all other specialists.................................... ........................ (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc Code  Employment, 2008  Professional and Related Occupations 365  ness sense, self-discipline, and good communication skills are helpful for success in private practice. Advancement. Dentists and aspiring dentists who want to teach or conduct research full time usually spend an additional 2 to 5 years in advanced dental training, in programs operated by dental schools or hospitals. Many private practitioners also teach part time, including supervising students in dental school clinics. (See the statement on teachers—postsecondary else­ where in the Handbook.) Some dental school graduates work for established dentists as associates for 1 to 2 years to gain experience and save money to equip an office of their own. Most dental school graduates, however, purchase an established practice or open a new one immediately after graduation.  However, employment of dentists is not expected to keep pace with the increased demand for dental services. Productiv­ ity increases from new technology, as well as the tendency to assign more tasks to dental hygienists and assistants, will allow dentists to perform more work than they have in the past. As their practices expand, dentists are likely to hire more hygien­ ists and dental assistants to handle routine services. Dentists will increasingly provide care and instruction aimed at preventing the loss of teeth, rather than simply providing treatments such as fillings. Improvements in dental technology also will allow dentists to offer more effective and less painful treatment to their patients. Job prospects.  As an increasing number of dentists from  Employment  the baby-boom generation reach retirement age, many of them  Dentists held about 141,900 jobs in 2008. Employment was dis­ tributed among general practitioners and specialists as follows:  will retire or work fewer hours and stop taking on new patients.  Dentists, general..........................................................120,200 Orthodontists...................................................................7,700 Oral and maxillofacial surgeons..................................... 6,700 Prosthodontists.................................................................. 500 Dentists, all other specialists.......................................... 6,900 Approximately 15 percent of all dentists were specialists. About 28 percent of dentists were self-employed and not incor­ porated. Very few salaried dentists worked in hospitals and of­ fices of physicians. Almost all dentists work in private practice. According to the American Dental Association, about 3 out of 4 dentists in private practice are solo proprietors, and almost 15 percent belonged to a partnership. Job Outlook Employment is projected to grow faster than the average. Job prospects should be good, reflecting the need to replace the large number of dentists expected to retire. Employment change. Employment of dentists is projected to grow by 16 percent through 2018, which is faster than the average for all occupations. The demand for dental services is expected to continue to increase. The overall U.S. population is growing, and the elderly segment of the population is grow­ ing even faster; these phenomena will increase the demand for dental care. Many members of the baby-boom generation will need complicated dental work. In addition, elderly people are more likely to retain their teeth than were their predecessors, so they will require much more care than in the past. The younger generation will continue to need preventive checkups despite an overall increase in the dental health of the public over the last few decades. Recently, some private insurance providers have increased their dental coverage. If this trend continues, people with new or expanded dental insurance will be more likely to visit a dentist than in the past. Also, although they are currently a small proportion of dental expenditures, cosmetic dental ser­ vices, such as providing teeth-whitening treatments, will be­ come increasingly popular. This trend is expected to continue as new technologies allow these procedures to take less time and be much less invasive.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Furthermore, the number of applicants to, and graduates from, dental schools has increased in recent years. Job prospects should be good, because younger dentists will be able to take over the work of older dentists who retire or cut back on hours, as well as provide dental services to accommodate the growing demand. Demand for dental services tends to follow the business cy­ cle, primarily because these services usually are paid for either by the patient or by private insurance companies. As a result, during slow times in the economy, demand for dental services can decrease; consequently, dentists may have difficulty finding employment, or if already in an established practice, they may work fewer hours because of reduced demand.  Earnings Median annual wages of salaried general dentists were $ 142,870 in May 2008. Earnings vary according to number of years in practice, location, hours worked, and specialty. Self-employed dentists in private practice tend to earn more than salaried den­ tists. Dentists who are salaried often receive benefits paid by their employer, with health insurance and malpractice insurance be­ ing among the most common. However, like other business owners, self-employed dentists must provide their own health insurance, life insurance, retirement plans, and other benefits.  Related Occupations Dentists examine, diagnose, prevent, and treat diseases and ab­ normalities. Other workers who perform similar tasks include: Page Chiropractors............................................................................ 360 Optometrists.............................................................................371 Physicians and surgeons...........................................................381 Podiatrists................................................................................. 385 Veterinarians.............................................................................402  366 Occupational Outlook Handbook  Sources of Additional Information For information on dentistry as a career, a list of accredited dental schools, and a list of State boards of dental examiners, contact: y American Dental Association, Commission on Dental Accreditation, 211 E. Chicago Ave., Chicago, IL 60611. Internet: http://www.ada.org For information on admission to dental schools, contact: y American Dental Education Association, 1400 K St. NW„ Suite 1100, Washington, DC 20005. Internet: http://www.adea.org For more information on general dentistry or on a specific dental specialty, contact: y Academy of General Dentistry, 211 East Chicago Ave., Suite 900, Chicago, IL 60611. Internet: http://www.agd.org y American Association of Orthodontists, 401 North Lindbergh Blvd., St. Louis, MO 63141. Internet: http://www.braces.org y American Association of Oral and Maxillofacial Surgeons, 9700 West Bryn Mawr Ave., Rosemont, IL 60018. Internet: http://www.aaoms.org y American Academy of Pediatric Dentistry, 211 East Chicago Ave., Suite 1700, Chicago, IL 60611. Internet: http ://www.aapd.org y American Academy of Periodontology, 737 North Michigan Ave., Suite 800, Chicago, IL 60611. Internet: http ://www.perio.org y American Academy of Prosthodontists, 211 East Chicago Ave., Suite 1000, Chicago, IL 60611. Internet: http ://www.prosthodontics.org  Dietitians and Nutritionists Significant Points • Most jobs are in hospitals, nursing care facilities, out­ patient care centers, and offices of physicians or other health practitioners. • Dietitians and nutritionists need at least a bachelor’s degree; licensure, certification, or registration re­ quirements vary by State. • Applicants with specialized training, an advanced degree, or certifications beyond the particular State’s minimum requirement should enjoy the best job opportunities. Nature of the Work Dietitians and nutritionists plan food and nutrition programs, supervise meal preparation, and oversee the serving of meals. They prevent and treat illnesses by promoting healthy eating habits and recommending dietary modifications. For example, dietitians might teach a patient with high blood pressure how to use less salt when preparing meals, or create a diet reduced in fat and sugar for an overweight patient. Dietitians manage food service systems for institutions such as hospitals and schools, promote sound eating habits through education, and conduct research. Many dietitians specialize, be­ coming a clinical dietitian, community dietitian, management dietitian, or consultant. Clinical dietitians provide nutritional services to patients in hospitals, nursing care facilities, and other institutions. They assess patients’ nutritional needs, develop and implement nutri­ tion programs, and evaluate and report the results. They also  y American Association of Endodontists, 211 East Chicago Ave., Suite 1100, Chicago, IL 60611. Internet: http://www.aae.org y American Academy of Oral and Maxillofacial Radiology, P.O. Box 1010, Evans, GA 30809. Internet: http ://www.aaomr.org y American Association of Public Health Dentistry, 3085 Stevenson Dr., Suite 200, Springfield, IL 62703. Internet: http://www.aaphd.org People interested in practicing dentistry should obtain the re­ quirements for licensure from the board of dental examiners of the State in which they plan to work. To obtain information on scholarships, grants, and loans, including Federal financial aid, prospective dental students should contact the office of student financial aid at the schools to which they apply. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos072.htm  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  fm  ________________  Dietitians counsel individuals and groups on nutritional prac­ tices designed to prevent disease and promote health.  Professional and Related Occupations 367  confer with doctors and other healthcare professionals to coor­ dinate medical and nutritional needs. Some clinical dietitians specialize in managing the weight of overweight patients or in the care of renal (kidney), diabetic, or critically ill patients. In addition, clinical dietitians in nursing care facilities, small hos­ pitals, or correctional facilities may manage the food service department. Community dietitians counsel individuals and groups on nutritional practices designed to prevent disease and promote health. Working in places such as public health clinics, home health agencies, and health maintenance organizations, com­ munity dietitians evaluate individual needs, develop nutritional care plans, and instruct individuals and their families. Dietitians working in home health agencies provide instruction on grocery shopping and food preparation to the elderly, children, and indi­ viduals with special needs. Increased public interest in nutrition has led to job opportuni­ ties in food manufacturing, advertising, and marketing. In these areas, dietitians analyze foods, prepare literature for distribu­ tion, or report on issues such as dietary liber, vitamin supple­ ments, or the nutritional content of recipes. Management dietitians oversee large-scale meal planning and preparation in healthcare facilities, company cafeterias, prisons, and schools. They hire, train, and direct other dietitians and food service workers; budget for and purchase food, equip­ ment, and supplies; enforce sanitary and safety regulations; and prepare records and reports. Consultant dietitians work under contract with healthcare facilities or in their own private practice. They perform nutri­ tion screenings for their clients and offer advice on diet-related concerns such as weight loss and cholesterol reduction. Some work for wellness programs, sports teams, supermarkets, and other nutrition-related businesses. They may consult with food service managers, providing expertise in sanitation, safety pro­ cedures, menu development, budgeting, and planning. Work environment. Dietitians and nutritionists usually work in clean, well-lighted, and well-ventilated areas. However, some work in hot, congested kitchens. Many dietitians and nutrition­ ists are on their feet for much of the workday. Most full-time dietitians and nutritionists work a standard 40hour week, although some work weekends. About 19 percent worked part time in 2008.  Training, Other Qualifications, and Advancement Dietitians and nutritionists need at least a bachelor’s degree. Licensure, certification, or registration requirements vary by State. Education and training. Becoming a dietitian or nutritionist usually requires at least a bachelor’s degree in dietetics, foods and nutrition, food service systems management, or a related area. Graduate degrees also are available. College students in these majors take courses in foods, nutrition, institution man­ agement, chemistry, biochemistry, biology, microbiology, and physiology. Other suggested courses include business, mathe­ matics, statistics, computer science, psychology, sociology, and economics. High school students interested in becoming a di­ etitian or nutritionist should take courses in biology, chemistry, Digitizedmathematics, for FRASER health, and communications. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  As of 2008, there were 279 bachelor’s degree programs and 18 master’s degree programs approved by the American Dietetic Association’s Commission on Accreditation for Dietet­ ics Education. Licensure. Of the 48 States and jurisdictions with laws gov­ erning dietetics, 35 require licensure, 12 require statutory certi­ fication, and 1 require registration. Specific requirements vary by State. As a result, interested candidates should determine the requirements of the State in which they want to work before sitting for any exam. In States that require licensure, only people who are licensed can work as dietitians and nutritionists. States that require statu­ tory certification limit the use of occupational titles to people who meet certain requirements; individuals without certifica­ tion can still practice as a dietitian or nutritionist but without using certain titles. Registration is the least restrictive form of State regulation of dietitians and nutritionists. Unregistered people are permitted to practice as a dietitian or nutritionist. Certification and other qualifications. Although not re­ quired, the Commission on Dietetic Registration of the Ameri­ can Dietetic Association awards the Registered Dietitian credential to those who pass an exam after completing aca­ demic coursework and a supervised internship. This certifica­ tion is different from the statutory certification regulated by some States and discussed in the previous section. To maintain a Registered Dietitian status, workers must complete at least 75 credit hours in approved continuing education classes every 5 years. A supervised internship, required for certification, can be completed in one of two ways. The first requires the comple­ tion of a program accredited by the Commission on Dietetic Registration. As of September 2009, there were 51 accredited programs that combined academic and supervised practice ex­ perience and generally lasted 4 to 5 years. The second option requires the completion of 900 hours of supervised practice experience in any of the 243 accredited internships. These in­ ternships may be full-time programs lasting 6 to 12 months or part-time programs lasting 2 years. Advancement. Experienced dietitians may advance to management positions, such as assistant director, associate director, or director of a dietetic department, or may become self-employed. Some dietitians specialize in areas such as re­ nal, diabetic, cardiovascular, or pediatric dietetics. Others leave the occupation to become sales representatives for equipment, pharmaceutical, or food manufacturers. A master’s degree can help some workers to advance their careers, particularly in ca­ reer paths related to research, advanced clinical positions, or public health.  Employment Dietitians and nutritionists held about 60,300 jobs in 2008. More than half of all jobs were in hospitals, nursing care facili­ ties, outpatient care centers, or offices of physicians and other health practitioners. State and local government agencies pro­ vided additional jobs—mostly in correctional facilities, health departments, and other public-health-related areas. Some dieti­ tians and nutritionists were employed in special food services, an industry made up of firms providing food services on con-  368 Occupational Outlook Handbook  Projections data from the National Employment Matrix Projected Change, 2008-2018 Employment, 2018 Number Percent 5,600 9 60,300 65,800 29-1031 Dietitians and nutritionists..................................... .............................. (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  SOC Code  Employment, 2008  tion Included in the Handbook.  tract to facilities such as colleges and universities, airlines, cor­ rectional facilities, and company cafeterias. Other jobs were in public and private educational services, community care facilities for the elderly (which includes assisted-living facilities), individual and family services, home healthcare services, and the Federal Government—mostly in the U.S. Department of Veterans Affairs. Some dietitians were self-employed, working as consultants to facilities such as hos­ pitals and nursing care facilities or providing dietary counseling to individuals.  Job Outlook Average employment growth is projected. Applicants with spe­ cialized training, an advanced degree, or certifications beyond the particular State’s minimum requirement should enjoy the best job opportunities. Employment change. Employment of dietitians and nutri­ tionists is expected to increase 9 percent during the 2008-18 projection decade, about as fast as the average for all occupa­ tions. Job growth will result from an increasing emphasis on disease prevention through improved dietary habits. A grow­ ing and aging population will boost demand for nutritional counseling and treatment in hospitals, residential care facili­ ties, schools, prisons, community health programs, and home healthcare agencies. Public interest in nutrition and increased emphasis on health education and prudent lifestyles also will spur demand, especially in food service management. Also, with increased public awareness of obesity and diabe­ tes, Medicare coverage has been expanded to include medical nutrition therapy for renal and diabetic patients, creating job growth for dietitians and nutritionists specializing in those diseases. Employment growth, however, may be constrained if some employers substitute other workers, such as health educators, food service managers, and dietetic technicians, to do work re­ lated to nutrition. Also, demand for nutritional therapy services is related to the ability of patients to pay, either out-of-pocket or through health insurance, and although more insurance plans now cover nutritional therapy services, the extent of such cover­ age varies among plans. Growth may be curbed by limitations on insurance reimbursement for dietetic services. Hospitals will continue to employ a large number of dietitians and nutritionists to provide medical nutritional therapy and plan meals. But hospitals also will continue to contract with outside agencies for food service and move medical nutritional therapy to outpatient care facilities, slowing job growth in hospitals rel­ ative to food service, outpatient facilities, and other employers. Finally, the number of dietitian positions in nursing care fa­ cilities is expected to decline, as these establishments continue to contract with outside agencies for food services. However, is expected to grow rapidly in contract providers employment https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  of food services, in outpatient care centers, and in offices of physicians and other health practitioners. Job prospects. In addition to employment growth, job open­ ings will result from the need to replace experienced workers who retire or leave the occupation for other reasons. Applicants with specialized training, an advanced degree, or certifications beyond the particular State’s minimum requirement should en­ joy the best job opportunities. Demand for dietitians should be particularly strong in outpatient care facilities, offices of phy­ sicians, and food service management. Applicants without a bachelor’s degree will face keen competition for jobs. Dietitians with specialized training, an advanced degree, or certifications beyond the particular State’s minimum require­ ment will experience the best job opportunities. Those special­ izing in renal and diabetic nutrition or gerontological nutrition will benefit from the growing number of diabetics and the aging of the population.  Earnings Median annual wages of dietitians and nutritionists were $50,590 in May 2008. The middle 50 percent earned between $41,060 and $61,790. The lowest 10 percent earned less than $31,460, and the highest 10 percent earned more than $73,410. Median annual wages in the industries employing the largest numbers of dietitians and nutritionists in May 2008 were: Outpatient care centers............................................... $52,120 General medical and surgical hospitals........................51,390 Nursing care facilities.................................................. 51,110 Local government......................................................... 47,390 Special food services.................................................... 45,410 According to the American Dietetic Association, median an­ nual wages for registered dietitians in 2007 varied by practice area as follows: $60,008 in consultation and business; $64,002 in food and nutrition management; $66,061 in education and re­ search; $52,000 in clinical nutrition/ambulatory care; $53,997 in clinical nutrition/long-term care; $48,006 in community nu­ trition; and $48,984 in clinical nutrition/acute care. Salaries also vary by years in practice, education level, and geographic region.  Related Occupations Other workers who may apply the principles of dietetics in­ clude: Page  Dietetic technicians..................................................................824 Food service managers...............................................................55 Health educators.......................................................................238 Registered nurses.....................................................................392  Professional and Related Occupations 369  Sources of Additional Information For a list of academic programs, scholarships, and other infor­ mation about dietitians, contact: y The American Dietetic Association, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Internet: http://www.eatright.org For information on the Registered Dietitian exam and other specialty credentials, contact: y The Commission on Dietetic Registration, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Internet: http://www.cdrnet.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos077.htm  Occupational Therapists Significant Points • Employment is expected to grow much faster than average, and job opportunities should be good, espe­ cially for therapists treating the elderly. • Occupational therapists are regulated in all 50 States; requirements vary by State. • Occupational therapists are increasingly taking on supervisory roles, allowing assistants and aides to work more closely with clients under the guidance of a therapist. Nature of the Work Occupational therapists help patients improve their ability to perform tasks in living and working environments. They work with individuals who suffer from a mentally, physically, devel­ opmentally, or emotionally disabling condition. Occupational therapists use treatments to develop, recover, or maintain the daily living and work skills of their patients. The therapist helps clients not only to improve their basic motor functions and rea­ soning abilities, but also to compensate for permanent loss of function. The goal is to help clients have independent, produc­ tive, and satisfying lives. Occupational therapists help clients to perform all types of activities, from using a computer to caring for daily needs such as dressing, cooking, and eating. Physical exercises may be used to increase strength and dexterity, while other activities may be chosen to improve visual acuity or the ability to discern patterns. For example, a client with short-term memory loss might be encouraged to make lists to aid recall, and a person with coordination problems might be assigned exercises to im­ prove hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision-making, abstract-reasoning, problem-solving, and perceptual skills, as well as memory, sequencing, and coordination—all of which Digitizedare for important FRASER for independent living. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Occupational therapists help patients learn to perform all types of activities, from using a computer to caring for daily needs such as dressing, cooking, and eating. Patients with permanent disabilities, such as spinal cord inju­ ries, cerebral palsy, or muscular dystrophy, often need special instruction to master certain daily tasks. For these individuals, therapists demonstrate the use of adaptive equipment, including wheelchairs, orthoses, eating aids, and dressing aids. They also design or build special equipment needed at home or at work, including computer-aided adaptive equipment. They teach cli­ ents how to use the equipment to improve communication and control various situations in their environment. Some occupational therapists treat individuals whose ability to function in a work environment has been impaired. These practitioners might arrange employment, evaluate the work space, plan work activities, and assess the client’s progress. Therapists also may collaborate with the client and the em­ ployer to modify the work environment so that the client can succeed at work. Assessing and recording a client’s activities and progress is an important part of an occupational therapist’s job. Accurate records are essential for evaluating clients, for billing, and for reporting to physicians and other healthcare providers. Occupational therapists may work exclusively with individu­ als in a particular age group or with a particular disability. In schools, for example, they evaluate children’s capabilities, rec­ ommend and provide therapy, modify classroom equipment, and help children participate in school activities. A therapist may work with children individually, lead small groups in the classroom, consult with a teacher, or serve on an administrative committee. Some therapists provide early intervention therapy to infants and toddlers who have, or are at risk of having, de­ velopmental delays. Therapies may include facilitating the use of the hands and promoting skills for listening, following direc­ tions, social play, dressing, or grooming.  370 Occupational Outlook Handbook  Other occupational therapists work with elderly patients. These therapists help the elderly lead more productive, active, and independent lives through a variety of methods. Therapists with specialized training in driver rehabilitation assess an in­ dividual’s ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommen­ dations for adaptive equipment, training to prolong driving independence, and alternative transportation options. Occupa­ tional therapists also work with clients to assess their homes for hazards and to identify environmental factors that contribute to falls. Occupational therapists in mental health settings treat in­ dividuals who are mentally ill, developmentally challenged, or emotionally disturbed. To treat these problems, therapists choose activities that help people learn to engage in and cope with daily life. Activities might include time management skills, budgeting, shopping, homemaking, and the use of public transportation. Occupational therapists also work with individ­ uals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress-related disorders. Work environment. In large rehabilitation centers, therapists may work in spacious rooms equipped with machines, tools, and other devices generating noise. The work can be tiring be­ cause therapists are on their feet much of the time. Therapists also face hazards such as back strain from lifting and moving clients and equipment. Occupational therapists working for one employer full-time usually work a 40-hour week. Around 31 percent of occupa­ tional therapists worked part-time. It is not uncommon for occupational therapists to work for more than one employer at multiple facilities, which may involve significant travel time. Those in schools may participate in meetings and other activi­ ties during and after the school day.  Training, Other Qualifications, and Advancement Occupational therapists are regulated in all 50 States. Individu­ als pursuing a career as an occupational therapist usually need to earn a post-baccalaureate degree from an accredited college or university or education deemed equivalent. Education and training. A master’s degree or higher in occupational therapy is the typical minimum requirement for entry into the field. In addition, occupational therapists must attend an academic program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) in or­ der to sit for the national certifying exam. In 2009,150 master’s degree programs or combined bachelor’s and master’s degree programs were accredited, and 4 doctoral degree programs were accredited. Most schools have full-time programs, although a growing number are offering weekend or part-time programs as well. Coursework in occupational therapy programs include the physical, biological, and behavioral sciences as well as the ap­  plication of occupational therapy theory and skills. All accred­ ited programs require at least 24 weeks of supervised fieldwork as part of the academic curriculum. People considering this profession should take high school courses in biology, chemistry, physics, health, art, and the so­ cial sciences. College admissions offices also look favorably on paid or volunteer experience in the healthcare field. Relevant undergraduate majors include biology, psychology, sociology, anthropology, liberal arts, and anatomy. Licensure. All States regulate the practice of occupational therapy. To obtain a license, applicants must graduate from an accredited educational program and pass a national certification examination. Those who pass the exam are awarded the title “Occupational Therapist Registered (OTR).” Specific eligibility requirements for licensure vary by State; contact your State’s licensing board for details. Some States have additional requirements for therapists who work in schools or early intervention programs. These require­ ments may include education-related classes, an education practice certificate, or early intervention certification. Certification and other qualifications. Certification is voluntary. The National Board for Certifying Occupational Therapy certifies occupational therapists through a national certifying exam. Those who pass the test are awarded the title Occupational Therapist Registered (OTR). In some States, the national certifying exam meets requirements for regulation while other States have their own licensing exam. Occupational therapists are expected to continue their pro­ fessional development by participating in continuing education courses and workshops. In fact, a number of States require con­ tinuing education as a condition of maintaining licensure. Occupational therapists need patience and strong interper­ sonal skills to inspire trust and respect in their clients. Patience is necessary because many clients may not show immediate im­ provement. Ingenuity and imagination in adapting activities to individual needs are assets. Those working in home healthcare services also must be able to adapt to a variety of settings. Advancement. Therapists are increasingly taking on su­ pervisory roles in addition to their supervision of occupational therapy assistants and aides. Occupational therapists may ad­ vance their careers by taking on administrative duties at hospi­ tals or rehabilitation centers. Occupational therapists also can advance by specializing in a clinical area and gaining expertise in treating a certain type of patient or ailment. Therapists may specialize in gerontology, mental health, pediatrics, and physical rehabilitation. In addi­ tion, some occupational therapists choose to teach classes in accredited occupational therapy educational programs.  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, 2018 Number Percent Occupational therapists........................................... ............................. 29-1122 104,500 131,300 26,800 26 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc Code  Employment, 2008  Professional and Related Occupations 371  Employment Occupational therapists held about 104,500 jobs in 2008. The largest number of occupational therapist jobs was in ambula­ tory health care services, which employed about 29 percent of occupational therapists. Other major employers were hospitals, offices of other health practitioners (including offices of oc­ cupational therapists), public and private educational services, and nursing care facilities. Some occupational therapists were employed by home health care services, outpatient care centers, offices of physicians, individual and family services, commu­ nity care facilities for the elderly, and government agencies. A small number of occupational therapists were selfemployed in private practice. These practitioners treated clients referred by other health professionals. They also provided con­ tract or consulting services to nursing care facilities, schools, adult day care programs, and home healthcare agencies.  Job Outlook Employment is expected to grow much faster than average. Job opportunities should be good, especially for occupational thera­ pists treating the elderly. Employment change. Employment of occupational thera­ pists is expected to increase by 26 percent between 2008 and 2018, much faster than the average for all occupations. The increasing elderly population will drive growth in the demand for occupational therapy services. The demand for occupational therapists should continue to rise as a result of the increasing number of individuals with disabilities or limited function who require therapy services. Older persons have an increased incidence of heart attack and stroke, which will spur demand for therapeutic services. Growth in the population 75 years and older—an age group that suffers from high incidences of disabling conditions—also will increase demand for therapeu­ tic services. In addition, medical advances now enable more patients with critical problems to survive—patients who ulti­ mately may need extensive therapy. However, growth may be dampened by the impact of Federal legislation imposing limits on reimbursement for therapy services. Hospitals will continue to employ a large number of occupa­ tional therapists to provide therapy services to acutely ill inpa­ tients. Hospitals also will need occupational therapists to staff their outpatient rehabilitation programs. Employment growth in schools will result from the expan­ sion of the school-age population and the federally funded extension of services for disabled students. Therapists will be needed to help children with disabilities prepare to enter special education programs. Job prospects. Job opportunities should be good for licensed occupational therapists in all settings, particularly in acute hos­ pital, rehabilitation, and orthopedic settings because the elderly receive most of their treatment in these settings. Occupational therapists with specialized knowledge in a treatment area also will have increased job prospects. Driver rehabilitation, training for the elderly, and ergonomic consulting are emerging practice areas for occupational therapy.  Earnings Median annual wages of occupational therapists were $66,780  DigitizedinforMay FRASER 2008. The middle 50 percent earned between $55,090 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  and $81,290. The lowest 10 percent earned less than $42,820, and the highest 10 percent earned more than $98,310. Median annual wages in the industries employing the largest numbers of occupational therapists in May 2008 were: Home health care services..........................................$74,510 Nursing care facilities..................................................72,790 Offices of other health care practitioners.................... 69,360 General medical and surgical hospitals........................68,100 Elementary and secondary schools..............................60,020  Related Occupations Occupational therapists use specialized knowledge to help indi­ viduals perform daily living skills and achieve maximum inde­ pendence. Other occupations performing similar duties include: Page Athletic trainers........................................................................405 Physical therapists....................................................................377 Recreational therapists.............................................................389 Respiratory therapists...............................................................397 Speech-language pathologists..................................................399  Sources of Additional Information For more information on occupational therapy as a career, contact: y American Occupational Therapy Association, 4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20824­ 1220. Internet: http://www.aota.org For information regarding the requirements to practice as an occupational therapist in schools, contact the appropriate occu­ pational therapy regulatory agency for your State. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos078.htm  Optometrists Significant Points • Admission to optometry school is competitive; only about 1 in 3 applicants was accepted in 2007. • Graduation from an accredited college of Optom­ etry and a State license administered by the National Board of Examiners in Optometry are required. • Employment is expected to grow much faster than the average in response to the vision care needs of a growing and aging population. • Job opportunities are likely to be excellent. Nature of the Work Optometrists, also known as doctors of optometry, or ODs, are the main providers of vision care. They examine people’s eyes to diagnose vision problems, such as nearsightedness and farsightedness, and they test patients’ depth and color percep-  372 Occupational Outlook Handbook  ft *  Some may specialize in occupational vision, developing ways to protect workers’ eyes from on-the-job strain or injury. Oth­ ers may focus on sports vision, head trauma, or ocular disease and special testing. A few optometrists teach optometry, per­ form research, or consult. Most optometrists are private practitioners who also handle the business aspects of running an office, such as developing a patient base, hiring employees, keeping paper and electronic records, and ordering equipment and supplies. Optometrists who operate franchise optical stores also may have some of these duties. Optometrists should not be confused with ophthalmologists or dispensing opticians. Ophthalmologists are physicians who perform eye surgery, as well as diagnose and treat eye diseases and injuries. Like optometrists, they also examine eyes and prescribe eyeglasses and contact lenses. Dispensing opticians fit and adjust eyeglasses and, in some States, may fit contact lenses according to prescriptions written by ophthalmologists or optometrists. (See the sections on physicians and surgeons; and opticians, dispensing, elsewhere in the Handbook.) Work environment. Optometrists usually work in their own offices that are clean, well lighted, and comfortable. Al­ though most full-time optometrists work standard business hours, some work weekends and evenings to suit the needs of patients. Emergency calls, once uncommon, have increased with the passage of therapeutic-drug laws expanding optom­ etrists’ ability to prescribe medications.  Training, Other Qualifications, and Advancement  The Doctor of Optometry degree requires the completion of a 4-year program at an accredited optometry school. tion and ability to focus and coordinate the eyes. Optometrists may prescribe eyeglasses or contact lenses, or they may pro­ vide other treatments, such as vision therapy or low-vision rehabilitation. Optometrists also test for glaucoma and other eye diseases and diagnose conditions caused by systemic diseases such as diabetes and high blood pressure, referring patients to other health practitioners as needed. They prescribe medication to treat vision problems or eye diseases, and some provide pre­ operative and postoperative care to cataract patients, as well as to patients who have had corrective laser surgery. Like other physicians, optometrists encourage preventative measures by promoting nutrition and hygiene education to their patients to minimize the risk of eye disease. Although most work in a general practice as a primary care optometrist, some optometrists prefer to specialize in a particular field, such as contact lenses, geriatrics, pediatrics, or vision therapy. As a result, an increasing number of op­ tometrists are forming group practices in which each group member specializes in a specific area while still remaining a full scope practitioner. For example, an expert in low-vision rehabilitation may help legally blind patients by custom fitting  them with a magnifying device that will enable them to read. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  The Doctor of Optometry degree requires the completion of a 4-year program at an accredited school of optometry, preceded by at least 3 years of preoptometric study at an ac­ credited college or university. All States require optometrists to be licensed. Education and training. Optometrists need a Doctor of Optometry degree, which requires the completion of a 4-year program at an accredited school of optometry. In 2009, there were 19 colleges of optometry in the U.S. and 1 in Puerto Rico that offered programs accredited by the Accreditation Coun­ cil on Optometric Education of the American Optometric As­ sociation. Requirements for admission to optometry schools include college courses in English, mathematics, physics, chemistry, and biology. Because a strong background in sci­ ence is important, many applicants to optometry school major in a science, such as biology or chemistry, as undergraduates. Other applicants major in another subject and take many sci­ ence courses offering laboratory experience. Admission to optometry school is competitive; about 1 in 3 applicants was accepted in 2007. All applicants must take the Optometry Admissions Test (OAT), a standardized exam which measures academic ability and scientific comprehen­ sion. The OAT consists of four tests: survey of the natural sciences, such as biology, general chemistry, and organic chemistry; reading comprehension; physics; and quantitative reasoning. As a result, most applicants take the test after their sophomore or junior year in college, allowing them an op­ portunity to take the test again and raise their score. A few applicants are accepted to optometry school after 3 years of  Professional and Related Occupations 373  Projections data from the National Employment Matrix Occupational Title  soc  Code  Employment, 2008  Projected Employment, 2018 43,200  Change, 2008-2018 Number Percent 8,500 24  29-1041 34,800 Optometrists........................................................................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  college and complete their bachelor’s degree while attend­ ing optometry school. However, most students accepted by a school or college of optometry have completed an under­ graduate degree. Each institution has its own undergraduate prerequisites, so applicants should contact the school or col­ lege of their choice for specific requirements. Optometry programs include classroom and laboratory study of health and visual sciences and clinical training in the diagnosis and treatment of eye disorders. Courses in phar­ macology, optics, vision science, biochemistry, and systemic diseases are included. One-year postgraduate clinical residency programs are available for optometrists who wish to obtain advanced clini­ cal competence within a particular area of optometry. Spe­ cialty areas for residency programs include family practice optometry, pediatric optometry, geriatric optometry, vision therapy and rehabilitation, low-vision rehabilitation, cornea and contact lenses, refractive and ocular surgery, primary eye care optometry, and ocular disease. Licensure. All States and the District of Columbia require that optometrists be licensed. Applicants for a license must have a Doctor of Optometry degree from an accredited op­ tometry school and must pass both a written National Board examination and a National, regional, or State clinical exami­ nation. The written and clinical examinations of the National Board of Examiners in Optometry usually are taken during the student’s academic career. Many States also require appli­ cants to pass an examination on relevant State laws. Licenses must be renewed every 1 to 3 years and, in all States, continu­ ing education credits are needed for renewal. Other qualifications. Business acumen, self-discipline, and the ability to deal tactfully with patients are important for success. The work of optometrists also requires attention to detail and manual dexterity. Advancement. Optometrists who wish to teach or con­ duct research may study for a master’s degree or Ph.D. in visual science, physiological optics, neurophysiology, public health, health administration, health information and commu­ nication, or health education.  Employment Optometrists held about 34,800 jobs in 2008. Salaried jobs for optometrists were primarily in offices of optometrists; of­ fices of physicians, including ophthalmologists; and health and personal care stores, including optical goods stores. A few salaried jobs for optometrists were in hospitals, the Fed­ eral Government, or outpatient care centers, including health maintenance organizations. About 25 percent of optometrists are self-employed. According to a 2008 survey by the Ameri­ can Optometric Association, most self-employed optometrists Digitized worked for FRASER in private practice or in partnership with other health https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  care professionals. A small number worked for optical chains or franchises or as independent contractors.  Job Outlook Employment of optometrists is expected to grow much faster than the average for all occupations through 2018, in response to the vision care needs of a growing and aging population. Excellent job opportunities are expected. Employment change. Employment of optometrists is pro­ jected to grow 24 percent between 2008 and 2018. A grow­ ing population that recognizes the importance of good eye care will increase demand for optometrists. Also, an increas­ ing number of health insurance plans that include vision care should generate more job growth. As the population ages, there will likely be more visits to optometrists and ophthalmologists because of the onset of vision problems that occur at older ages, such as cataracts, glaucoma, and macular degeneration. In addition, increased incidences of diabetes and hypertension in the general popu­ lation as well as in the elderly will generate greater demand for optometric services as these diseases often affect eyesight. Employment of optometrists would grow more rapidly if not for productivity gains expected to allow each optometrist to see more patients. These expected gains stem from greater use of optometric assistants and other support personnel, who can reduce the amount of time optometrists need with each patient. The increasing popularity of laser surgery to correct some vision problems was previously thought to have an adverse effect on the demand for optometrists as patients often do not require eyeglasses afterward. However, optometrists will still be needed to provide preoperative and postoperative care for laser surgery patients, therefore laser eye surgery will likely have little to no impact on the employment of optometrists. Job prospects. Excellent job opportunities are expected over the next decade because there are only 19 schools of op­ tometry in the United States, resulting in a limited number of graduates—about 1,200—each year. This number is not expected to keep pace with demand. However, admission to optometry school is competitive. In addition to job growth, the need to replace optometrists who retire will also create many employment opportunities. Ac­ cording to the American Optometric Association, nearly onequarter of practicing optometrists are approaching retirement age. As they begin to retire, many opportunities will arise, par­ ticularly in individual and group practices.  Earnings Median annual wages of salaried optometrists were $96,320 in May 2008. The middle 50 percent earned between $70,140 and $125,460. Median annual wages of salaried optometrists  374 Occupational Outlook Handbook  in offices of optometrists were $92,670. Salaried optometrists tend to earn more initially than do optometrists who set up their own practices. In the long run, however, those in private practice usually earn more. According to the American Optometric Association, av­ erage annual income for self-employed optometrists was $175,329 in 2007. Self-employed optometrists, including those in individual, partnerships, and group practice, continue to earn higher in­ come than those in other settings. Earnings also vary by group size. For example, practitioners in large groups—six or more— earn $159,300; practitioners in mid-sized groups—three to five people—earn $179,205; those in small practices—two people—earn $176,944; and individual practitioners earn an average of $134,094. Self-employed optometrists must also provide their own benefits. Practitioners associated with opti­ cal chains earn $100,704 on average. However, they typically enjoy paid vacation, sick leave, and pension contributions.  Related Occupations Other workers who apply scientific knowledge to prevent, di­ agnose, and treat disorders and injuries include the following: Page Chiropractors............................................................................ 360 Dentists..................................................................................... 363 Physicians and surgeons........................................................... 381 Podiatrists................................................................................. 385 Psychologists............................................................................ 215 Veterinarians............................................................................. 402  Sources of Additional Information For information on optometry as a career and a list of accredited optometric institutions of education, contact: Association of Schools and Colleges of Optometry, 6110 Executive Blvd., Suite 420, Rockville, MD 20852. Internet: http ://www.opted.org  Pharmacists Significant Points • Excellent job opportunities are expected. • Earnings are relatively high, but some pharmacists are required to work nights, weekends, and holidays. • Pharmacists are becoming more involved in counsel­ ing patients and planning drug therapy programs. • Pharmacists must graduate from an accredited col­ lege of pharmacy and pass a series of examinations to be licensed. Nature of the Work Pharmacists distribute prescription drugs to individuals. They also advise their patients, physicians, and other health practi­ tioners on the selection, dosages, interactions, and side effects of medications, as well as monitor the health and progress of those patients to ensure that they are using their medications safely and effectively. Compounding—the actual mixing of in­ gredients to form medications—is a small part of a pharmacist’s practice, because most medicines are produced by pharmaceu­ tical companies in standard dosages and drug delivery forms. Most pharmacists work in a community setting, such as a retail drugstore, or in a healthcare facility, such as a hospital. Pharmacists in community pharmacies dispense medica­ tions, counsel patients on the use of prescription and over-thecounter medications, and advise physicians about medication therapy. They also advise patients about general health topics, such as diet, exercise, and stress management, and provide information on products, such as durable medical equipment or home healthcare supplies. In addition, they often complete third-party insurance forms and other paperwork. Those who own or manage community pharmacies may sell non-healthrelated merchandise, hire and supervise personnel, and over­ see the general operation of the pharmacy. Some community pharmacists provide specialized services to help patients with conditions such as diabetes, asthma, smoking cessation, or high  Additional career information is available from: y American Optometric Association, Educational Services, 243 N. Lindbergh Blvd., St. Louis, MO 63141. Internet: http://www.aoa.org The board of optometry in each State can supply information on licensing requirements. For information on specific admission requirements and sources of financial aid, contact the admissions officers of indi­ vidual optometry schools. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos073.htm  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Pharmacists provide prescription medications to patients in hospitals, grocery stores, and a variety of other settings.  Professional and Related Occupations 375  blood pressure. Some pharmacists are trained to administer vaccinations. Pharmacists in healthcare facilities dispense medications and advise the medical staff on the selection and effects of drugs. They may make sterile solutions to be administered intrave­ nously. They also plan, monitor, and evaluate drug programs or regimens. They may counsel hospitalized patients on the use of drugs before the patients are discharged. Some pharmacists specialize in specific drug therapy areas, such as intravenous nutrition support, oncology (cancer), nu­ clear pharmacy (used for chemotherapy), geriatric pharmacy, and psychiatric pharmacy (the use of drugs to treat mental disorders). Most pharmacists keep confidential computerized records of patients’ drug therapies to prevent harmful drug interactions. Pharmacists are responsible for the accuracy of every prescrip­ tion that is filled, but they often rely upon pharmacy techni­ cians to assist them in the dispensing medications. (Pharmacy technicians are covered elsewhere in the Handbook.) Thus, the pharmacist may delegate prescription-filling and administra­ tive tasks and supervise their completion. Pharmacists also fre­ quently oversee pharmacy students serving as interns. Some pharmacists are involved in research for pharmaceuti­ cal manufacturers, developing new drugs and testing their ef­ fects. Others work in marketing or sales, providing clients with expertise on the use, effectiveness, and possible side effects of drugs. Some pharmacists work for health insurance companies, developing pharmacy benefit packages and carrying out costbenefit analyses on certain drugs. Other pharmacists work for the government, managed care organizations, public healthcare services, or the armed services. Finally, some pharmacists are employed full time or part time as college faculty, teaching classes and performing research in a wide range of areas. Work environment. Pharmacists work in clean, well-lighted, and well-ventilated areas. Many pharmacists spend most of their workday on their feet. When working with sterile or dangerous pharmaceutical products, pharmacists wear gloves, masks, and other protective equipment. Most pharmacists work about 40 hours a week, but about 12 percent worked more than 50 hours per week in 2008. In addition, about 19 percent of pharmacists worked part-time. Many community and hospital pharmacies are open for ex­ tended hours, so pharmacists may be required to work nights, weekends, and holidays. Consultant pharmacists may travel to healthcare facilities to monitor patients’ drug therapies.  Training, Other Qualifications, and Advancement A license is required in all States and the District of Columbia, as well as in Guam, Puerto Rico, and the U.S. Virgin Islands. In order to obtain a license, pharmacists generally must earn a  Doctor of Pharmacy (Pharm.D.) degree from a college of phar­ macy and pass several examinations. Education and training. Pharmacists who are trained in the United States must earn a Pharm.D. degree from an accred­ ited college or school of pharmacy. The Pharm.D. degree has replaced the Bachelor of Pharmacy degree, which is no longer being awarded. To be admitted to a Pharm.D. program, an ap­ plicant must have completed at least 2 years of specific pro­ fessional study. This requirement generally includes courses in mathematics and natural sciences, such as chemistry, biology, and physics, as well as courses in the humanities and social sci­ ences. In addition, most applicants have completed 3 or more years at a college or university before moving on to a Pharm.D. program, although this is not specifically required. Pharm.D. programs generally take 4 years to complete. The courses offered are designed to teach students about all aspects of drug therapy. In addition, students learn how to communicate with patients and other healthcare providers about drug infor­ mation and patient care. Students also learn professional ethics, concepts of public health, and business management. In addi­ tion to receiving classroom instruction, students in Pharm.D. programs spend time working with licensed pharmacists in a variety of practice settings. Some Pharm.D. graduates obtain further training through 1 -year or 2-year residency programs or fellowships. Pharmacy residencies are postgraduate training programs in pharmacy practice and usually require the completion of a research project. The programs are often mandatory for pharmacists who wish to work in a clinical setting. Pharmacy fellowships are highly in­ dividualized programs that are designed to prepare participants to work in a specialized area of pharmacy, such clinical practice or research laboratories. Some pharmacists who own their own pharmacy obtain a master’s degree in business administration (MBA). Others may obtain a degree in public administration or public health. Licensure. A license to practice pharmacy is required in all States and the District of Columbia, as well as in Guam, Puerto Rico, and the U.S. Virgin Islands. To obtain a license, a prospective pharmacist generally must obtain a Pharm.D. de­ gree from a college of pharmacy that has been approved by the Accreditation Council for Pharmacy Education. After obtaining the Pharm.D. degree, the individual must pass a series of exami­ nations. All States, U.S. territories, and the District of Columbia require the North American Pharmacist Licensure Exam (NAPLEX), which tests pharmacy skills and knowledge. Forty-four States and the District of Columbia also require the Multistate Pharmacy Jurisprudence Exam (MPJE), which tests pharmacy law. Both exams are administered by the National Association of Boards of Pharmacy (NABP). Each of the eight States and territories that do not require the MJPE has its own pharmacy law exam. Besides requiring the NAPLEX and law examina-  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Pharmacists............................................................... ............................. 29-1051 269.900 315,800 45,900 17 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  376 Occupational Outlook Handbook  tion, some States and territories require additional exams that are unique to their jurisdictions. All jurisdictions also require a specified number of hours of experience in a practice setting be­ fore a license is awarded. In most jurisdictions, this requirement can be met while obtaining the Pharm.D. In many States, ap­ plicants must meet an age requirement before a license can be obtained, and some States require a criminal background check. All States and U.S. territories except Puerto Rico permit li­ censure for graduates of foreign pharmacy schools. These indi­ viduals must apply for certification from the Foreign Pharmacy Graduate Examination Committee (FPGEC). Once certified, they must pass the Foreign Pharmacy Graduate Equivalency Examination (FPGEE), Test of English as a Foreign Language (TOEFL) exam, and Test of Spoken English (TSE) exam. Then they must pass all of the exams required by the licensing juris­ diction, such as the NAPLEX and MJPE, and meet the require­ ments for practical experience. In some States, applicants who graduated from programs accredited by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) between 1993 and 2004 are exempt from FPGEC certification and ex­ amination requirements. Other qualifications. Prospective pharmacists should have scientific aptitude, good interpersonal skills, and a desire to help others. They also must be conscientious and pay close attention to detail, because the decisions they make affect human lives. Advancement. In community pharmacies, pharmacists usu­ ally begin at the staff level. Pharmacists in chain drugstores may be promoted to pharmacy supervisor or store manager. Some pharmacists may be promoted to manager at the district or regional level and, later, to an executive position within the chain’s headquarters. Hospital pharmacists may advance to supervisory or administrative positions. Some pharmacists be­ come owners or part owners of independent pharmacies. Phar­ macists in the pharmaceutical industry may advance in market­ ing, sales, research, quality control, production, or other areas.  Employment Pharmacists held about 269,900 jobs in 2008. About 65 percent worked in retail settings. Most of these were salaried employ­ ees, but a small number were self-employed owners. About 22 percent of pharmacists worked in hospitals. A small proportion worked in mail-order and Internet pharmacies, pharmaceutical wholesalers, offices of physicians, and the Federal Government.  Job Outlook Employment is expected to increase faster than the average. As a result of job growth, the need to replace workers who leave the occupation, and the limited capacity of training programs, job prospects should be excellent. Employment change. Employment of pharmacists is ex­ pected to grow by 17 percent between 2008 and 2018, which is faster than the average for all occupations. The increasing numbers of middle-aged and elderly people—who use more prescription drugs than younger people—will continue to spur demand for pharmacists throughout the projection period. In addition, as scientific advances lead to new drug products, and as an increasing number of people obtain prescription drug cov­ erage, the need for these workers will continue to expand.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Pharmacists also are becoming more involved in patient care. As prescription drugs become more complex, and as the num­ ber of people taking multiple medications increases, the poten­ tial for dangerous drug interactions will grow. Pharmacists will be needed to counsel patients on the proper use of medication, assist in drug selection and dosage, and monitor complex drug regimens. This need will lead to rapid growth for pharmacists in medical care establishments, such as doctors’ offices, outpatient care centers, and nursing care facilities. Demand also will increase in mail-order pharmacies, which often are more efficient than pharmacies in other practice set­ tings. Employment also will continue to grow in hospitals, drugstores, grocery stores, and mass retailers, because pharma­ cies in these settings will continue to process the majority of all prescriptions and increasingly will offer patient care services, such as the administration of vaccines. Job prospects. Job prospects are expected to be excellent over the 2008-18 period. Employers in many parts of the coun­ try report difficulty in attracting and retaining adequate num­ bers of pharmacists—primarily the result of the limited training capacity of Pharm.D. programs. In addition, as a larger percent­ age of pharmacists elects to work part time, more individuals will be needed to fill the same number of prescriptions. Job openings also will result from faster than average employment growth and from the need to replace workers who retire or leave the occupation for other reasons.  Earnings Median annual wages of wage and salary pharmacists in May 2008 were $106,410. The middle 50 percent earned between $92,670 and $121,310 a year. The lowest 10 percent earned less than $77,390, and the highest 10 percent earned more than $131,440 a year.  Related Occupations Other workers who are employed in pharmacies, work with pharmaceutical compounds, or are involved in patient care include: Page Biological scientists................................................................. 181 Medical scientists..................................................................... 189 Pharmacy technicians and aides.............................................. 436 Physicians and surgeons...........................................................381 Registered nurses.....................................................................392  Sources of Additional Information For information on pharmacy as a career, preprofessional and professional requirements, programs offered by colleges of pharmacy, and student financial aid, contact: y American Association of Colleges of Pharmacy, 1727 King St., Alexandria, VA 22314. Internet: http://www.aacp.org General information on careers in pharmacy is available from: y American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Internet: http://www.ashp.org y National Association of Chain Drug Stores, 413 N. Lee St., Alexandria, VA 22313. Internet: http://www.nacds.org  Professional and Related Occupations 377  y Academy of Managed Care Pharmacy, 100 North Pitt St., Suite 400, Alexandria, VA 22314. Internet: http://www.amcp.org y American Pharmacists Association, 2215 Constitution Ave. NW., Washington, DC 20037. Internet: http://www.pharmacist.com Information on the North American Pharmacist Licensure Exam (NAPLEX) and the Multistate Pharmacy Jurisprudence Exam (MPJE) is available from: y National Association of Boards of Pharmacy, 1600 Feehanville Dr., Mount Prospect, IL 60056. Internet: http ://www.nabp.net State licensure requirements are available from each State’s board of pharmacy. Information on specific college entrance re­ quirements, curricula, and financial aid is available from any college of pharmacy. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos079.htm  Physical Therapists Significant Points • Employment is expected to grow much faster than average. • Job opportunities should be good. • Today’s entrants to this profession need a post­ baccalaureate degree from an accredited physical therapist program.  and supervision of a physical therapist. Physical therapists evalu­ ate and diagnose movement dysfunction and use interventions to treat patient/clients. Interventions may include therapeutic ex­ ercise, functional training, manual therapy techniques, assistive and adaptive devices and equipment, and physical agents and electrotherapeutic modalities. Physical therapists often consult and practice with a variety of other professionals, such as physicians, dentists, nurses, educa­ tors, social workers, occupational therapists, speech-language pathologists, and audiologists. Work environment. Physical therapists practice in hospitals, outpatient clinics, and private offices that have specially equipped facilities. These jobs can be physically demanding, because ther­ apists may have to stoop, kneel, crouch, lift, and stand for long periods. In addition, physical therapists move heavy equipment and lift patients or help them turn, stand, or walk. In 2008, most full-time physical therapists worked a 40-hour week; some worked evenings and weekends to fit their patients’ schedules. About 27 percent of physical therapists worked part-time.  Training, Other Qualifications, and Advancement Today’s entrants to this profession need a post-baccalaureate degree from an accredited physical therapy program. All States regulate the practice of physical therapy, which usually requires passing scores on national and State examinations. Education and training. The American Physical Therapy As­ sociation’s accrediting body, called the Commission on Accredi­ tation of Physical Therapy Education (CAPTE), accredits entrylevel academic programs in physical therapy. In 2009, there were 212 physical therapist education programs. Of these accredited programs, 12 awarded master’s degrees; and 200 awarded doc­ toral degrees. Currently, only graduate degree physical therapist programs are accredited. Master’s degree programs typically are  • About 60 percent of physical therapists work in hos­ pitals or in offices of other health practitioners. Nature of the Work Physical therapists, sometimes referred to as simply PTs, are healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limits their abilities to move and perform functional activities as well as they would like in their daily lives. Physical therapists examine each individual and develop a plan using treatment tech­ niques to promote the ability to move, reduce pain, restore func­ tion, and prevent disability. In addition, PTs work with individu­ als to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles. Physical therapists provide care to people of all ages who have functional problems resulting from, for example, back and neck injuries, sprains/strains and fractures, arthritis, bums, amputa­ tions, stroke, multiple sclerosis, conditions such as cerebral palsy and spina bifida, and injuries related to work and sports. Physi­ cal therapy care and services are provided by physical therapists Digitizedand for FRASER physical therapist assistants who work under the direction https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Physical therapists may practice in hospitals, clinics, private offices, private homes, or schools.  378 Occupational Outlook Handbook  Projections data from the National Employment Matrix Projected Change, 2008-2018 Employment, Code 2018 Number Percent Physical therapists............................................ ..................................... 29-1123 185,500 241,700 56,200 30 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  Occupational Title  soc  Employment, 2008  tion Included in the Handbook.  2 to 2.5 years in length, while doctoral degree programs last 3 years. Physical therapist education programs include foundational science courses, such as biology, anatomy, physiology, cellu­ lar histology, exercise physiology, neuroscience, biomechanics, pharmacology, pathology, and radiology/imaging, as well as behavioral science courses, such as evidence-based practice and clinical reasoning. Some of the clinically-based courses include medical screening, examination tests and measures, diagnostic process, therapeutic interventions, outcomes assessment, and practice management. In addition to classroom and laboratory instmction, students receive supervised clinical experience. Among the undergraduate courses that are useful when one applies to a physical therapist education program are anatomy, biology, chemistry, physics, social science, mathematics, and sta­ tistics. Before granting admission, many programs require volun­ teer experience in the physical therapy department of a hospital or clinic. Licensure. All States regulate the practice of physical ther­ apy. Eligibility requirements vary by State. Typical requirements for physical therapists include graduation from an accredited physical therapy education program; passing the National Physi­ cal Therapy Examination; and fulfilling State requirements such as jurisprudence exams. A number of States require continuing education as a condition of maintaining licensure. Other qualifications. Physical therapists should have strong interpersonal and communication skills, so they can educate pa­ tients about their condition and physical therapy treatments and communicate with patients’ families. Physical therapists also should be compassionate and possess a desire to help patients. Advancement. Physical therapists are expected to continue their professional development by participating in continuing education courses and workshops. Some physical therapists be­ come board certified in a clinical specialty. Opportunities for physical therapists exist in academia and research. Some become self-employed, providing contract services or opening a private practice. Employment Physical therapists held about 185,500 jobs in 2008. The number of physical therapist jobs is probably greater than the number of practicing physical therapists, because some physical therapists work part time, holding two or more jobs. For example, some may work in a private practice, but also work part time in another healthcare facility. About 60 percent of physical therapists worked in hospitals or in offices of other health practitioners. Other jobs were in the home health care services industry, nursing care facilities, outpa­ tient care centers, and offices of physicians. Some physical thera­ pists were self-employed in private practices, seeing individual patients and contracting to provide services in hospitals, rehabili­  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  tation centers, nursing care facilities, home healthcare agencies, adult day care programs, and schools. Physical therapists also teach in academic institutions and conduct research. Job Outlook Employment is expected to grow much faster than average. Job opportunities should be good. Employment change. Employment of physical therapists is expected to grow by 30 percent from 2008 to 2018, much faster than the average for all occupations. Changes to restrictions on reimbursement for physical therapy services by third-party pay­ ers will increase patient access to services and, thus, increase de­ mand. The increasing elderly population will drive growth in the demand for physical therapy services. The elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. Also, the baby-boom generation is entering the prime age for heart attacks and strokes, increasing the demand for cardiac and physical rehabilitation. Medical and technological developments will permit a greater percentage of trauma victims and newborns with birth defects to survive, creat­ ing additional demand for rehabilitative care. In addition, growth may result from advances in medical technology and the use of evidence-base practices, which could permit the treatment of an increasing number of disabling conditions that were untreatable in the past. In addition, the federally mandated Individuals with Disabili­ ties Education Act guarantees that students have access to ser­ vices from physical therapists and other therapeutic and rehabili­ tative services. Demand for physical therapists will continue in schools. Job prospects. Job opportunities will be good for licensed physical therapists in all settings. Job opportunities should be particularly good in acute hospital, skilled nursing, and ortho­ pedic settings, where the elderly are most often treated. Job prospects should be especially favorable in rural areas as many physical therapists tend to cluster in highly populated urban and suburban areas. Earnings Median annual wages of physical therapists were $72,790 in May 2008. The middle 50 percent earned between $60,300 and $85,540. The lowest 10 percent earned less than $50,350, and the highest 10 percent earned more than $104,350. Median an­ nual wages in the industries employing the largest numbers of physical therapists in May 2008 were; Home health care services.......................................... $77,630 Nursing care facilities..................................................76,680 General medical and surgical hospitals........................73,270 Offices of physicians.................................................... 72,790 Offices of other health practitioners.............................71,400  Professional and Related Occupations 379  Related Occupations Physical therapists rehabilitate people with physical disabilities and provide wellness and prevention programs. Others who work in the rehabilitation field include: Page Audiologists.......................................................................................358  Chiropractors............................................................................ 360 Occupational therapists............................................................369 Recreational therapists............................................................. 389 Speech-language pathologists..................................................399  Sources of Additional Information Additional career information and a list of accredited educa­ tional programs in physical therapy are available from: > American Physical Therapy Association, 1111 North Fairfax St., Alexandria, VA 22314-1488. Internet: http://www.apta.org y In addition, the American Physical Therapy Association has developed the PT Centralized Application Service (PTCAS) that allows one to apply to some of the accredited physical therapist programs. Internet: http://www.ptcas.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos080.htm  Physician Assistants Significant Points • Requirements for admission to training programs vary; most applicants have a college degree and some health-related work experience. • Physician assistants must complete an accredited education program and pass a national exam in order to obtain a license.  certain medications. In some establishments, a PA is responsi­ ble for managerial duties, such as ordering medical supplies or equipment and supervising medical technicians and assistants. Physician assistants work under the supervision of a physi­ cian. However, PAs may be the principal care providers in rural or inner-city clinics where a physician is present for only 1 or 2 days each week. In such cases, the PA confers with the su­ pervising physician and other medical professionals as needed and as required by law. PAs also may make house calls or go to hospitals and nursing care facilities to check on patients, after which they report back to the physician. The duties of physician assistants are determined by the supervising physician and by State law. Aspiring PAs should investigate the laws and regulations in the States in which they wish to practice. Many PAs work in primary care specialties, such as general internal medicine, pediatrics, and family medicine. Other spe­ cialty areas include general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in sur­ gery provide preoperative and postoperative care and may work as first or second assistants during major surgery. Work environment. Although PAs usually work in a com­ fortable, well-lighted environment, those in surgery often stand for long periods. At times, the job requires a considerable amount of walking. PA’s work schedules may vary according to the practice set­ ting and often depend on the hours of the supervising physician. The workweek of hospital-based PAs may include weekends, nights, or early morning hospital rounds to visit patients. These workers also may be on call. PAs in clinics usually work about a 40-hour week.  3=1-  • Employment is projected to grow much faster than the average. • Job opportunities should be good, particularly in rural and inner-city healthcare facilities. Nature of the Work Physician assistants (PAs) practice medicine under the supervi­ sion of physicians and surgeons. They should not be confused with medical assistants, who perform routine clinical and cleri­ cal tasks. (Medical assistants are discussed elsewhere in the Handbook.) PAs are formally trained to provide diagnostic, therapeutic, and preventive healthcare services, as delegated by a physician. Working as members of a healthcare team, they take medical histories, examine and treat patients, order and in­ terpret laboratory tests and x rays, and make diagnoses. They also treat minor injuries by suturing, splinting, and casting. PAs record progress notes, instruct and counsel patients, and order out therapy. Physician assistants also may prescribe Digitizedorforcarry FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Physician assistants are formally trained to provide diagnos­ tic, therapeutic, and preventive healthcare services, under the supervision of a physician.  380 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code 2018 Number Percent 29,200 39 103,900 74,800 29-1071 Physician assistants........................................... .................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ________  Occupational Title  Training, Other Qualifications, and Advancement Requirements for admission to training programs vary; most applicants have a college degree and some health-related work experience. All States require physician assistants to complete an accredited, formal education program and pass a national exam to obtain a license. Education and training. Physician assistant educational programs usually take at least 2 years to complete for full-time students. Most programs are at schools of allied health, aca­ demic health centers, medical schools, or 4-year colleges; a few are at community colleges, are part of the military, or are at hospitals. Many accredited PA programs have clinical teaching affiliations with medical schools. In 2008, 142 education programs for physician assistants were accredited or provisionally accredited by the Accreditation Review Commission on Education for the Physician Assistant. Eighty percent, or 113, of these programs offered the option of a master’s degree, 21 of them offered a bachelor’s degree, 3 awarded associate degrees, and 5 awarded a certificate. Most applicants to PA educational programs already have a college degree and some health-related work experience; how­ ever, admissions requirements vary from program to program. Many PAs have prior experience as registered nurses, emer­ gency medical technicians, and paramedics. PA education includes classroom and laboratory instruc­ tion in subjects like biochemistry, pathology, human anatomy, physiology, clinical pharmacology, clinical medicine, physical diagnosis, and medical ethics. PA programs also include super­ vised clinical training in several areas, including family medi­ cine, internal medicine, surgery, prenatal care and gynecology, geriatrics, emergency medicine, and pediatrics. Sometimes, PA students serve in one or more of these areas under the supervi­ sion of a physician who is seeking to hire a PA. The rotation may lead to permanent employment in one of the areas where the student works. Licensure. All States and the District of Columbia have legislation governing the practice of physician assistants. All jurisdictions require physician assistants to pass the Physician Assistant National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA) and open only to graduates of accredited PA educa­ tion programs. Only those who have successfully completed the examination may use the credential “Physician AssistantCertified.” To remain certified, PAs must complete 100 hours of continuing medical education every 2 years. Every 6 years, they must pass a recertification examination or complete an alterna­ tive program combining learning experiences and a take-home examination. Other qualifications. Physician assistants must have a de­ sire to serve patients and be self-motivated. PAs also must have a good bedside manner, emotional stability, and the ability to  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  make decisions in emergencies. Physician assistants should have an enthusiasm for lifelong learning, because their eligibil­ ity to practice depends on continuing education. Advancement. Some PAs pursue additional education in a specialty. PA postgraduate educational programs are available in areas such as internal medicine, rural primary care, emer­ gency medicine, surgery, pediatrics, neonatology, and occupa­ tional medicine. Candidates must be graduates of an accredited program and be certified by the NCCPA. As they attain greater clinical knowledge and experience, PAs can earn new responsibilities and higher wages. However, by the very nature of the profession, clinically practicing PAs always are supervised by physicians.  Employment Physician assistants held about 74,800 jobs in 2008. The num­ ber of jobs is greater than the number of practicing PAs because some hold two or more jobs. For example, some PAs work with a supervising physician but also work in another healthcare fa­ cility. According to the American Academy of Physician As­ sistants, about 15 percent of actively practicing PAs worked in more than one clinical job concurrently in 2008. More than 53 percent of jobs for PAs were in the offices of physicians. About 24 percent were in general medical and sur­ gical hospitals, public or private. The rest were mostly in outpa­ tient care centers, including health maintenance organizations; the Federal Government; and public or private colleges, univer­ sities, and professional schools. Very few were self-employed.  Job Outlook Employment is expected to grow much faster than the average for all occupations. Job opportunities for PAs should be good, particularly in rural and inner-city healthcare facilities. Employment change. Employment of physician assistants is expected to grow by 39 percent from 2008 to 2018, much faster than the average for all occupations. Projected rapid job growth reflects the expansion of healthcare industries and an emphasis on cost containment, which results in increasing use of PAs by healthcare establishments. Physicians and institutions are expected to employ more PAs to provide primary care and to assist with medical and surgi­ cal procedures because PAs are cost-effective and productive members of the healthcare team. Physician assistants can re­ lieve physicians of routine duties and procedures. Healthcare providers will use more physician assistants as States continue to expand PAs’ scope of practice by allowing them to perform more procedures. Besides working in traditional office-based settings, PAs should find a growing number of jobs in institutional settings such as hospitals, academic medical centers, public clinics, and prisons.  Professional and Related Occupations 381  Job prospects. Job opportunities for PAs should be good, particularly in rural and inner-city clinics because those settings have difficulty attracting physicians. Job openings will result both from employment growth and from the need to replace physician assistants who retire or leave the occupation perma­ nently. Opportunities will be best in States that allow PAs a wider scope of practice.  acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos081.htm  Physicians and Surgeons Significant Points  Earnings The median annual wage of physician assistants was $81,230 in May 2008. The middle 50 percent of physician assistants earned between $68,210 and $97,070. The lowest 10 percent earned less than $51,360, and the highest 10 percent earned more than $110,240. Median annual wages in the industries employing the largest numbers of physician assistants in May 2008 were: General medical and surgical hospitals......................$84,550 Outpatient care centers................................................. 84,390 Offices of physicians.................................................... 80,440 Federal Executive Branch............................................ 78,200 Colleges, universities, and professional schools......... 74,200 According to the American Academy of Physician Assistants’ 2008 Census Report, median income for physician assistants in full-time clinical practice was $85,710 in 2008; median income for first-year graduates was $74,470. Income varies by specialty, practice setting, geographical location, and years of experience. Employers often pay for their employees’ professional liability insurance, registration fees with the Drug Enforcement Admin­ istration, State licensing fees, and credentialing fees.  Related Occupations Occupations with similar educational backgrounds, healthcare experience, and/or responsibilities include: Page Audiologists............................................................................. 358 Occupational therapists............................................................ 369 Physical therapists.................................................................... 377 Registered nurses..................................................................... 392 Speech-language pathologists..................................................399  Sources of Additional Information For information on a career as a physician assistant, including a list of accredited programs, contact: y American Academy of Physician Assistants Information Center, 950 North Washington St., Alexandria, VA 22314. Internet: http://www.aapa.org For a list of accredited physician assistant programs, contact: y Accreditation Review Commission on Education for the Physician Assistants, 12000 Findley Road, Suite 240, Johns Creek, Georgia 30097. Internet: http://www.arc-pa.org For eligibility requirements and a description of the Physi­ cian Assistant National Certifying Examination, contact: y National Commission on Certification of Physician Assistants, Inc., 12000 Findley Rd., Suite 200, Duluth, GA 30097. Internet: http://www.nccpa.net The Occupational Information Network (0*NET) pro­ Digitizedvides for FRASER information on a wide range of occupational char­ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  • Many physicians and surgeons work long, irregular hours. • Acceptance to medical school is highly competitive. • Formal education and training requirements—typi­ cally 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency—are among the most demanding of any occupation, but earnings are among the highest. • Job opportunities should be very good, particularly in rural and low-income areas. Nature of the Work Physicians and surgeons diagnose illnesses and prescribe and administer treatment for people suffering from injury or dis­ ease. Physicians examine patients, obtain medical histories, and order, perform, and interpret diagnostic tests. They counsel pa­ tients on diet, hygiene, and preventive health care. There are two types of physicians: M.D. (Medical Doctor) and D.O. (Doctor of Osteopathic Medicine). M.D.s also are known as allopathic physicians. While both M.D.s and D.O.s may use all accepted methods of treatment, including drugs and surgery, D.O.s place special emphasis on the body’s musculo­ skeletal system, preventive medicine, and holistic patient care. D.O.s are most likely to be primary care specialists although they can be found in all specialties. About half of D.O.s prac­ tice general or family medicine, general internal medicine, or general pediatrics. Physicians work in one or more of several specialties, includ­ ing, but not limited to, anesthesiology, family and general med­ icine, general internal medicine, general pediatrics, obstetrics and gynecology, psychiatry, and surgery. Anesthesiologists focus on the care of surgical patients and pain relief. Like other physicians, they evaluate and treat pa­ tients and direct the efforts of their staffs. Through continual monitoring and assessment, these critical care specialists are responsible for maintenance of the patient’s vital life func­ tions—heart rate, body temperature, blood pressure, breath­ ing—during surgery. They also work outside of the operating room, providing pain relief in the intensive care unit, during labor and delivery, and for those who suffer from chronic pain. Anesthesiologists confer with other physicians and surgeons about appropriate treatments and procedures before, during, and after operations. Family and general physicians often provide the first point of contact for people seeking health care, by acting as the tra­ ditional family physician. They assess and treat a wide range of conditions, from sinus and respiratory infections to broken bones. Family and general physician typically have a base of  382 Occupational Outlook Handbook  Physicians examine patients, obtain medical histories, and or­ der, perform, and interpret diagnostic tests. regular, long-term patients. These doctors refer patients with more serious conditions to specialists or other health care facili­ ties for more intensive care. General internists diagnose and provide nonsurgical treat­ ment for a wide range of problems that affect internal organ systems, such as the stomach, kidneys, liver, and digestive tract. Internists use a variety of diagnostic techniques to treat patients through medication or hospitalization. Like general practitio­ ners, general internists commonly act as primary care special­ ists. They treat patients referred from other specialists and, in turn, they refer patients to other specialists when more complex care is required. General pediatricians care for the health of infants, children, teenagers, and young adults. They specialize in the diagnosis and treatment of a variety of ailments specific to young people and track patients’ growth to adulthood. Like most physicians, pediatricians work with different health care workers, such as nurses and other physicians, to assess and treat children with various ailments. Most of the work of pediatricians involves treating day-to-day illnesses—minor injuries, infectious dis­ eases, and immunizations—that are common to children, much as a general practitioner treats adults. Some pediatricians spe­ cialize in pediatric surgery or serious medical conditions, such as autoimmune disorders or serious chronic ailments. Obstetricians and gynecologists (OB/GYNs) specialize in women’s health. They are responsible for women’s general medical care, and they also provide care related to pregnancy and the reproductive system. Like general practitioners, OB/ GYNs attempt to prevent, diagnose, and treat general health problems, but they focus on ailments specific to the female anatomy, such as cancers of the breast or cervix, urinary tract and pelvic disorders, and hormonal disorders. OB/GYNs also specialize in childbirth, which includes treating and counseling women throughout their pregnancy, from giving prenatal diag­ noses to assisting with delivery and providing postpartum care. Psychiatrists are the primary mental health caregivers. They assess and treat mental illnesses through a combination of psychotherapy, psychoanalysis, hospitalization, and medica­ tion. Psychotherapy involves regular discussions with patients about their problems; the psychiatrist helps them find solutions through changes in their behavioral patterns, the exploration of  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  their past experiences, or group and family therapy sessions. Psychoanalysis involves long-term psychotherapy and counsel­ ing for patients. In many cases, medications are administered to correct chemical imbalances that cause emotional problems. Surgeons specialize in the treatment of injury, disease, and deformity through operations. Using a variety of instruments, and with patients under anesthesia, a surgeon corrects physical deformities, repairs bone and tissue after injuries, or performs preventive surgeries on patients with debilitating diseases or disorders. Although a large number perform general surgery, many surgeons choose to specialize in a specific area. One of the most prevalent specialties is orthopedic surgery: the treat­ ment of the musculoskeletal system. Others include neurologi­ cal surgery (treatment of the brain and nervous system), car­ diovascular surgery, otolaryngology (treatment of the ear, nose, and throat), and plastic or reconstructive surgery. Like other physicians, surgeons also examine patients, perform and inter­ pret diagnostic tests, and counsel patients on preventive health care. Other physicians and surgeons work in a number of other medical and surgical specialists, including allergists, cardiolo­ gists, dermatologists, emergency physicians, gastroenterolo­ gists, ophthalmologists, pathologists, and radiologists. Work environment. Many physicians—primarily general and family practitioners, general internists, pediatricians, OB/ GYNs, and psychiatrists—work in small private offices or clin­ ics, often assisted by a small staff of nurses and other admin­ istrative personnel. Increasingly, physicians are practicing in groups or health care organizations that provide backup cover­ age and allow for more time off. Physicians in a group practice or health care organization often work as part of a team that coordinates care for a number of patients; they are less inde­ pendent than the solo practitioners of the past. Surgeons and anesthesiologists usually work in well-lighted, sterile environ­ ments while performing surgery and often stand for long peri­ ods. Most work in hospitals or in surgical outpatient centers. Many physicians and surgeons work long, irregular hours. In 2008, 43 percent of all physicians and surgeons worked 50 or more hours a week. Nine percent of all physicians and surgeons worked part-time. Physicians and surgeons travel between office and hospital to care for their patients. While on call, a physician will deal with many patients’ concerns over the phone and make emergency visits to hospitals or nursing homes.  Training, Other Qualifications, and Advancement The common path to practicing as a physician requires 8 years of education beyond high school and 3 to 8 additional years of internship and residency. All States, the District of Columbia, and U.S. territories license physicians. Education and training. Formal education and training re­ quirements for physicians are among the most demanding of any occupation—4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on the specialty selected. A few medical schools of­ fer combined undergraduate and medical school programs that last 6 or 7 years rather than the customary 8 years. Premedical students must complete undergraduate work in physics, biology, mathematics, English, and inorganic and  organic chemistry. Students also take courses in the humani­ ties and the social sciences. Some students volunteer at local hospitals or clinics to gain practical experience in the health professions. The minimum educational requirement for entry into medi­ cal school is 3 years of college; most applicants, however, have at least a bachelor’s degree, and many have advanced degrees. In 2008, there were 129 medical schools accredited by the Li­ aison Committee on Medical Education (LCME). The LCME is the national accrediting body for M.D. medical education programs. The American Osteopathic Association accredits schools that award a D.O. degree; there were 25 schools ac­ credited in 31 locations in 2008. Acceptance to medical school is highly competitive. Most ap­ plicants must submit transcripts, scores from the Medical Col­ lege Admission Test, and letters of recommendation. Schools also consider an applicant’s character, personality, leadership qualities, and participation in extracurricular activities. Most schools require an interview with members of the admissions committee. Students spend most of the first 2 years of medical school in laboratories and classrooms, taking courses such as anatomy, biochemistry, physiology, pharmacology, psychology, microbi­ ology, pathology, medical ethics, and laws governing medicine. They also learn to take medical histories, examine patients, and diagnose illnesses. During their last 2 years, students work with patients under the supervision of experienced physicians in hos­ pitals and clinics, learning acute, chronic, preventive, and reha­ bilitative care. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and treatment of illness. Following medical school, almost all M.D.s enter a resi­ dency—graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.s serve a 12-month rotating internship after graduation and before entering a residency, which may last 2 to 6 years. A physician’s training is costly. According to the Association of American Medical Colleges, in 2007 85 percent of public medical school graduates and 86 percent of private medical school graduates were in debt for educational expenses. Licensure and certification. To practice medicine as a phy­ sician, all States, the District of Columbia, and U.S. territories require licensing. All physicians and surgeons practicing in the United States must pass the United States Medical Licensing Examination (USMLE). To be eligible to take the USMLE in its entirety, physicians must graduate from an accredited medical school. Although physicians licensed in one State usually can get a license to practice in another without further examina­ tion, some States limit reciprocity. Graduates of foreign medi­ cal schools generally can qualify for licensure after passing an examination and completing a U.S. residency. For specific information on licensing in a given State, contact that State’s medical board. M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years in residency training, depending on the specialty. A final examination immediately after residency or after 1 or 2 years of practice is also necessary for certification member board of the American Board of Medical Special­ Digitizedbyfora FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 383  ists (ABMS) or the American Osteopathic Association (AOA). The ABMS represents 24 boards related to medical specialties ranging from allergy and immunology to urology. The AOA has approved 18 specialty boards, ranging from anesthesiology to surgery. For certification in a subspecialty, physicians usually need another 1 to 2 years of residency. Other qualifications. People who wish to become physi­ cians must have a desire to serve patients, be self-motivated, and be able to survive the pressures and long hours of medical education and practice. Physicians also must have a good bed­ side manner, emotional stability, and the ability to make deci­ sions in emergencies. Prospective physicians must be willing to study throughout their career to keep up with medical advances. Advancement. Some physicians and surgeons advance by gaining expertise in specialties and subspecialties and by de­ veloping a reputation for excellence among their peers and pa­ tients. Physicians and surgeons may also start their own prac­ tice or join a group practice. Others teach residents and other new doctors, and some advance to supervisory and managerial roles in hospitals, clinics, and other settings.  Employment Physicians and surgeons held about 661,400 jobs in 2008; ap­ proximately 12 percent were self-employed. About 53 percent of wage-and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. Oth­ ers practiced in Federal, State, and local governments, educa­ tional services, and outpatient care centers. According to 2007 data from the American Medical Associa­ tion (AMA), 32 percent of physicians in patient care were in primary care, but not in a subspecialty of primary care. (See table 1.) Table 1. Percent distribution of active physicians in patient care by specialty, 2007 SpecialtyPercent Internal medicine................................................................... 20 Family medicine/general practice........................................ 12 Pediatrics................................................................................. 10 Obstetrics and gynecology................................................... 6 Anesthesiology....................................................................... 6 Psychiatry..................................................................................... 5 General Surgery ......................................................................... 5 Emergency Medicine.................................................................. 4 SOURCE: American Medical Association, 2009 Physican Characteristic and Distribution in the US.  A growing number of physicians are partners or wage-andsalary employees of group practices. Organized as clinics or as associations of physicians, medical groups can more easily afford expensive medical equipment, share support staff, and benefit from other business advantages. According to the AMA, the New England and Middle Atlan­ tic States have the highest ratios of physicians to population; the South Central and Mountain States have the lowest. Physicians tend to locate in urban areas, close to hospitals and education centers. AMA data showed that in 2007, about 75 percent of physicians in patient care were located in metropolitan areas while the remaining 25 percent were located in rural areas.  384 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code 2018 Number Percent 144,100 22 661,400 805,500 29-1060 Physicians and surgeons........................................................................ (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ___________________________  Occupational Title  Job Outlook Employment is expected to grow much faster than the average for all occupations. Job opportunities should be very good, par­ ticularly in rural and low-income areas. Employment change. Employment of physicians and sur­ geons is projected to grow 22 percent from 2008 to 2018, much faster than the average for all occupations. Job growth will oc­ cur because of continued expansion of health care-related in­ dustries. The growing and aging population will drive overall growth in the demand for physician services, as consumers con­ tinue to demand high levels of care using the latest technolo­ gies, diagnostic tests, and therapies. Many medical schools are increasing their enrollments based on perceived new demand for physicians. Despite growing demand for physicians and surgeons, some factors will temper growth. For example, new technologies al­ low physicians to be more productive. This means physicians can diagnose and treat more patients in the same amount of time. The rising cost of health care can dramatically affect de­ mand for physicians’ services. Physician assistants and nurse practitioners, who can perform many of the routine duties of physicians at a fraction of the cost, may be increasingly used. Furthermore, demand for physicians’ services is highly sen­ sitive to changes in health care reimbursement policies. If changes to health coverage result in higher out-of-pocket costs for consumers, they may demand fewer physician services. Job prospects. Opportunities for individuals interested in becoming physicians and surgeons are expected to be very good. In addition to job openings from employment growth, openings will result from the need to replace the relatively high number of physicians and surgeons expected to retire over the 2008-18 decade. Job prospects should be particularly good for physicians willing to practice in rural and low-income areas because these medically underserved areas typically have difficulty attracting these workers. Job prospects will also be especially good for physicians in specialties that afflict the rapidly growing elderly population. Examples of such specialties are cardiology and ra­ diology because the risks for heart disease and cancer increase as people age.  Earnings Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association’s Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had to­ tal median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation  of $339,738. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  Self-employed physicians—those who own or are part own­ ers of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health in­ surance and retirement.  Related Occupations Physicians work to prevent, diagnose, and treat diseases, dis­ orders, and injuries. Other health care practitioners who need similar skills and who exercise critical judgment include: Page Chiropractors............................................................................ 360 Dentists..................................................................................... 363 Optometrists............................................................................. 371 Physician assistants..................................................................379 Podiatrists................................................................................. 385 Registered nurses.....................................................................392 Veterinarians.............................................................................402  Sources of Additional Information For a list of medical schools and residency programs, as well as general information on premedical education, financial aid, and medicine as a career contact: y Association of American Medical Colleges, Section for Student Services, 2450 N St. NW., Washington, DC 20037. Internet: http://www.aamc.org/students For information on licensing, contact: y Federation of State Medical Boards, P.O. Box 619850 Dallas, TX 75261-9850. Internet: http://www.fsmb.org For general information on physicians, contact: y American Medical Association, 515 N. State St., Chicago, IL 60654. Internet: http://www.ama-assn.org/go/becominganmd y American Osteopathic Association, Department of Communications, 142 East Ontario St., Chicago, IL 60611. Internet: http://www.osteopathic.org For information about various medical specialties, contact: y American Academy of Family Physicians, Resident Student Activities Department, P.O. Box 11210, Shawnee Mission, KS 66207-1210. Internet: http://fmignet.aafp.org y American Board of Medical Specialties, 222 N. LaSalle St., Suite 1500, Chicago, IL 60601. Internet: http ://www.abms.org y American College of Obstetricians and Gynecologists, P.O. Box 96920, Washington, DC 20090. Internet: http://www.acog.org  Professional and Related Occupations 385  y American College of Surgeons, Division of Education, 633 North Saint Clair St., Chicago, IL 60611. Internet: http ://www.facs.org y American Psychiatric Association, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209. Internet: http://www.psych.org  mm '  y American Society of Anesthesiologists, 520 N. Northwest Hwy., Park Ridge, IL 60068. Internet: http://www.asahq.org/career/homepage.htm Information on Federal scholarships and loans is available from the directors of student financial aid at schools of medi­ cine. Information on licensing is available from State boards of examiners. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos074.htm  Podiatrists Significant Points • Podiatrists must be licensed, requiring 3 to 4 years of undergraduate education, the completion of a 4-year podiatric college program, and passing scores on na­ tional and State examinations. • Job opportunities should be good for entry-level grad­ uates of accredited podiatric medicine programs. • Opportunities will be better in group medical prac­ tices, clinics, and health networks than in traditional, solo practices. • Podiatrists enjoy very high earnings. Nature of the Work Americans spend a great deal of time on their feet. As the Na­ tion becomes more active across all age groups, the need for foot care will become increasingly important. Podiatrists, also known as doctors ofpodiatric medicine (DPMs), diagnose and treat disorders, diseases, and injuries of the foot and lower leg. Podiatrists treat corns, calluses, ingrown toenails, bunions, heel spurs, and arch problems; ankle and foot injuries, defor­ mities, and infections; and foot complaints associated with diabetes and other diseases. To treat these problems, podiatrists prescribe drugs and physical therapy, set fractures, and perform surgery. They also fit corrective shoe inserts called orthotics, design plaster casts and strappings to correct deformities, and design custom-made shoes. Podiatrists may use a force plate or scanner to help design the orthotics: patients walk across a plate connected to a computer that “reads” their feet, picking up pres­ sure points and weight distribution. From the computer readout, podiatrists order the correct design or recommend another kind of treatment. To diagnose a foot problem, podiatrists also may order X rays and Digitized for laboratory FRASER tests. The foot may be the first area to show signs https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Podiatrists diagnose and treat disorders, diseases, and injuries of the foot and lower leg. of serious conditions such as arthritis, diabetes, and heart dis­ ease. For example, patients with diabetes are prone to foot ul­ cers and infections because of poor circulation. Podiatrists con­ sult with and refer patients to other health practitioners when they detect symptoms of these disorders. Most podiatrists have a solo practice, although more are forming group practices with other podiatrists or health practi­ tioners. Some specialize in surgery, orthopedics, primary care, or public health. Besides these board-certified specialties, po­ diatrists may practice other specialties, such as sports medicine, pediatrics, dermatology, radiology, geriatrics, or diabetic foot care. Podiatrists who are in private practice are responsible for run­ ning a small business. They may hire employees, order sup­ plies, and keep records, among other tasks. In addition, some educate the community on the benefits of foot care through speaking engagements and advertising. Work environment. Podiatrists usually work in small private offices or clinics, sometimes supported by a small staff of assis­ tants and other administrative personnel. They also may spend time visiting patients in nursing homes or performing surgery at hospitals or ambulatory surgical centers. Work hours vary from 30-60 hours per week. Podiatrists with private practices may set their own hours but may work evenings and weekends to accommodate their patients. Podiatrists usually treat fewer emergencies than other doctors.  386 Occupational Outlook Handbook  Training, Other Qualifications, and Advancement Podiatrists must be licensed, requiring 3 to 4 years of under­ graduate education, the completion of a 4-year podiatric college program, and passing scores on national and State examinations. Education and training. Prerequisites for admission to a college of podiatric medicine include the completion of at least 90 semester hours of undergraduate study, an acceptable grade point average, and suitable scores on the Medical College Admission Test. (Some colleges also may accept the Dental Admission Test or the Graduate Record Exam.) Admission to podiatric colleges usually requires at least 8 semester hours each of biology, inorganic chemistry, organic chemistry, and physics and at least 6 hours of English. The sci­ ence courses should be those designed for premedical students. Extracurricular and community activities, personal interviews, and letters of recommendation are also important. About 95 percent of podiatric students have at least a bachelor’s degree. In 2008, there were eight colleges of podiatric medicine fully accredited by the Council on Podiatric Medical Education. Col­ leges of podiatric medicine offer a 4-year program whose core curriculum is similar to that in other schools of medicine. Dur­ ing the first 2 years, students receive classroom instruction in basic sciences, including anatomy, chemistry, pathology, and pharmacology. Third-year and fourth-year students have clini­ cal rotations in private practices, hospitals, and clinics. During these rotations, they learn how to take general and podiatric histories, perform routine physical examinations, interpret tests and findings, make diagnoses, and perform therapeutic pro­ cedures. Graduates receive the degree of Doctor of Podiatric Medicine (DPM). Most graduates complete a hospital-based residency program after receiving a DPM. Residency programs last from 2 to 4 years. Residents receive advanced training in podiatric medi­ cine and surgery and serve clinical rotations in anesthesiology, internal medicine, infectious disease, pediatrics, emergency medicine, and orthopedic and general surgery. Residencies last­ ing more than 1 year provide more extensive training in spe­ cialty areas. Licensure. All States and the District of Columbia require a license for the practice of podiatric medicine. Each State defines its own licensing requirements, although many States grant reciprocity to podiatrists who are licensed in another State. Applicants for licensure must be graduates of an accred­ ited college of podiatric medicine and must pass written and oral examinations. Some States permit applicants to substitute the examination of the National Board of Podiatric Medical Examiners, given in the second and fourth years of podiatric medical college, for part or all of the written State examination. In general, States require a minimum of 2 years of postgradu­ ate residency training in an approved healthcare institution. For licensure renewal, most States require continuing education.  Other qualifications. People planning a career in podiatry should have scientific aptitude, manual dexterity, interpersonal skills, and a friendly bedside manner. In private practice, podia­ trists also should have good business sense. Certification and advancement. There are a number of certifying boards for the podiatric specialties of orthopedics, primary medicine, and surgery. Certification has requirements beyond licensure. Each board requires advanced training, the completion of written and oral examinations, and experience as a practicing podiatrist. Most managed-care organizations prefer board-certified podiatrists. Podiatrists may advance to become professors at colleges of podiatric medicine, department chiefs in hospitals, or general health administrators. Employment Podiatrists held about 12,200 jobs in 2008. About 19 percent of podiatrists were self-employed. Most podiatrists were solo practitioners, although more are entering group practices with other podiatrists or other health practitioners. Solo practitioners were either unincorporated self-employed workers or incorpo­ rated wage and salary workers in offices of other health prac­ titioners. Other podiatrists were employed by hospitals and the Federal Government.  Job Outlook Employment is expected to increase about as fast as average. Job prospects should be good. Employment change. Employment of podiatrists is expected to increase by 9 percent from 2008 to 2018, about as fast as the average for all occupations. More people will turn to po­ diatrists for foot care because of the rising number of injuries sustained by a more active and increasingly older population. Also, demand for podiatrists will increase because of the rising number of Americans who are diagnosed with diabetes and who are severely overweight. People with diabetes have circulatory problems that create the need for them to seek the aid of po­ diatrists; persons who experience rapid weight gain may have intense pressure on the foot and ankle, and therefore need the services of podiatrists. Medicare and most private health insurance programs cover acute medical and surgical foot services, as well as diagnostic X rays and leg braces. Details of such coverage vary among plans. However, routine foot care, including the removal of corns and calluses, is not usually covered unless the patient has a systemic condition that has resulted in severe circulatory problems or ar­ eas of desensitization in the legs or feet. Like dental services, podiatric care is often discretionary and, therefore, more depen­ dent on disposable income than some other medical services. Employment of podiatrists would grow even faster were it not for continued emphasis on controlling the costs of specialty  Projections data from the National Employment Matrix Occupational Title Podiatrists.................................................................. .............................  soc  Code 29-1081  Employment, 2008  12,200  Projected Employment, 2018 13,300  Change, 2008-2018 Number Percent 1,100 9  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 387  healthcare. Insurers will balance the cost of sending patients to podiatrists against the cost and availability of substitute practitioners, such as physicians, chiropractors, and physical therapists. Job prospects. Although the occupation is small and most podiatrists continue to practice until retirement, job opportuni­ ties should be good for entry-level graduates of accredited podiatric medicine programs. Job growth, coupled with the need to replace podiatrists who stop practicing, should create enough job openings for the supply of new podiatric medicine gradu­ ates. Opportunities will be better for board-certified podiatrists because many managed-care organizations require board certi­ fication. Newly trained podiatrists will find more opportunities in group medical practices, clinics, and health networks than in traditional solo practices. Establishing a practice will be most difficult in the areas surrounding colleges of podiatric medi­ cine, where podiatrists concentrate.  acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos075.htm  Earnings  Radiation therapy is used to treat cancer in the human body. As part of a medical radiation oncology team, radiation ther­ apists use machines called linear accelerators to administer radiation treatment to patients. Linear accelerators are most commonly used in a procedure called external beam therapy, which projects high-energy x-rays at targeted cancer cells. As the X-rays collide with human tissue, they produce highly en­ ergized ions that can shrink and eliminate cancerous tumors. Radiation therapy is sometimes used as the sole treatment for cancer, but it is usually used in conjunction with chemother­  Podiatrists enjoy very high earnings. Median annual wages of salaried podiatrists were $113,560 in May 2008. Additionally, a survey by Podiatry Management Magazine reported median net income of $114,768 in 2008. Podiatrists in partnerships tended to earn higher net incomes than those in solo practice. Sala­ ried podiatrists typically receive heath insurance and retirement benefits from their employer, whereas self-employed podiatrists must provide for their own health insurance and retirement. Also, solo practitioners must absorb the costs of running their own offices.  Related Occupations Other workers who apply medical knowledge to prevent, diag­ nose, and treat muscle and bone disorders and injuries include: Page Athletic trainers.................................................................................405 Chiropractors..................................................................................... 360 Massage therapists........................................................................... 452 Occupational therapists................................................................... 369 Physical therapists............................................................................ 377 Physicians and surgeons.................................................................. 381 Workers who specialize in developing orthopedic shoe in­ serts, braces, and prosthetic limbs are: Orthotists and prosthetists...............................................................825  Radiation Therapists Significant Points • A bachelor’s degree, associate degree, or certificate in radiation therapy is generally required. • Employment is projected to grow much faster than the average for all occupations. • Good job opportunities are expected. • Earnings are relatively high. Nature of the Work  apy or surgery. Before treatment can begin, the oncology team has to de­ velop a treatment plan. To create this plan, the radiation ther­ apist must first use an X-ray imaging machine or computer tomography (CT) scan to pinpoint the location of the tumor. Then, a radiation oncologist (a physician who specializes in therapeutic radiology) and a radiation physicist (a worker who calibrates the linear accelerator) determine the best way to ad­ minister treatment. The therapist completes the plan by posi­ tioning the patient and adjusting the linear accelerator to the specifications developed by the team, recording the details so that these conditions can be replicated during treatment. The  Sources of Additional Information For information on a career in podiatric medicine, contact: y American Podiatric Medical Association, 9312 Old Georgetown Rd., Bethesda, MD 20814-1621. Internet: http ://www.apma.org Information on colleges of podiatric medicine and their en­ trance requirements, curricula, and student financial aid is available from: y American Association of Colleges of Podiatric Medicine, 15850 Crabbs Branch Way, Suite 320, Rockville, MD 20855. Internet: http://www.aacpm.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Radiation therapists have goodjob prospects.  388 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Occupational Title Number Percent 2018 4,100 27 19,400 15,200 29-1124 Radiation therapists................................................................................ (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ____________________________________________________________ __ SOC Code  t i o 1:1 pit later explains the treatment plan to the patient and answers any questions that the patient may have. The next step in the process is treatment. To begin each treatment session, the radiation therapist uses the guidelines developed during the planning phase to position the patient and adjust the linear accelerator. Then, from a separate room that is protected from the X-ray radiation, the therapist oper­ ates the linear accelerator and monitors the patient’s condition through a TV monitor and an intercom system. Treatment can take anywhere from 10 to 30 minutes. During the treatment phase, the radiation therapist moni­ tors the patient’s physical condition to determine whether the patient is having any adverse reactions to the treatment. The therapist must also be aware of the patient’s emotional well­ being. Because many patients are under stress and are emo­ tionally fragile, it is important for the therapist to maintain a positive attitude and provide emotional support. Radiation therapists keep detailed records of their patients’ treatments. These records include information such as the dose of radiation used for each treatment, the total amount of radiation used to date, the area treated, and the patient’s reactions. Radiation oncologists and dosimetrists (technicians who calculate the dose of radiation that will be used for treat­ ment) review these records to ensure that the treatment plan is working, to monitor the amount of radiation exposure that the patient has received, and to keep side effects to a minimum. Therapists also may assist dosimetrists with routine aspects of dosimetry, the process used to calculate radiation dosages. Work environment. Radiation therapists work in hospi­ tals or in cancer treatment centers. These places are clean, well lighted, and well ventilated. Therapists do a considerable amount of lifting and must be able to help disabled patients get on and off treatment tables. They spend most of their time on their feet. Radiation therapists generally work 40 hours a week, and unlike workers in some other healthcare occupations, they nor­ mally work only during the day. However, because radiation therapy emergencies do occur, some therapists are required to be on call and may have to work outside of their normal hours. Working with cancer patients can be stressful, but many ra­ diation therapists also find it rewarding. Because they work around radioactive materials, radiation therapists take great care to ensure that they are not exposed to dangerous levels of radiation. By following standard safety procedures, radiation therapists can prevent overexposure.  Training, Other Qualifications, and Advancement A bachelor’s degree, associate degree, or certificate in ra­ diation therapy generally is required. Many States require radiation therapists to be licensed, and most employers re­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Employment, 2008  quire certification. With experience, therapists can advance to managerial positions. Education and training. Employers usually require ap­ plicants to complete an associate or a bachelor’s degree program in radiation therapy. Individuals also may become qualified by completing an associate or a bachelor’s degree program in radiography, which is the study of radiologi­ cal imaging, and then by completing a 12-month certificate program in radiation therapy. Radiation therapy programs include core courses on radiation therapy procedures and the scientific theories behind them. In addition, such pro­ grams often include courses on human anatomy and physiol­ ogy, physics, algebra, precalculus, writing, public speaking, computer science, and research methodology. In 2009, there were 102 radiation therapy programs in the U.S. that were accredited by the American Registry of Radiologic Tech­ nologists (ARRT). Licensure. In 2009, 33 States required radiation thera­ pists to be licensed by a State accrediting board. Licensing requirements vary by State, but many States require appli­ cants to pass the ARRT certification examination. Further information is available from individual State licensing of­ fices. Certification and other qualifications. Some States, as well as many employers, require radiation therapists to be certified by ARRT. To become ARRT-certified, an applicant must complete an accredited radiation therapy program, ad­ here to ARRT ethical standards, and pass the ARRT certifi­ cation examination. The examination covers radiation pro­ tection and quality assurance, clinical concepts in radiation oncology, treatment planning, treatment delivery, and patient care and education. Candidates also must demonstrate com­ petency in several clinical practices including patient care activities; simulation procedures; dosimetry calculations; fabrication of beam modification devices; low-volume, highrisk procedures; and the application of radiation. ARRT certification is valid for 1 year, after which ther­ apists must renew their certification. Requirements for renewal include abiding by the ARRT ethical standards, paying annual dues, and satisfying continuing education requirements. Continuing education requirements must be met every 2 years and include either the completion of 24 course credits related to radiation therapy or the attainment of ARRT certification in a discipline other than radiation therapy. Certification renewal, however, may not be required by all States or employers that require initial certification. All radiation therapists need good communication skills because their work involves a great deal of interaction with patients. Individuals interested in becoming radiation thera­ pists should be psychologically capable of working with cancer patients. They should be caring and empathetic be-  Professional and Related Occupations 389  cause they work with patients who are ill and under stress. They should be able to keep accurate, detailed records. They also should be physically fit because they work on their feet for long periods and lift and move disabled patients. Advancement. Experienced radiation therapists may ad­ vance to manage radiation therapy programs in treatment centers or other health care facilities. Managers generally continue to treat patients while taking on management re­ sponsibilities. Other advancement opportunities include teaching, technical sales, and research. With additional train­ ing and certification, therapists also can become dosimetrists, who use complex mathematical formulas to calculate proper radiation doses.  Employment Radiation therapists held about 15,200 jobs in 2008. About 70 percent worked in hospitals, and about 18 percent worked in the offices of physicians. A small proportion worked in outpatient care centers and medical and diagnostic laboratories.  Job Outlook Employment is expected to increase much faster than the aver­ age, and job prospects should be good. Employment change. Employment of radiation therapists is projected to grow by 27 percent between 2008 and 2018, which is much faster than the average for all occupations. The growing elderly population is expected to cause an increase in the number of people needing treatment. In addition, as ra­ diation technology becomes safer and more effective, it will be prescribed more often, leading to an increased demand for radiation therapists. Growth is likely to be rapid across all practice settings, including hospitals, physicians’ offices, and outpatient centers. Job prospects. Job prospects are expected to be good. Job openings will result from employment growth and from the need to replace workers who retire or leave the occupation for other reasons. Applicants with a bachelor’s degree and related work experience may have the best opportunities.  Earnings Median annual wages of radiation therapists were $72,910 in May 2008. The middle 50 percent earned between $59,050 and $87,910. The lowest 10 percent earned less than $47,910, and the highest 10 percent earned more than $104,350. Some em­ ployers also reimburse their employees for the cost of continu­ ing education.  Related Occupations Other occupations that administer medical treatment to patients include Page Cardiovascular technologists and technicians......................... 408 Dental hygienists...................................................................... 414 Diagnostic medical sonographers............................................416 Nuclear medicine technologists...............................................426 Nursing and psychiatric aides..................................................460 Physical therapist assistants and aides.................................... 465 Radiologic technologists and technicians............................... 438 Registered nurses..................................................................... 392   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Sources of Additional Information Information on certification by the American Registry of Ra­ diologic Technologists and on accredited radiation therapy pro­ grams may be obtained from: > American Registry of Radiologic Technologists, 1255 Northland Dr., St. Paul, MN 55120. Internet: http://www.arrt.org Information on careers in radiation therapy may be obtained from: > American Society of Radiologic Technologists, 15000 Central Ave. SE., Albuquerque, NM 87123. Internet: http ://www.asrt.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bIs.gov/ooh/ocos299.htm  Recreational Therapists Significant Points • Applicants for recreational therapist jobs will experi­ ence competition. • A bachelor’s degree in therapeutic recreation is the usual educational requirement. • Some States regulate recreational therapists through licensure, registration, or regulation of titles, but re­ quirements vary. • Recreational therapists should be comfortable work­ ing with persons who are ill or who have disabilities. Nature of the Work Recreational therapists, also referred to as therapeutic recre­ ation specialists, provide treatment services and recreation activities for individuals with disabilities or illnesses. Using a variety of techniques, including arts and crafts, animals, sports, games, dance and movement, drama, music, and community outings, therapists improve and maintain the physical, mental, and emotional well-being of their clients. Therapists help in­ dividuals reduce depression, stress, and anxiety; recover basic motor functioning and reasoning abilities; build confidence; and socialize effectively so that they can enjoy greater inde­ pendence and reduce or eliminate the effects of their illness or disability. In addition, therapists help people with disabilities integrate into the community by teaching them how to use com­ munity resources and recreational activities. Recreational thera­ pists are different from recreation workers, who organize recre­ ational activities primarily for enjoyment. (Recreation workers are discussed elsewhere in the Handbook.) In acute healthcare settings, such as hospitals and rehabilita­ tion centers, recreational therapists treat and rehabilitate indi­ viduals with specific health conditions, usually in conjunction or collaboration with physicians, nurses, psychologists, social workers, and physical and occupational therapists. In long-term and residential care facilities, recreational therapists use leisure  390 Occupational Outlook Handbook  activities—especially structured group programs—to improve and maintain their clients’ general health and well-being. They also may provide interventions to prevent the client from suffer­ ing further medical problems and complications. Recreational therapists assess clients using information from observations, medical records, standardized assessments, the medical staff, the clients’ families, and the clients themselves. They then develop and carry out therapeutic interventions con­ sistent with the clients’ needs and interests. For example, they may encourage clients who are isolated from others or who have limited social skills to play games with others, and they may teach right-handed people with right-side paralysis how to use their unaffected left side to throw a ball or swing a racket. Recreational therapists may instruct patients in relaxation tech­ niques to reduce stress and tension, stretching and limbering ex­ ercises, proper body mechanics for participation in recreational activities, pacing and energy conservation techniques, and team activities. As they work, therapists observe and document a pa­ tient’s participation, reactions, and progress. Community-based recreational therapists may work in park and recreation departments, special education programs for school districts, or assisted living, adult day care, and substance abuse rehabilitation centers. In these programs, therapists use interventions to develop specific skills, while providing op­ portunities for exercise, mental stimulation, creativity, and fun. Those few who work in schools help counselors, teachers, and parents address the special needs of students, including easing disabled students’ transition into adult life. Work environment. Recreational therapists provide services in special activity rooms but also plan activities and prepare documentation in offices. When working with clients during community integration programs, they may travel locally to teach clients how to use public transportation and other pub-  ftBm n ■ 1 i  Recreational therapists observe and document a patient’s par­ ticipation, reaction, and progress.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  lie areas, such as parks, playgrounds, swimming pools, restau­ rants, and theaters. Therapists often lift and carry equipment. Recreational therapists generally work a 40-hour week. Work hours may include some evenings, weekends, and holidays. Some therapists may work part time and for more than one em­ ployer, requiring travel.  Training, Other Qualifications, and Advancement A bachelor’s degree with a major or concentration in therapeu­ tic recreation is the usual requirement. Some States regulate recreational therapists, but requirements vary. Education and training. Most entry-level recreational ther­ apists need a bachelor’s degree in therapeutic recreation, or in recreation with a concentration in therapeutic recreation. A few may qualify with some combination of education, training, and work experience that would be equivalent to what is considered competent in the field. There are more than 100 academic pro­ grams that prepare students to become recreational therapists. Most offer bachelor’s degrees, although some offer associate’s, master’s, or doctoral degrees. Therapeutic recreation programs include courses in assessment, treatment and program planning, intervention design, and evaluation. Students also study human anatomy, physiology, abnormal psychology, medical and psy­ chiatric terminology, characteristics of illnesses and disabili­ ties, professional ethics, and the use of assistive devices and technology. Bachelor’s degree programs include an internship in the field as part of their curriculum. Some States regulate recreational therapists Licensure. through licensure, registration, or regulation of titles. Require­ ments vary by State. In 2009, Oklahoma, North Carolina, Utah, and New Hampshire required licensure to practice as a recre­ ational therapist. For specifics on regulations and requirements, contact the State’s medical board. Certification and other qualifications. Although certifica­ tion is voluntary, most employers prefer to hire candidates who are certified therapeutic recreation specialists. Work in clinical settings often requires certification by the National Council for Therapeutic Recreation Certification. The council offers the Certified Therapeutic Recreation Specialist credential to candi­ dates who pass a written certification examination and complete a supervised internship of at least 480 hours. A minimum of a bachelor’s degree in recreational therapy from an accredited institution is required for credentialing, but some may qualify with equivalent education, training, and experience. Therapists must meet additional requirements to maintain certification. For specific details on credentialing, contact the National Council for Therapeutic Recreation Certification. (See Sources of Ad­ ditional Information below for address.) Recreational therapists may dedicate themselves to a certain type of therapy. Therapists wanting to practice a concentration can also earn certifications in specific therapies, such as art therapy and aquatic therapy. Recreational therapists must be comfortable working with people who are ill or disabled. Therapists must be patient, tact­ ful, and persuasive when working with people who have a vari­ ety of special needs. Ingenuity, a sense of humor, and imagina­ tion are needed to adapt activities to individual needs, and good  Professional and Related Occupations 391  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 2018 Number Percent Recreational therapists.................................. ?q_ 11 ? s 23.300 26.700 3 400 15 (NOTH) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  Occupational Title  SOC  Code  Employment, 2008  tion Included in the Handbook.  physical coordination is necessary to demonstrate or participate in recreational activities. Advancement. Therapists may advance to supervisory or administrative positions. Some teach, conduct research, or con­ sult for health or social services agencies.  and the highest 10 percent earned more than $60,280. Median annual wages in the industries employing the largest numbers of recreational therapists in May 2008 were: General medical and surgical hospitals..... ............... $42,210  Employment  State government................................  Recreational therapists held about 23,300 jobs in 2008. About 24 percent were in nursing care facilities. Others worked pri­ marily in hospitals, residential care facilities, and State and lo­ cal government agencies.  Psychiatric and substance abuse hospitals . ................. 40,150 Nursing care facilities.................... ......... 33 920 Community care facilities for the elderly... ................. 33,490  Related Occupations Job Outlook Employment is projected to grow faster than the average. Ap­ plicants will face competition for jobs. Employment change. Employment of recreational thera­ pists is expected to increase 15 percent from 2008 to 2018, faster than the average for all occupations. Job growth will stem from the therapy needs of the aging population. With age comes an inevitable decrease in physical ability and, in some cases, mental ability, which can be limited or managed with recreation therapy. In nursing care facilities—the largest industry employ­ ing recreational therapists—employment will grow faster than the occupation as a whole as the number of older adults contin­ ues to grow. Employment growth in schools will result from the expan­ sion of the school-age population and the federally funded ex­ tension of services for disabled students. Reimbursement for recreational therapy services will con­ tinue to affect how and where therapeutic recreation is pro­ vided. As payers and employers try to contain costs, recreation therapy services will shift to outpatient settings and away from hospitals. Job prospects. Recreational therapists will experience com­ petition for jobs. Lower paid recreational therapy aides may be increasingly used in an effort to contain costs. Job oppor­ tunities should be best for people with a bachelor’s degree in therapeutic recreation and the Certified Therapeutic Recreation Specialist credential. Recreational therapists might experience more competition for jobs in certain regions of the country as jobs in therapeutic recreation tend to cluster in more densely populated areas.  Earnings Median annual wages of recreational therapists were $38,370 in May 2008. The middle 50 percent earned between $29,660 and $49,140. The lowest 10 percent earned less than $23,150,   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Recreational therapists primarily design activities to help peo­ ple with disabilities lead more fulfilling and independent lives. Other occupations in therapy and rehabilitation include: Page Counselors........................ Occupational therapists................... Physical therapists.......................  377  Speech-language pathologists.................... Teachers—special education............  2Q4  Sources of Additional Information For information and materials on careers and academic programs in recreational therapy, contact: y American Therapeutic Recreation Association, 629 N. Main St., Hattiesburg, MS 39401. Internet: http://atra-online.com/ y National Therapeutic Recreation Society, 22377 Belmont Ridge Rd„ Ashburn, VA 20148-4501. Internet: http://www.nrpa.org/ Information on certification may be obtained from: y National Council for Therapeutic Recreation Certification, 7 Elmwood Dr., New City, NY 10956. Internet: http://www.nctrc.org For information on licensure requirements, contact the ap­ propriate recreational therapy regulatory agency for your State. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics.  Links to 0*NET appear at the end of the In­  ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos082.htm  392 Occupational Outlook Handbook  Registered Nurses Significant Points • Registered nurses (RNs) constitute the largest health­ care occupation, with 2.6 million jobs. • About 60 percent of RN jobs are in hospitals. • The three typical educational paths to registered nurs­ ing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program; ad­ vanced practice nurses—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practi­ tioners—need a master’s degree. • Overall job opportunities are expected to be excellent, but may vary by employment and geographic setting; some employers report difficulty in attracting and re­ taining an adequate number of RNs. Nature of the Work Registered nurses (RNs), regardless of specialty or work set­ ting, treat patients, educate patients and the public about various medical conditions, and provide advice and emotional support to patients’ family members. RNs record patients’ medical his­ tories and symptoms, help perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation. RNs teach patients and their families how to manage their ill­ nesses or injuries, explaining post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication and physical therapy. Some RNs may work to promote general health by educating the public on warning signs and symptoms of disease. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions. When caring for patients, RNs establish a care plan or con­ tribute to an existing plan. Plans may include numerous activi­ ties, such as administering medication, including careful check­ ing of dosages and avoiding interactions; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treat­ ments; observing the patient and recording those observations; and consulting with physicians and other healthcare clinicians. Some RNs provide direction to licensed practical nurses and nursing aides regarding patient care. (See the statements on licensed practical and licensed vocational nurses; nursing and psychiatric aides; and home health aides elsewhere in the Hand­ book). RNs with advanced educational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority. Specific work responsibilities will vary from one RN to the next. An RN’s duties and title are often determined by their work setting or patient population served. RNs can special­ ize in one or more areas of patient care. There generally are four ways to specialize. RNs may work a particular setting or type of treatment, such as perioperative nurses, who work in operating rooms and assist surgeons. RNs may specialize in   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  specific health conditions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs may also specialize with a well-defined popula­ tion, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer. The opportunities for specialization in registered nursing are exten­ sive and are often determined on the job. There are many options for RNs who specialize in a work setting or type of treatment. Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians’ offices or in clinics. Some ambu­ latory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing, the Internet, or by telephone. Critical care nurses provide care to patients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units. Emergency, or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions. Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by heli­ copter or airplane to the nearest medical facility. Holistic nurses provide care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients’ mental and spiritual health in addition to their physical health. Home health care nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a reha­ bilitation, long-term care, or skilled nursing facility. Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for terminally ill patients. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins. Long-term care nurses provide healthcare services on a recurring basis to patients with chronic physical or mental disorders, often in long-term care or skilled nursing facilities. Medical-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diag­ noses. Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services, and help employers implement health and safety stan­ dards. Perianesthesia nurses provide preoperative and postop­ erative care to patients undergoing anesthesia during surgery or other procedure. Perioperative nurses assist surgeons by select­ ing and handling instruments, controlling bleeding, and sutur­ ing incisions. Some of these nurses also can specialize in plas­ tic and reconstructive surgery. Psychiatric-mental health nurses treat patients with personality and mood disorders. Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses. Rehabilitation nurses care for patients with temporary and permanent disabili­ ties. Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection.  Professional and Related Occupations 393  DRSFI  Registered nurses teach patients and theirfamilies how to man­ age their illness or injury. RNs specializing in a particular disease, ailment, or health­ care condition are employed in virtually all work settings, in­ cluding physicians’ offices, outpatient treatment facilities, home healthcare agencies, and hospitals. Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other addictions. Intellectual and developmental disabilities nurses provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently, and speak­ ing or other communication. Diabetes management nurses help diabetics to manage their disease by teaching them proper nu­ trition and showing them how to test blood sugar levels and administer insulin injections. Genetics nurses provide early de­ tection screenings, counseling, and treatment of patients with genetic disorders, including cystic fibrosis and Huntington’s disease. HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring. Wound, ostomy, and continence nurses treat patients with wounds caused by trau­ matic injury, ulcers, or arterial disease; provide postoperative care for patients with openings that allow for alternative meth­ ods of bodily waste elimination; and treat patients with urinary and fecal incontinence. RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or criti­ cal care units, specialty clinics, and outpatient care facilities. Cardiovascular nurses treat patients with coronary heart dis­ ease and those who have had heart surgery, providing services such as postoperative rehabilitation. Dermatology nurses treat patients with disorders of the skin, such as skin cancer and psoriasis. Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue. Gynecol­ ogy nurses provide care to women with disorders of the repro­ ductive system, including endometriosis, cancer, and sexually transmitted diseases. Nephrology nurses care for patients with   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  kidney disease caused by diabetes, hypertension, or substance abuse. Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures. Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma, and to patients undergoing eye surgery. Orthopedic nurses care for pa­ tients with muscular and skeletal problems, including arthritis, bone fractures, and muscular dystrophy. Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such as cleft palates, allergies, and sinus disorders. Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis. Urology nurses care for patients with disorders of the kidneys, urinary tract, and male reproductive organs, including infections, kidney and bladder stones, and cancers. RNs who specialize by population provide preventive and acute care in all healthcare settings to the segment of the popu­ lation in which they specialize, including newborns (neonatol­ ogy), children and adolescents (pediatrics), adults, and the el­ derly (gerontology or geriatrics). RNs also may provide basic healthcare to patients outside of healthcare settings in such ven­ ues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and throughout the world providing care to patients in areas with shortages of healthcare workers. Most RNs work as staff nurses as members of a team provid­ ing critical healthcare. However, some RNs choose to become advanced practice nurses, who work independently or in col­ laboration with physicians, and may focus on the provision of primary care services. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing spe­ cialties, such as psychiatric-mental health. Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management. Nurse-midwives provide primary care to women, including gynecological exams, family planning ad­ vice, prenatal care, assistance in labor and delivery, and neona­ tal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and healthcare services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia. Some nurses have jobs that require little or no direct patient care, but still require an active RN license. Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity, and traumatic accident. Infection control nurses identify, track, and control infectious outbreaks in healthcare facilities and develop programs for out­ break prevention and response to biological terrorism. Nurse educators plan, develop, implement, and evaluate educational programs and curricula for the professional development of student nurses and RNs. Nurse informaticists manage and com­ municate nursing data and information to improve decision  394 Occupational Outlook Handbook  making by consumers, patients, nurses, and other healthcare providers. RNs also may work as healthcare consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors. Work environment. Most RNs work in well-lit, comfortable healthcare facilities. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites. RNs may spend considerable time walking, bending, stretching, and standing. Patients in hospitals and nursing care facilities require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on call—available to work on short notice. Nurses who work in offices, schools, and other settings that do not provide 24-hour care are more likely to work regular business hours. About 20 percent of RNs worked part time in 2008. RNs may be in close contact with individuals who have infec­ tious diseases and with toxic, harmful, or potentially hazard­ ous compounds, solutions, and medications. RNs must observe rigid, standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients.  Training, Other Qualifications, and Advancement The three typical educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor’s de­ gree program. Individuals then must complete a national licens­ ing examination in order to obtain a nursing license. Advanced practice nurses—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners—need a master’s degree. Education and training. There are three typical educational paths to registered nursing—a bachelor’s of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. ADN programs, offered by community and junior colleges, take about 2 to 3 years to com­ plete. Diploma programs, administered in hospitals, last about 3 years. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as a staff nurse. There are hundreds of registered nursing programs that result in an ADN or BSN; however, there are relatively few diploma programs. Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher. Individuals who complete a bach­  elor’s degree receive more training in areas such as communica­ tion, leadership, and critical thinking, all of which are becom­ ing more important as nursing practice becomes more complex. Additionally, bachelor’s degree programs offer more clinical experience in nonhospital settings. A bachelor’s or higher de­ gree is often necessary for administrative positions, research, consulting, and teaching Many RNs with an ADN or diploma later enter bachelor’s degree programs to prepare for a broader scope of nursing prac­ tice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. Accelerated master’s degree in nursing (MSN) programs also are available. They typically take 3-4 years to complete full time and result in the award of both the BSN and MSN. There are education programs available for people interested in switching to a career in nursing as well. Individuals who already hold a bachelor’s degree in another field may enroll in an accelerated BSN program. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for in­ dividuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor’s or higher degree in another field; master’s degree programs usually last 2 years. All nursing education programs include classroom instruc­ tion and supervised clinical experience in hospitals and other healthcare facilities. Students take courses in anatomy, physiol­ ogy, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students. Supervised clinical experience is provided in hospital depart­ ments such as pediatrics, psychiatry, maternity, and surgery. A number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics. Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing exami­ nation, known as the National Council Licensure Examination, or NCLEX-RN, in order to obtain a nursing license. Other eli­ gibility requirements for licensure vary by State. Contact your State’s board of nursing for details. Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses. RNs should enjoy learning because continuing education credits are required by some States and/or employers at regular intervals. Career-long learning is a distinct reality for RNs.  Projections data from the National Employment Matrix Occupational Title  SOC Code  Employment, 2008  Projected Change, Employment, 2008-2018 2018________Number Percent 3,200,200 581,500_________ 22_  29-1111 2,618,700 Registered nurses (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. _____________________________________ ____________   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 395  Some nurses may become credentialed in specialties such as ambulatory care, gerontology, informatics, pediatrics, and many others. Credentialing for RNs is available from the American Nursing Credentialing Center, the National League for Nursing, and many others. Although credentialing is usually voluntary, it demonstrates adherence to a higher standard and some employ­ ers may require it. Advancement. Most RNs begin as staff nurses in hospitals and, with experience and good performance, often move to other settings or are promoted to positions with more responsi­ bility. In management, nurses can advance from assistant unit manager or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief of nurs­ ing. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services ad­ ministration. Administrative positions require leadership, com­ munication and negotiation skills, and good judgment. Some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on providing primary care services. There are four types of advanced practice nurses: clinical nurse special­ ists, nurse anesthetists, nurse-midwives, and nurse practitio­ ners. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health. Nurse anesthetists provide anes­ thesia and related care before and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and emergency services, such as airway manage­ ment. Nurse-midwives provide primary care to women, includ­ ing gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. Nurse prac­ titioners serve as primary and specialty care providers, provid­ ing a blend of nursing and healthcare services to patients and families. All four types of advanced practice nurses require at least a master’s degree. In addition, all States specifically define re­ quirements for registered nurses in advanced practice roles. Advanced practice nurses may prescribe medicine, but the au­ thority to prescribe varies by State. Contact your State’s board of nursing for specific regulations regarding advanced practice nurses. Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and univer­ sity faculty or conduct research.  Employment As the largest healthcare occupation, registered nurses held about 2.6 million jobs in 2008. Hospitals employed the major­ ity of RNs, with 60 percent of such jobs. About 8 percent of jobs were in offices of physicians, 5 percent in home health care services, 5 percent in nursing care facilities, and 3 percent in employment  services. The remainder worked mostly in govhttps://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  emment agencies, social assistance agencies, and educational services.  Job Outlook Overall job opportunities for registered nurses are expected to be excellent, but may vary by employment and geographic setting. Some employers report difficulty in attracting and re­ taining an adequate number of RNs. Employment of RNs is expected to grow much faster than the average and, because the occupation is very large, 581,500 new jobs will result, among the largest number of new jobs for any occupation. Addition­ ally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation. Employment change. Employment of registered nurses is expected to grow by 22 percent from 2008 to 2018, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly. However, employment of RNs will not grow at the same rate in every industry. The projected growth rates for RNs in the industries with the highest employment of these workers are: Offices of physicians........................................................48% Home health care services................................................... 33 Nursing care facilities......................................................... 25 Employment services.......................................................... 24 Hospitals, public and private............................................... 17 Employment is expected to grow more slowly in hospitals— healthcare’s largest industry—than in most other healthcare in­ dustries. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain in the hospital for more than 24 hours) is not likely to grow by much. Patients are being discharged ear­ lier, and more procedures are being done on an outpatient basis, both inside and outside hospitals. Rapid growth is expected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy. More and more sophisticated procedures, once performed only in hospitals, are being performed in physicians’ offices and in outpatient care centers, such as freestanding ambulatory surgical and emergency centers. Accordingly, employment is expected to grow fast in these places as healthcare in general expands. Employment in nursing care facilities is expected to grow because of increases in the number of older persons, many of whom require long-term care. Many elderly patients want to be treated at home or in residential care facilities, which will drive demand for RNs in those settings. The financial pressure on hospitals to discharge patients as soon as possible should pro­ duce more admissions to nursing and residential care facilities and referrals to home healthcare. Job growth also is expected in units that provide specialized long-term rehabilitation for stroke and head injury patients, as well as units that treat Al­ zheimer’s victims.  396 Occupational Outlook Handbook  Employment in home healthcare is expected to increase in response to the growing number of older persons with func­ tional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring in­ creasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures. Job prospects. Overall job opportunities are expected to be excellent for registered nurses. Employers in some parts of the country and in certain employment settings report difficulty in attracting and retaining an adequate number of RNs, primarily because of an aging RN workforce and a lack of younger work­ ers to fill positions. Qualified applicants to nursing schools are being turned away because of a shortage of nursing faculty. The need for nursing faculty will only increase as many instructors near retirement. Despite the slower employment growth in hos­ pitals, job opportunities should still be excellent because of the relatively high turnover of hospital nurses. To attract and retain qualified nurses, hospitals may offer signing bonuses, familyfriendly work schedules, or subsidized training. Although faster employment growth is projected in physicians’ offices and out­ patient care centers, RNs may face greater competition for these positions because they generally offer regular working hours and more comfortable working environments. Generally, RNs with at least a bachelor’s degree will have better job prospects than those without a bachelor’s. In addition, all four advanced practice specialties—clinical nurse specialists, nurse practitio­ ners, nurse-midwives, and nurse anesthetists—will be in high demand, particularly in medically underserved areas such as inner cities and rural areas. Relative to physicians, these RNs increasingly serve as lower-cost primary care providers.  Earnings Median annual wages of registered nurses were $62,450 in May 2008. The middle 50 percent earned between $51,640 and $76,570. The lowest 10 percent earned less than $43,410, and the highest 10 percent earned more than $92,240. Median an­ nual wages in the industries employing the largest numbers of registered nurses in May 2008 were: Employment services................................................. $68,160 General medical and surgical hospitals........................63,880 Offices of physicians.................................................... 59,210 Home health care services............................................ 58,740 Nursing care facilities.................................................. 57,060 Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of regis­ tered nurses are union members or covered by union contract.  Related Occupations Because of the number of specialties for registered nurses, and the variety of responsibilities and duties, many other healthcare occupations are similar in some aspects of their job. Some https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  healthcare occupations with similar levels of responsibility that work under the direction of physicians or dentists are: Page Dental hygienists......................................................................414 Diagnostic medical sonographers........................................... 416 Emergency medical technicians and paramedics.................... 419 Licensed practical and licensed vocational nurses.................. 421 Physician assistants..................................................................379  Sources of Additional Information For information on a career as a registered nurse and nursing education, contact: V National League for Nursing, 61 Broadway, 33rd Floor, New York, NY 10006. Internet: http://www.nln.org For information on baccalaureate and graduate nursing edu­ cation, nursing career options, and financial aid, contact: > American Association of Colleges of Nursing, 1 Dupont Circle NW„ Suite 530, Washington, DC 20036. Internet: http ://www.aacn.nche.edu For additional information on registered nurses, including credentialing, contact: y American Nurses Association, 8515 Georgia Ave., Suite 400, Silver Spring, MD 20910. Internet: http://nursingworld.org For information on the National Council Licensure Exami­ nation (NCLEX-RN) and a list of individual State boards of nursing, contact: > National Council of State Boards of Nursing, 111 E. Wacker Dr., Suite 2900, Chicago, IL 60601. Internet: http://www.ncsbn.org For a list of accredited clinical nurse specialist programs, contact: y National Association of Clinical Nurse Specialists, 2090 Linglestown Rd., Suite 107, Harrisburg, PA 17110. Internet: http://www.nacns.org For information on nurse anesthetists, including a list of ac­ credited programs, contact: y American Association of Nurse Anesthetists, 222 S. Prospect Ave., Park Ridge, IL 60068. Internet: http ://www.aana.com/ For information on nurse-midwives, including a list of ac­ credited programs, contact: y American College of Nurse-Midwives, 8403 Colesville Rd., Suite 1550, Silver Spring, MD 20910. Internet: http ://w ww.midwife.org For information on nurse practitioners, including a list of ac­ credited programs, contact: y American Academy of Nurse Practitioners, P.O. Box 12846, Austin, TX 78711. Internet: http://www.aanp.org For additional information on registered nurses in all fields and specialties, contact: y American Society of Registered Nurses, 1001 Bridgeway, Suite 233, Sausalito, CA 94965. Internet: http ://www.asrn.org  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In-  Professional and Related Occupations 397  temet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos083.htm  Respiratory Therapists Significant Points • Job opportunities should be very good. • Hospitals will account for the vast majority of job openings, but a growing number of openings will arise in other settings. • An associate degree is the minimum educational re­ quirement, but a bachelor’s or master’s degree may be important for advancement. • All States, except Alaska and Hawaii, require respira­ tory therapists to be licensed. Nature of the Work Respiratory therapists—also known as respiratory care prac­ titioners—evaluate, treat, and care for patients with breathing or other cardiopulmonary disorders. Practicing under the di­ rection of a physician, respiratory therapists assume primary responsibility for all respiratory care therapeutic treatments and diagnostic procedures, including the supervision of respi­ ratory therapy technicians. They consult with physicians and other healthcare staff to help develop and modify patient care plans. Therapists also provide complex therapy requiring con­ siderable independent judgment, such as caring for patients on life support in intensive-care units of hospitals. Respiratory therapists evaluate and treat all types of pa­ tients, ranging from premature infants whose lungs are not fully developed to elderly people whose lungs are diseased. They provide temporary relief to patients with chronic asthma or emphysema and give emergency care to patients who are victims of a heart attack, stroke, drowning, or shock. Respiratory therapists interview patients, perform limited physical examinations, and conduct diagnostic tests. For ex-  I Respiratory therapists interview patients, perform limited phys­ ical and conduct diagnostic tests. Digitized for examinations, FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  ample, respiratory therapists test a patient’s breathing capac­ ity and determine the concentration of oxygen and other gases in a patient’s blood. They also measure a patient’s pH, which indicates the acidity or alkalinity of the blood. To evaluate a patient’s lung capacity, respiratory therapists have the patient breathe into an instrument that measures the volume and flow of oxygen during inhalation and exhalation. By comparing the reading with the norm for the patient’s age, height, weight, and sex, respiratory therapists can provide information that helps determine whether the patient has any lung deficiencies. To analyze oxygen, carbon dioxide, and blood pH levels, ther­ apists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician, who then makes treatment decisions. To treat patients, respiratory therapists use oxygen or oxy­ gen mixtures, chest physiotherapy, and aerosol medications— liquid medications suspended in a gas that forms a mist which is inhaled. They teach patients how to inhale the aerosol properly to ensure its effectiveness. When a patient has dif­ ficulty getting enough oxygen into his or her blood, therapists increase the patient’s concentration of oxygen by placing an oxygen mask or nasal cannula on the patient and setting the oxygen flow at the level prescribed by a physician. Therapists also connect patients who cannot breathe on their own to ven­ tilators that deliver pressurized oxygen into the lungs. The therapists insert a tube into the patient’s trachea, or windpipe; connect the tube to the ventilator; and set the rate, volume, and oxygen concentration of the oxygen mixture entering the patient’s lungs. Therapists perform regular assessments of patients and equipment. If a patient appears to be having difficulty breath­ ing or if the oxygen, carbon dioxide, or pH level of the blood is abnormal, therapists change the ventilator setting according to the doctor’s orders or check the equipment for mechanical problems. Respiratory therapists perform chest physiotherapy on pa­ tients to remove mucus from their lungs and make it easier for them to breathe. Therapists place patients in positions that help drain mucus, and then vibrate the patients’ rib cages, of­ ten by tapping on the chest, and tell the patients to cough. Chest physiotherapy may be needed after surgery, for example, because anesthesia depresses respiration. As a result, physio­ therapy may be prescribed to help get the patient’s lungs back to normal and to prevent congestion. Chest physiotherapy also helps patients suffering from lung diseases, such as cystic fi­ brosis, that cause mucus to collect in the lungs. Therapists who work in home care teach patients and their families to use ventilators and other life-support systems. In addition, these therapists visit patients in their homes to in­ spect and clean equipment, evaluate the home environment, and ensure that patients have sufficient knowledge of their dis­ eases and the proper use of their medications and equipment. Therapists also make emergency visits if equipment problems arise. In some hospitals, therapists perform tasks that fall out­ side their traditional role. Therapists are becoming involved in areas such as pulmonary rehabilitation, smoking-cessation counseling, disease prevention, case management, and poly-  398 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 22.100 21 128,100 105,900 29-1126 Respiratory therapists............................................................................ (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ______________________________________________________  Occupational Title  somnography—the diagnosis of breathing disorders during sleep, such as apnea. Respiratory therapists also increasingly treat critical-care patients, either as part of surface and air transport teams or as part of rapid-response teams in hospitals. Work environment. Respiratory therapists generally work between 35 and 40 hours a week. Because hospitals operate around the clock, therapists can work evenings, nights, or weekends. They spend long periods standing and walking be­ tween patients’ rooms. In an emergency, therapists work under the stress of the situation. Respiratory therapists employed in home healthcare must travel frequently to patients’ homes. Respiratory therapists are trained to work with gases stored under pressure. Adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of injury. As in many other health occupations, respiratory thera­ pists are exposed to infectious diseases, but by carefully fol­ lowing proper procedures, they can minimize these risks.  Training, Other Qualifications, and Advancement An associate degree is the minimum educational requirement, but a bachelor’s or master’s degree may be important for ad­ vancement. All States, except Alaska and Hawaii, require re­ spiratory therapists to be licensed. Education and training. An associate degree is required to become a respiratory therapist. Training is offered at the post­ secondary level by colleges and universities, medical schools, vocational-technical institutes, and the Armed Forces. Most programs award associate or bachelor’s degree and prepare graduates for jobs as advanced respiratory therapists. A lim­ ited number of associate degree programs lead to jobs as en­ try-level respiratory therapists. According to the Commission on Accreditation of Allied Health Education Programs (CAAHEP), 31 entry-level and 346 advanced respiratory therapy programs were accredited in the United States in 2008. Among the areas of study in respiratory therapy programs are human anatomy and physiology, pathophysiology, chem­ istry, physics, microbiology, pharmacology, and mathematics. Other courses deal with therapeutic and diagnostic procedures and tests, equipment, patient assessment, cardiopulmonary resuscitation, the application of clinical practice guidelines, patient care outside of hospitals, cardiac and pulmonary re­ habilitation, respiratory health promotion and disease preven­ tion, and medical recordkeeping and reimbursement. High school students interested in applying to respira­ tory therapy programs should take courses in health, biol­ ogy, mathematics, chemistry, and physics. Respiratory care involves basic mathematical problem solving and an under­ standing of chemical and physical principles. For example, respiratory care workers must be able to compute dosages of medication and calculate gas concentrations.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  Licensure and certification. A license is required to prac­ tice as a respiratory therapist, except in Alaska and Hawaii. Also, most employers require respiratory therapists to main­ tain a cardiopulmonary resuscitation (CPR) certification. Licensure is usually based, in large part, on meeting the requirements for certification from the National Board for Respiratory Care (NBRC). The board offers the Certified Re­ spiratory Therapist (CRT) credential to those who graduate from entry-level or advanced programs accredited by CAAHEP or the Committee on Accreditation for Respiratory Care (CoARC) and who also pass an exam. The board also awards the Registered Respiratory Therapist (RRT) to CRTs who have graduated from advanced programs and pass two separate examinations. Supervisory positions and intensive-care specialties usually require the RRT. Other qualifications. Therapists should be sensitive to a patient’s physical and psychological needs. Respiratory care practitioners must pay attention to detail, follow instructions, and work as part of a team. In addition, operating advanced equipment requires proficiency with computers. Advancement. Respiratory therapists advance in clinical practice by moving from general care to the care of critically ill patients who have significant problems in other organ sys­ tems, such as the heart or kidneys. Respiratory therapists, es­ pecially those with a bachelor’s or master’s degree, also may advance to supervisory or managerial positions in a respiratory therapy department. Respiratory therapists in home healthcare and equipment rental firms may become branch managers. Some respiratory therapists advance by moving into teaching positions. Some others use the knowledge gained as a respira­ tory therapist to work in another industry, such as developing, marketing, or selling pharmaceuticals and medical devices.  Employment Respiratory therapists held about 105,900 jobs in 2008. About 81 percent of jobs were in hospitals, mainly in departments of respiratory care, anesthesiology, or pulmonary medicine. Most of the remaining jobs were in offices of physicians or other health practitioners, consumer-goods rental firms that supply respiratory equipment for home use, nursing care facilities, em­ ployment services, and home healthcare services.  Job Outlook Much faster than average growth is projected for respiratory therapists. Job opportunities should be very good. Employment change. Employment of respiratory thera­ pists is expected to grow by 21 percent from 2008 to 2018, much faster than the average for all occupations. The increas­ ing demand will come from substantial growth in the mid­ dle-aged and elderly population—a development that will heighten the incidence of cardiopulmonary disease. Growth in  Professional and Related Occupations 399  demand also will result from the expanding role of respiratory therapists in case management, disease prevention, emergency care, and the early detection of pulmonary disorders. Older Americans suffer most from respiratory ailments and cardiopulmonary diseases, such as pneumonia, chronic bronchitis, emphysema, and heart disease. As the number of older persons increases, the need for respiratory therapists is expected to increase as well. In addition, advances in inhalable medications and in the treatment of lung transplant pa­ tients, heart attack and accident victims, and premature in­ fants—many of whom depend on a ventilator during part of their treatment—will increase the demand for the services of respiratory care practitioners. Job prospects. Job opportunities are expected to be very good, especially for those with a bachelor’s degree and certi­ fication, and those with cardiopulmonary care skills or experi­ ence working with infants. The vast majority of job openings will continue to be in hospitals. However, a growing number of openings are expected to be outside of hospitals, especially in home health care services, offices of physicians or other health practitioners, consumer-goods rental firms, or in the employment services industry as a temporary worker in vari­ ous settings.  Earnings Median annual wages of wage-and-salary respiratory thera­ pists were $52,200 in May 2008. The middle 50 percent earned between $44,490 and $61,720. The lowest 10 percent earned less than $37,920 and the highest 10 percent earned more than $69,800.  y Commission on Accreditation for Allied Health Education Programs, 1361 Park St., Clearwater, FL 33756. Internet: http ://www.caahep.org y Committee on Accreditation for Respiratory Care, 1248 Harwood Rd., Bedford, TX 76021. Information on gaining credentials in respiratory care and a list of State licensing agencies can be obtained from: y National Board for Respiratory Care, Inc., 18000 W. 105th St., Olathe, KS 66061. Internet: http://www.nbrc.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos321 .htm  Speech-Language Pathologists Significant Points • About 48 percent worked in educational services; most others were employed by health care and social assistance facilities. • A master’s degree in speech-language pathology is the standard educational requirement; almost all States regulate these workers, and licensing require­ ments vary. • Favorable job opportunities are expected. Nature of the Work  Related Occupations Under the supervision of a physician, respiratory therapists ad­ minister respiratory care and life support to patients with heart and lung difficulties. Other workers who care for, treat, or train people to improve their physical condition include: Page Athletic trainers.................................................................................405  Occupational therapists............................................................ 369 Physical therapists............................................................................ 377  Radiation therapists.................................................................. 387 Registered nurses............................................................................. 392  Respiratory care practitioners workwith advanced medical technology, as do other healthcare technicians including: Cardiovascular technologists and technicians......................... 408 Diagnostic medical sonographers............................................416 Nuclear medicine technologists...............................................426 Radiologic technologists and technicians............................... 438  Sources of Additional Information Information concerning a career in respiratory care is available from: y American Association for Respiratory Care, 9425 N. MacArthur Blvd., Suite 100, Irving, TX 75063. Internet: http ://www.aarc.org For a list of accredited educational programs for respiratory care practitioners, contact either of the following organizations:  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Speech-language pathologists, sometimes called speech ther­ apists, assess, diagnose, treat, and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing, and fluency. Speech-language pathologists work with people who cannot produce speech sounds or cannot produce them clearly; those with speech rhythm and fluency problems, such as stuttering; people with voice disorders, such as inappropriate pitch or harsh voice; those with problems understanding and produc­ ing language; those who wish to improve their communica­ tion skills by modifying an accent; and those with cognitive communication impairments, such as attention, memory, and problem-solving disorders. They also work with people who have swallowing difficulties. Speech, language, and swallowing difficulties can result from a variety of causes including stroke, brain injury or deteriora­ tion, developmental delays or disorders, learning disabilities, cerebral palsy, cleft palate, voice pathology, mental retardation, hearing loss, or emotional problems. Problems can be congeni­ tal, developmental, or acquired. Speech-language pathologists use special instruments and qualitative and quantitative assess­ ment methods, including standardized tests, to analyze and di­ agnose the nature and extent of impairments. Speech-language pathologists develop an individualized plan of care, tailored to each patient’s needs. For individuals with little or no speech capability, speech-language pathologists may select augmentative or alternative communication methods, in-  400 Occupational Outlook Handbook  medical settings, they may work at the patient’s bedside and assist in positioning the patient. In schools, they may work with students in an office or classroom. Some work in the client’s home. Although the work is not physically demanding, it requires at­ tention to detail and intense concentration. The emotional needs of clients and their families may be demanding. Most full-time speech-language pathologists work 40 hours per week. About 20 percent of speech-language pathologists worked part-time in 2008. Those who work on a contract basis may spend a substan­ tial amount of time traveling between facilities.  Training, Other Qualifications, and Advancement  Speech-language pathologists usually work at desks or tables in clean comfortable surroundings. eluding automated devices and sign language, and teach their use. They teach patients how to make sounds, improve their voices, or increase their oral or written language skills to com­ municate more effectively. They also teach individuals how to strengthen muscles or use compensatory strategies to swallow without choking or inhaling food or liquid. Speech-language pathologists help patients develop, or recover, reliable commu­ nication and swallowing skills so patients can fulfill their edu­ cational, vocational, and social roles. Speech-language pathologists keep records on the initial evaluation, progress, and discharge of clients. This helps pin­ point problems, tracks client progress, and justifies the cost of treatment when applying for reimbursement. They counsel indi­ viduals and their families concerning communication disorders and how to cope with the stress and misunderstanding that often accompany them. They also work with family members to rec­ ognize and change behavior patterns that impede communica­ tion and treatment and show them communication-enhancing techniques to use at home. Most speech-language pathologists provide direct clinical services to individuals with communication or swallowing disorders. In medical facilities, they may perform their job in conjunction with physicians, social workers, psychologists, and other therapists. Speech-language pathologists in schools collaborate with teachers, special educators, interpreters, other school personnel, and parents to develop and implement in­ dividual or group programs, provide counseling, and support classroom activities. Some speech-language pathologists conduct research on how people communicate. Others design and develop equipment or techniques for diagnosing and treating speech problems. Work environment. Speech-language pathologists usually work at a desk or table in clean comfortable surroundings. In  A master’s degree is the most common level of education among speech-language pathologists. Licensure or certification requirements also exist, but vary by State. Education and training. Most speech-language patholo­ gist jobs require a master’s degree. The Council on Academic Accreditation is an entity of the American Speech-Language­ Hearing Association; it accredits postsecondary academic pro­ grams in speech-language pathology. While graduation from an accredited program is not always required, it is required by some States for licensure and is mandatory for professional credentialing from the American Speech-Language-Hearing Association. In 2009, about 240 colleges and universities of­ fered graduate programs, at both the master’s and doctoral levels, in speech-language pathology accredited by the Coun­ cil on Academic Accreditation. Speech-language pathology courses cover anatomy, physiology, and the development of the areas of the body involved in speech, language, and swallow­ ing; the nature of disorders; principles of acoustics; and psycho­ logical aspects of communication. Graduate students may also learn to evaluate and treat speech, language, and swallowing disorders as part of curriculum in supervised clinical practicum. Licensure and certification. In 2009, 47 States regulated speech-language pathologists. Typical licensing requirements are a master’s degree from an accredited college or university; a passing score on the national examination on speech-language pathology, offered through the Praxis Series of the Educational Testing Service; 300 to 375 hours of supervised clinical experience; and 9 months of postgraduate professional clini­ cal experience. Most States have continuing education require­ ments for licensure renewal. Medicaid, Medicare, and private health insurers generally require a practitioner to be licensed to qualify for reimbursement. For specific regulation and eligibil­ ity requirements contact your State’s regulatory board. State regulation of speech-language pathologists may differ for pathologists practicing in schools. For information on State regulation of speech-language pathologists in public schools contact your State’s Department of Education. The Certificate of Clinical Competence in Speech-Language Pathology (CCC-  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 22,100 19 141,400 119,300 29-1127 Speech-language pathologists.............................................................. (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  Occupational Title  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  Professional and Related Occupations 401  SLP) credential offered by the American Speech-Language­ Hearing Association is a voluntary credential; however, the CCC-SLP meets some or all of the requirements for licensure in some States. To earn a CCC, a person must have a graduate degree from an accredited university, which typically includes a 400-hour supervised clinical practicum, complete a 36-week full-time postgraduate clinical fellowship, and pass the Praxis Series examination in speech-language pathology administered by the Educational Testing Service. Other qualifications. Speech-language pathologists should be able to effectively communicate diagnostic test results, diag­ noses, and proposed treatment in a manner easily understood by their patients and their families. They must be able to approach problems objectively and be supportive. Because a patient’s progress may be slow, patience, compassion, and good listen­ ing skills are necessary. Advancement. As speech-language pathologists gain clini­ cal experience and engage in continuing professional educa­ tion, many develop expertise with certain populations, such as preschoolers and adolescents, or disorders, such as aphasia and learning disabilities. Some may obtain board recognition in a specialty area, such as child language, fluency, or feeding and swallowing. Experienced clinicians may become mentors or su­ pervisors of other therapists or be promoted to administrative positions.  Employment Speech-language pathologists held about 119,300 jobs in 2008. About 48 percent were employed in educational services. Others were employed in hospitals; offices of other health prac­ titioners, including speech-language pathologists; nursing care facilities; home health care services; individual and family ser­ vices; outpatient care centers; and child day care centers. Nine percent of speech-language pathologists were selfemployed in 2008. They contract to provide services in schools, offices of physicians, hospitals, or nursing care facilities, or work as consultants to industry.  Job Outlook Faster than average employment growth is projected. Job op­ portunities are expected to be favorable. Employment change. Employment of speech-language pa­ thologists is expected to grow by 19 percent from 2008 to 2018, faster than the average for all occupations. As the members of the baby-boom generation continue to age, the possibility of neurological disorders and associated speech, language, and swallowing impairments increases. Medical advances also are improving the survival rate of premature infants and trauma and stroke victims, who then need assessment and sometimes treatment. Employment in educational services will increase with the growth in elementary and secondary school enrollments, in­ cluding enrollment of special education students. The 2004 Individuals with Disabilities Education Act is a Federal law that guarantees special education and related services to all eligible children with disabilities. Greater awareness of the importance of early identification and diagnosis of speech and language disorders in young children will also increase employment.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  In healthcare facilities, restrictions on reimbursement for therapy services may limit the growth of speech-language pa­ thologist jobs in the near term. However, the long-run demand for therapists should continue to rise as growth in the number of individuals with disabilities or limited function spurs demand for therapy services. The number of speech-language pathologists in private prac­ tice should increase because hospitals, schools, and nursing care facilities will contain costs by increasingly contracting out for these services. Job prospects. In addition to job growth, a number of job openings in speech-language pathology will be due to retire­ ments. Opportunities should be favorable, particularly for those with the ability to speak a second language, such as Spanish. Demand for speech-language pathologists can be regional so job prospects are expected to be favorable for those who are willing to relocate, particularly to areas experiencing difficulty in attracting and hiring speech-language pathologists.  Earnings Median annual wages of speech-language pathologists were $62,930 in May 2008. The middle 50 percent earned between $50,330 and $79,620. The lowest 10 percent earned less than $41,240, and the highest 10 percent earned more than $99,220. Median annual wages in the industries employing the largest numbers of speech-language pathologists were: Nursing care facilities................................................$79,120 Home health care services............................................77,030 General medical and surgical hospitals........................68,430 Offices of other health practitioners.............................67,910 Elementary and secondary schools..............................58,140 Some employers may reimburse speech-language patholo­ gists for their required continuing education credits. About 40 percent of speech-language pathologists were union members or covered by union contract in 2008.  Related Occupations Speech-language pathologists specialize in the prevention, diagnosis, and treatment of speech and language problems. Workers who treat other physical and mental health problems include: Page Audiologists...................................................................................... 358 Occupational therapists...................................................................369 Physical therapists............................................................................ 377 Psychologists..................................................................................... 215 Recreational therapists.................................................................... 389  Sources of Additional Information State licensing boards can provide information on licensure requirements. State departments of education can supply in­ formation on certification requirements for those who wish to work in public schools. For information on careers in speech-language pathology, a description of the CCC-SLP credential, and a listing of accred­ ited graduate programs in speech-language pathology, contact:  402 Occupational Outlook Handbook  y American Speech-Language-Hearing Association, 2200 Research Blvd., Rockville, MD 20850. Internet: http://www.asha.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos099.htm  Veterinarians Significant Points • Veterinarians should love animals and be able to get along with their owners. • Graduation from an accredited college of veterinary medicine and a State license are required; admission to veterinary school is competitive. • Job opportunities should be excellent. • About 80 percent of veterinarians work in private practice. Nature of the Work Veterinarians diagnose and treat diseases and dysfunctions of animals. Specifically, they care for the health of pets, livestock, and animals in zoos, racetracks, and laboratories. Some veteri­ narians use their skills to protect humans against diseases car­ ried by animals and conduct clinical research on human and animal health problems. Others work in basic research, broad­ ening our knowledge of animals and medical science, and in applied research, developing new ways to use knowledge. Most veterinarians diagnose animal health problems, vacci­ nate against diseases, medicate animals suffering from infec­ tions or illnesses, treat and dress wounds, set fractures, perform surgery, and advise owners about animal feeding, behavior, and breeding. According to the American Medical Veterinary Association, 77 percent of veterinarians who work in private medical prac­ tices treat pets. These practitioners usually care for dogs and cats but also treat birds, reptiles, rabbits, ferrets, and other ani­ mals that can be kept as pets. About 16 percent of veterinarians work in private mixed and food animal practices, where they see pigs, goats, cattle, sheep, and some wild animals in addition to farm animals. A small proportion of private-practice veteri­ narians, about 6 percent, work exclusively with horses. Veterinarians who work with food animals or horses usu­ ally drive to farms or ranches to provide veterinary services for herds or individual animals. These veterinarians test for and vaccinate against diseases and consult with farm or ranch own­ ers and managers regarding animal production, feeding, and housing issues. They also treat and dress wounds, set fractures, and perform surgery, including cesarean sections on birthing animals. Other veterinarians care for zoo, aquarium, or labora­ tory animals. Veterinarians of all types euthanize animals when  necessary. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Veterinarians who treat animals use medical equipment such as stethoscopes, surgical instruments, and diagnostic equipment, including radiographic and ultrasound equipment. Veterinarians working in research use a full range of sophisti­ cated laboratory equipment. Some veterinarians contribute to human as well as animal health. A number of veterinarians work with physicians and scientists as they research ways to prevent and treat various human health problems. For example, veterinarians contributed greatly to conquering malaria and yellow fever, solved the mys­ tery of botulism, produced an anticoagulant used to treat some people with heart disease, and defined and developed surgical techniques for humans, such as hip and knee joint replacements and limb and organ transplants. Today, some determine the ef­ fects of drug therapies, antibiotics, or new surgical techniques by testing them on animals. Some veterinarians are involved in food safety and inspec­ tion. Veterinarians who are livestock inspectors, for example, check animals for transmissible diseases such as E. coli, advise owners on the treatment of their animals, and may quarantine animals. Veterinarians who are meat, poultry, or egg product inspectors examine slaughtering and processing plants, check live animals and carcasses for disease, and enforce government regulations regarding food purity and sanitation. More veteri­ narians are finding opportunities in food security as they ensure that the Nation has abundant and safe food supplies. Veterinar­ ians involved in food security often work along the country’s borders as animal and plant health inspectors, where they ex­ amine imports and exports of animal products to prevent dis­ ease here and in foreign countries. Many of these workers are employed by the Department of Agriculture’s Animal and Plant Health Inspection Service division, or the U.S. Food and Drug Administration’s Center for Veterinary Medicine. Work environment. Veterinarians in private or clinical practice often work long hours in a noisy indoor environment. Sometimes they have to deal with emotional or demanding pet owners. When working with animals that are frightened or in pain, veterinarians risk being bitten, kicked, or scratched. Veterinarians who work with food animals or horses spend time driving between their offices and farms or ranches. They  Employment opportunities for veterinarians are expected to be very good, but competition for admission to veterinary school is keen.  Professional and Related Occupations 403  work outdoors in all kinds of weather and may have to treat animals or perform surgery, often under unsanitary conditions. Veterinarians working in nonclinical areas, such as public health and research, work in clean, well-lit offices or labora­ tories and have working conditions similar to those of other professionals who work in these environments. Veterinarians in nonclinical areas spend much of their time dealing with people rather than animals. Veterinarians often work long hours. Those in group prac­ tices may take turns being on call for evening, night, or week­ end work; solo practitioners may work extended hours (includ­ ing weekend hours), responding to emergencies or squeezing in unexpected appointments.  Training, Other Qualifications, and Advancement Veterinarians must obtain a Doctor of Veterinary Medicine degree and a State license. Admission to veterinary school is competitive. Education and training. Prospective veterinarians must graduate with a Doctor of Veterinary Medicine (D.V.M. or V.M.D.) degree from a 4-year program at an accredited college of veterinary medicine. There are 28 colleges in 26 States that meet accreditation standards set by the Council on Education of the American Veterinary Medical Association (AVMA). The prerequisites for admission to veterinary programs vary. Many programs do not require a bachelor’s degree for entrance, but all require a significant number of credit hours—ranging from 45 to 90 semester hours—at the undergraduate level. How­ ever, most of the students admitted have completed an under­ graduate program and earned a bachelor’s degree. Applicants without a degree face a difficult task in gaining admittance. Preveterinary courses should emphasize the sciences. Veteri­ nary medical colleges typically require applicants to have taken classes in organic and inorganic chemistry, physics, biochemis­ try, general biology, animal biology, animal nutrition, genetics, vertebrate embryology, cellular biology, microbiology, zool­ ogy, and systemic physiology. Some programs require calculus; some require only statistics, college algebra and trigonometry, or pre-calculus. Most veterinary medical colleges also require some courses in English or literature, other humanities, and the social sciences. Increasingly, courses in general business man­ agement and career development have become a standard part of the curriculum to teach new graduates how to effectively run a practice. In addition to satisfying preveterinary course requirements, applicants must submit test scores from the Graduate Record Examination (GRE), the Veterinary College Admission Test (VCAT), or the Medical College Admission Test (MCAT), de­ pending on the preference of the college to which they are ap­ plying. Currently, 22 schools require the GRE, 4 require the VCAT, and 2 accept the MCAT.  Admission to veterinary school is competitive. The number of accredited veterinary colleges has remained largely the same since 1983, but the number of applicants has risen significantly. Only about 1 in 3 applicants was accepted in 2007. New graduates with a Doctor of Veterinary Medicine degree may begin to practice veterinary medicine once they receive their license, but many new graduates choose to enter a 1-year internship. Interns receive a small salary but often find that their internship experience leads to better paying opportunities later, relative to those of other veterinarians. Veterinarians who then seek board certification also must complete a 3-year to 4-year residency program that provides intensive training in one of the 39 AVMA-recognized veterinary specialties including internal medicine, oncology, pathology, dentistry, nutrition, radiology, surgery, dermatology, anesthesiology, neurology, cardiology, ophthalmology, preventive medicine, and exotic-small-animal medicine. Licensure. All States and the District of Columbia require that veterinarians be licensed before they can practice. The only exemptions are for veterinarians working for some Federal agencies and some State governments. Licensing is controlled by the States and is not uniform, although all States require the successful completion of the D.V.M. degree—or equivalent education—and a passing grade on a national board exami­ nation, the North American Veterinary Licensing Exam. This 8-hour examination consists of 360 multiple-choice questions covering all aspects of veterinary medicine as well as visual materials designed to test diagnostic skills. The Educational Commission for Foreign Veterinary Graduates grants certification to individuals trained outside the United States who demonstrate that they meet specified require­ ments for English language and clinical proficiency. This certi­ fication fulfills the educational requirement for licensure in all States. Most States also require candidates to pass a State jurispru­ dence examination covering State laws and regulations. Some States do additional testing on clinical competency as well. There are few reciprocal agreements between States, so veteri­ narians who wish to practice in a different State usually must first pass that State’s examinations. Other qualifications. When deciding whom to admit, some veterinary medical colleges place heavy consideration on can­ didates’ veterinary and animal experience. Formal experience, such as work with veterinarians or scientists in clinics, agribusi­ ness, research, or some area of health science, is particularly advantageous. Less formal experience, such as working with animals on a farm, or at a stable or animal shelter, also can be helpful. Students must demonstrate ambition and an eagerness to work with animals. Prospective veterinarians should love animals and have the ability to get along with their owners, especially pet owners,  Projections data from the National Employment Matrix Occupational Title Veterinarians..........................................................................................  soc  Code 29-1131  Employment,  2008 59,700  Projected Employment, 2018  79,400  Change,  2008-2018 Number  19,700  Percent 33  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  404 Occupational Outlook Handbook  who usually have strong bonds with their pets. They need good manual dexterity. Veterinarians who intend to go into private practice should possess excellent communication and business skills, because they will need to successfully manage their prac­ tice and employees and promote, market, and sell their services. Advancement. Most veterinarians begin as employees in established group practices. Despite the substantial financial investment in equipment, office space, and staff, many veteri­ narians with experience eventually set up their own practice or purchase an established one. Newly trained veterinarians can become U.S. Government meat and poultry inspectors, disease-control workers, animal welfare and safety workers, epidemiologists, research as­ sistants, or commissioned officers in the U.S. Public Health Service or various branches of the U.S. Armed Forces. A State license may be required. Nearly all States have continuing education requirements for licensed veterinarians. Requirements differ by State and may involve attending a class or otherwise demonstrating knowl­ edge of recent medical and veterinary advances.  Employment Veterinarians held about 59,700 jobs in 2008. According to the American Veterinary Medical Association, 80 percent of veteri­ narians were employed in a solo or group practice. Most oth­ ers were salaried employees of colleges or universities; medi­ cal schools; private industry, such as research laboratories and pharmaceutical companies; and Federal, State, or local govern­ ment. The Federal Government employed about 1,300 civilian vet­ erinarians, chiefly in the U.S. Department of Agriculture and the U.S. Food and Drug Administration’s Center for Veterinary Medicine. A few veterinarians work for zoos, but most veteri­ narians caring for zoo animals are private practitioners who contract with the zoos to provide services, usually on a part­ time basis. In addition, many veterinarians hold veterinary faculty posi­ tions in colleges and universities and are classified as teachers. (See the statement on teachers—postsecondary elsewhere in the Handbook.) Job Outlook Employment is expected to increase much faster than average. Excellent job opportunities are expected. Employment change. Employment of veterinarians is ex­ pected to increase 33 percent over the 2008-18 decade, much faster than the average for all occupations. Veterinarians usually practice in animal hospitals or clinics and care primarily for small pets. Recent trends indicate particularly strong interest in cats as pets. Faster growth of the cat population is expected to increase the demand for feline medicine and veterinary ser­ vices, while demand for veterinary care for dogs should con­ tinue to grow at a more modest pace. Many pet owners consider their pets as members of the fam­ ily, which serves as evidence that people are placing a higher value on their pets and is an example of the human-animal bond. These pet owners are becoming more aware of the avail­ ability of advanced care and are more willing to pay for in­ Digitizedtensive for FRASER veterinary care than owners in the past. Furthermore, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  the number of pet owners purchasing pet insurance is rising, increasing the likelihood that considerable money will be spent on veterinary care. More pet owners also will take advantage of nontraditional veterinary services, such as cancer treatment and preventive dental care. Modem veterinary services have caught up to hu­ man medicine; certain procedures, such as hip replacement, kidney transplants, and blood transfusions, which were once only available for humans, are now available for animals. Continued support for public health and food and animal safety, national disease control programs, and biomedical re­ search on human health problems will contribute to the demand for veterinarians, although the number of positions in these ar­ eas is smaller than the number in private practice. Homeland se­ curity also may provide opportunities for veterinarians involved in efforts to maintain abundant food supplies and minimize ani­ mal diseases in the United States and in foreign countries. Excellent job opportunities are expected Job prospects. because there are only 28 accredited schools of veterinary medicine in the United States, resulting in a limited number of graduates—about 2,500—each year. However, admission to veterinary school is competitive. New graduates continue to be attracted to companion-animal medicine because they usually prefer to deal with pets and to live and work near heavily populated areas, where most pet owners live. Employment opportunities are very good in cities and suburbs but even better in rural areas because fewer veteri­ narians compete to work there. Beginning veterinarians may take positions requiring evening or weekend work to accommodate the extended hours of opera­ tion that many practices are offering. Some veterinarians take salaried positions in retail stores offering veterinary services. Self-employed veterinarians usually have to work hard and long to build a sufficient client base. The number of jobs for farm-animal veterinarians is likely to grow more slowly than the number of jobs for companionanimal veterinarians. Nevertheless, job prospects should be excellent for farm-animal veterinarians because of their lower earnings and because many veterinarians do not want to work outside or in rural or isolated areas. Veterinarians with training in food safety and security, ani­ mal health and welfare, and public health and epidemiology should have the best opportunities for a career in the Federal Government.  Earnings Median annual wages of veterinarians were $79,050 in May 2008. The middle 50 percent earned between $61,370 and $104,110. The lowest 10 percent earned less than $46,610, and the highest 10 percent earned more than $143,660. The average annual salary for veterinarians in the Federal Government was $93,398 in March 2009. According to a survey by the American Veterinary Medical Association, average starting salaries of veterinary medical col­ lege graduates in 2008 varied by type of practice as follows: Small animals, exclusively.........................................$64,744 Large animals, exclusively...........................................62,424 Small animals, predominantly......................................61,753  Professional and Related Occupations 405  Mixed animals...............................................................58,522 Large animals, predominantly...................................... 57,745 Equine (horses)............................................................. 41,636  Related Occupations Page Animal care and service workers.............................................504 Biological scientists................................................................. 181 Chiropractors............................................................................ 360 Dentists......................................................................................363 Medical scientists......................................................................189 Optometrists............................................................................. 371 Physicians and surgeons........................................................... 381 Podiatrists................................................................................. 385 Veterinary technologists and technicians................................ 443  Sources of Additional Information For additional information on careers in veterinary medicine, a list of U.S. schools and colleges of veterinary medicine, and ac­ creditation policies, send a letter-size, self-addressed, stamped envelope to: y American Veterinary Medical Association, 1931 N. Meacham Rd., Suite 100, Schaumburg, IL 60173. Internet: http://www.avma.org For information on veterinary education, contact:  y Association of American Veterinary Medical Colleges, 1101 Vermont Ave. NW„ Suite 301, Washington, DC 20005. Internet: http://www.aavmc.org For information on scholarships, grants, and loans, contact the financial aid officer at the veterinary schools to which you wish to apply. For information on veteri narians working in zoos, see the Occu­ pational Outlook Quarterly article “Wild jobs with wildlife,” on­ line at http://www.bls.gov/opub/ooq/2001/spring/art01.pdf. Information on obtaining a veterinary position with the Federal Government is available from the Office of Personnel Management through USAJOBS, the Federal Government’s of­ ficial employment information system. This resource for locat­ ing and applying for job opportunities can be accessed through the Internet at http://www.usajobs.opm.gov or through an in­ teractive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not toll free, so charges may result. For advice on how to find and apply for Federal jobs, see the Occupational Outlook Quarterly article “How to get a job in the Federal Government,” available online at http://www.bls.gov/opub/ooq/2004/summer/art01.pdf. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos076.htm  Health Technologists and Technicians Athletic Trainers Significant Points • A bachelor’s degree is usually the minimum require­ ment, but many athletic trainers hold a master’s or doctoral degree. • Long hours, sometimes including nights and week­ ends, are common. • Job prospects should be good in the healthcare indus­ try and in high schools, but competition is expected for positions with professional and college sports teams. Nature of the Work Athletic trainers help prevent and treat injuries for people of all ages. Their patients and clients include everyone from professional athletes to industrial workers. Recognized by the American Medical Association as allied health profes­ sionals, athletic trainers specialize in the prevention, diag­ nosis, assessment, treatment, and rehabilitation of muscle and bone injuries and illnesses. Athletic trainers, as one of the first healthcare providers on the scene when injuries oc­ cur, must be able to recognize, evaluate, and assess injuries and provide immediate care when needed. Athletic trainers should not be confused with fitness trainers or personal train­ who are not healthcare workers, but rather train people Digitizeders, for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  to become physically fit. (Fitness workers are discussed else­ where in the Handbook.) Athletic trainers try to prevent injuries by educating peo­ ple on how to reduce their risk for injuries and by advising them on the proper use of equipment, exercises to improve balance and strength, and home exercises and therapy pro­ grams. They also help apply protective or injury-preventive devices such as tape, bandages, and braces. Athletic trainers may work under the direction of a li­ censed physician, and in cooperation with other healthcare providers. The extent of the direction ranges from discuss­ ing specific injuries and treatment options with a physician to performing evaluations and treatments as directed by a physician. Some athletic trainers meet with the team physi­ cian or consulting physician once or twice a week; others interact with a physician every day. Athletic trainers often have administrative responsibilities. These may include reg­ ular meetings with an athletic director, physician practice manager, or other administrative officer to deal with bud­ gets, purchasing, policy implementation, and other businessrelated issues. Work environment. The industry and individual employer are significant in determining the work environment of ath­ letic trainers. Many athletic trainers work indoors most of the time; others, especially those in some sports-related jobs, spend much of their time working outdoors. The job also might require standing for long periods, working with medi-  406 Occupational Outlook Handbook  Athletic trainers are responsible for their clients’ health, and sometimes have to make quick decisions that could affect the health or career of their clients. Athletics trainers also can be affected by the pressure to win that is typical of competitive sports teams.  Training, Other Qualifications, and Advancement i . :lSu.  ■  Athletic trainers apply protective devices such as tape, ban­ dages, and braces. cal equipment or machinery, and being able to walk, run, kneel, stoop, or crawl. Travel may be required. Schedules vary by work setting. Athletic trainers in nons­ ports settings generally have an established schedule—usu­ ally about 40 to 50 hours per week—with nights and week­ ends off. Athletic trainers working in hospitals and clinics may spend part of their time working at other locations do­ ing outreach services. The most common outreach programs include conducting athletic training services and speaking at high schools, colleges, and commercial businesses. Athletic trainers in sports settings have schedules that are longer and more variable. These athletic trainers must be present for team practices and competitions, which of­ ten are on evenings and weekends, and their schedules can change on short notice when games and practices have to be rescheduled. In high schools, athletic trainers who also teach may work 60 to 70 hours a week, or more. In National Col­ legiate Athletic Association Division I colleges and universi­ ties, athletic trainers generally work with one team; when that team’s sport is in season, working at least 50 to 60 hours a week is common. Athletic trainers in smaller colleges and universities often work with several teams and have teaching responsibilities. During the off-season, a 40-hour to 50-hour work week may be normal in most settings. Athletic trainers for professional sports teams generally work the most hours per week. During training camps, practices, and competi­ tions, they may be required to work up to 12 hours a day. There is some stress involved with being an athletic trainer. The work of athletic trainers requires frequent in­ teraction with others. They consult with physicians as well as have frequent contact with athletes and patients to dis­ cuss and administer treatments, rehabilitation programs, injury-preventive practices, and other health-related issues.  A bachelor’s degree is usually the minimum requirement, but many athletic trainers hold a master’s or doctoral degree. In 2009,47 States required athletic trainers to be licensed or hold some form of registration. Education and training. A bachelor’s degree from an ac­ credited college or university is required for almost all jobs as an athletic trainer. In 2009, there were about 350 accred­ ited undergraduate programs nationwide. Students in these programs are educated both in the classroom and in clinical settings. Formal education includes many science and healthrelated courses, such as human anatomy, physiology, nutri­ tion, and biomechanics. According to the National Athletic Trainers’ Association, almost 70 percent of athletic trainers have a master’s degree or higher. Athletic trainers may need a master’s or higher degree to be eligible for some positions, especially those in colleges and universities, and to increase their advancement opportuni­ ties. Because some positions in high schools involve teaching along with athletic trainer responsibilities, a teaching certifi­ cate or license could be required. Licensure and certification. In 2009, 47 States required athletic trainers to be licensed or registered; this requires certi­ fication from the Board of Certification, Inc. (BOC). For BOC certification, athletic trainers need a bachelor’s or master’s degree from an accredited athletic training program and must pass a rigorous examination. To retain certification, credential holders must continue taking medical-related courses and ad­ here to the BOC standards of practice. In Alaska, California, West Virginia, and the District of Columbia where licensure is not required, certification is voluntary but may be helpful for those seeking jobs and advancement. Other qualifications. Because all athletic trainers deal directly with a variety of people, they need good social and communication skills. They should be able to manage difficult situations and the stress associated with them, such as when disagreements arise with coaches, patients, clients, or parents regarding suggested treatment. Athletic trainers also should be organized, be able to manage time wisely, be inquisitive, and have a strong desire to help people. Advancement. There are a few ways for athletic trainers to advance. Some athletic trainers advance by switching teams or sports to gain additional responsibility or pay. Assistant ath­ letic trainers may become head athletic trainers and, eventu­ ally, athletic directors or physician, hospital or clinic practice  Projections data from the National Employment Matrix Occupational Title  soc  Employment,  Code  2008  Projected Employment,  Change,  2008-2018  Number Percent 2018 6,000 37 22,400 16,300 Athletic trainers........................................................ .......................... 29-9091 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 407  administrators where they assume a management role. Some athletic trainers move into sales and marketing positions, us­ ing their expertise to sell medical and athletic equipment.  Employment Athletic trainers held about 16,300 jobs in 2008 and are found in every part of the country. Most athletic trainer jobs are re­ lated to sports, although an increasing number also work in nonsports settings. About 39 percent were found in public and private educational services, primarily in colleges, universities, and high schools. Another 38 percent of athletic trainers worked in healthcare, including jobs in hospitals, offices of physicians, and offices of other health practitioners. About 13 percent worked in fitness and recreational sports centers. Around 5 per­ cent work in spectator sports.  Job Outlook Employment is projected to grow much faster than average. Job prospects should be good in the healthcare industry and in high schools, but competition is expected for positions with profes­ sional and college sports teams. Employment change. Employment of athletic trainers is pro­ jected to grow 37 percent from 2008 to 2018, much faster than the average for all occupations, because of their role in preventing in­ juries and reducing healthcare costs. Job growth will be concen­ trated in the healthcare industry, including hospitals and offices of health practitioners. Fitness and recreation sports centers also will provide new jobs, as these establishments grow and continue to need additional athletic trainers to provide support for their clients. Growth in positions with sports teams will be somewhat slower, however, as most professional sports clubs and colleges and universities already have complete athletic training staffs. The demand for healthcare, with an emphasis on preventive care, should grow as the population ages and as a way to re­ duce healthcare costs. Increased licensure requirements and regulation has led to a greater acceptance of athletic trainers as qualified healthcare providers. As a result, third-party reim­ bursement is expected to continue to grow for athletic training services. Athletic trainers will benefit from this expansion be­ cause they provide a cost-effective way to increase the number of health professionals in an office or other setting. In some States, there are efforts underway to have an ath­ letic trainer in every high school to work with student-athletes, which may lead to growth in the number of athletic trainers employed in high schools. In addition, as more young athletes specialize in certain sports, there is increasing demand for ath­ letic trainers to deal with repetitive stress injuries. As athletic trainers continue to expand their services, more employers are expected to use these workers to reduce health­ care costs by preventing work-related injuries. Athletic trainers can help prevent injuries and provide immediate treatment for many injuries that do occur. For example, some athletic trainers may be hired to increase the fitness and performance of police and firefighters. Job prospects. Job prospects should be good for athletic trainers in the healthcare industry and in high schools. Those looking for a position with a professional or college sports team may face competition.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Because of relatively low turnover, the settings with the best job prospects will be the ones that are expected to have the most job growth, primarily positions in the healthcare and fitness and recreational sports centers industries. Additional job opportuni­ ties may arise in elementary and secondary schools as more positions are created. Some of these positions also will require teaching responsibilities. There are relatively few positions for professional and col­ legiate sports teams in comparison to the number of applicants. Turnover among professional sports team athletic trainers is also limited. Many athletic trainers prefer to continue to work with the same coaches, administrators, and players when a good working relationship already exists. There also are opportunities for athletic trainers to join the military, although they would not be classified as an athletic trainer. Enlisted soldiers and officers who are athletic trainers are usually placed in another program, such as health educator or training specialist, in which their skills are useful. (For infor­ mation on military careers, see the Handbook statement on job opportunities in the Armed Forces.) This occupation is expected to continue to change over the next decade, including more administrative responsibilities, adapting to new technology, and working with larger popula­ tions, and jobseekers must be prepared to adapt to these changes.  Earnings Most athletic trainers work in full-time positions, and typically receive benefits. The salary of an athletic trainer depends on experience and job responsibilities, and varies by job setting. Median annual wages for athletic trainers were $39,640 in May 2008. The middle 50 percent earned between $32,070 and $49,250. The lowest 10 percent earned less than $23,450, while the top 10 percent earned more than $60,960. Many employers pay for some of the continuing education required for athletic trainers to remain certified, although the amount covered varies from employer to employer.  Related Occupations Other American Medical Association allied health profession­ als include: Page Chiropractors............................................................................360 Emergency medical technicians and paramedics.................... 419 Licensed practical and licensed vocational nurses..................421 Massage therapists...................................................................452 Occupational therapists............................................................369 Physical therapists....................................................................377 Physician assistants..................................................................379 Physicians and surgeons...........................................................381 Podiatrists................................................................................. 385 Recreational therapists.............................................................389 Registered nurses.....................................................................392 Respiratory therapists...............................................................397  408 Occupational Outlook Handbook  Sources of Additional Information For further information on careers in athletic training, contact: V National Athletic Trainers’ Association, 2952 Stemmons Freeway, Suite 200, Dallas, TX 75247. Internet: http://www.nata.org For further information on certification, contact: y Board of Certification, Inc., 1415 Harney St., Suite 200, Omaha, NE 68102. Internet: http://www.bocatc.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos294.htm  Cardiovascular Technologists and Technicians Significant Points • Employment is expected to grow much faster than average. • Technologists and technicians with multiple profes­ sional credentials, trained to perform a wide range of procedures, will have the best prospects. • About 77 percent of jobs are in hospitals. • Workers typically need a 2-year associate degree at a junior or community college; most employers also require a professional credential.  Nature of the Work Cardiovascular technologists and technicians assist physicians in diagnosing and treating cardiac (heart) and peripheral vascu­ lar (blood vessel) ailments. Cardiovascular technologists and technicians schedule ap­ pointments, review physicians’ interpretations and patient files, and monitor patients’ heart rates. They also operate and care for testing equipment, explain test procedures, and compare find­ ings to a standard to identify problems. Other day-to-day activi­ ties vary significantly between specialties. Technologists may specialize in different areas of prac­ tice: invasive cardiology, non-invasive—which includes echocardiography—or vascular technology. Technicians spe­ cialize in electrocardiograms and stress testing. Invasive cardiology. Cardiovascular technologists specializ­ ing in invasive procedures are called cardiology technologists. They assist physicians with cardiac catheterization procedures in which a small tube, or catheter, is threaded through a pa­ tient’s artery from a spot on the patient’s groin to the heart. The procedure can determine whether a blockage exists in the blood vessels that supply the heart muscle or help to diagnose other problems. Some of these procedures may involve balloon an­ gioplasty, which can be used to treat blockages of blood vessels or heart valves without the need for heart surgery. Cardiology technologists assist physicians as they insert a catheter with a balloon on the end to the point of the obstruction. Catheters are  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  also used in electrophysiology tests, which help locate the spe­ cific areas of heart tissue that give rise to the abnormal electrical impulses that cause arrhythmias. Technologists prepare patients for cardiac catheterization by first positioning them on an examining table and then shaving, cleaning, and administering anesthesia to the top of their leg near the groin. During the procedures, they monitor patients’ blood pressure and heart rate with EKG equipment and notify the physician if something appears to be wrong. Some cardi­ ology technologists also prepare and monitor patients during open-heart surgery and during the insertion of pacemakers and stents that open up blockages in arteries to the heart and major blood vessels. Noninvasive technology. Technologists who specialize in echocardiography or vascular technology perform noninvasive tests. Tests are called “noninvasive” if they do not require the insertion of probes or other instruments into the patient’s body. For example, procedures such as Doppler ultrasound transmit high-frequency sound waves into areas of the patient’s body and then processes reflected echoes of the sound waves to form an image. Technologists view the ultrasound image on a screen and may record the image on videotape or photograph it for interpretation and diagnosis by a physician. (See the statement on diagnostic medical sonographers elsewhere in the Handbook to learn more about other sonographers.) Echocardiographers. Technologists who use ultrasound to examine the heart chambers, valves, and vessels are referred to as cardiac sonographers, or echocardiographers. They use ultrasound instrumentation to create images called echocardio­ grams. An echocardiogram may be performed while the patient is either resting or physically active. Technologists may ad­ minister medication to physically active patients to assess their heart function. Cardiac sonographers also may assist physicians who perform other procedures.  w® -___  asff tB m  Cardiovascular technologists may specialize in invasive cardi­ ology, echocardiography, and vascular technology.  Professional and Related Occupations 409  Vascular technologists. Technologists who assist physicians in the diagnosis of disorders affecting the circulation are known as vascular technologists or vascular sonographers. Vascu­ lar technologists complete patients’ medical history, evaluate pulses and assess blood flow in arteries and veins by listening to the vascular flow sounds for abnormalities, and assure the appropriate vascular test has been ordered. Then they perform a noninvasive procedure using ultrasound instruments to re­ cord vascular information such as vascular blood flow, blood pressure, oxygen saturation, cerebral circulation, peripheral circulation, and abdominal circulation. Many of these tests are performed during or immediately after surgery. Vascular tech­ nologists then provide a summary of findings to the physician to aid in patient diagnosis and management. Cardiographic technicians. Technicians who specialize in electrocardiography, or EKG, stress testing, and perform Holter monitor procedures are known as cardiographic or electrocardiograph (or EKG) technicians. Technicians take EKGs, which trace electrical impulses transmitted by the heart, attach electrodes to the patient’s chest, arms, and legs, and then manipulate switches on an EKG ma­ chine to obtain a reading. An EKG is printed out for interpreta­ tion by the physician. This test is done before most kinds of surgery or as part of a routine physical examination. EKG technicians with advanced training perform Holter monitor and stress testing. For Holter monitoring, technicians place electrodes on the patient’s chest and attach a portable EKG monitor to the patient’s belt. Following 24 or more hours of normal activity by the patient, the technician removes a tape from the monitor and places it in a scanner. After checking the quality of the recorded impulses on an electronic screen, the technician usually prints the information from the tape for analysis by a physician. Physicians use the output from the scanner to diagnose heart ailments, such as heart rhythm abnor­ malities or problems with pacemakers. For a treadmill stress test, EKG technicians document the patient’s medical history, explain the procedure, connect the patient to an EKG monitor, and obtain a baseline reading and resting blood pressure. Next, they monitor the heart’s perfor­ mance while the patient is walking on a treadmill, gradually in­ creasing the treadmill’s speed to observe the effect of increased exertion. Like vascular technologists and cardiac sonographers, cardiographic technicians who perform EKGs, Holter monitor­ ing, and stress tests are known as “noninvasive” technicians. Work environment. Cardiovascular technologists and techni­ cians spend a lot of time walking and standing. Heavy lifting may be involved to move equipment or transfer patients. Those who work in catheterization laboratories may face stressful working conditions because they are in close contact with patients with serious heart ailments. For example, some patients may encoun­ ter complications that have life-or-death implications.  Some cardiovascular technologists and technicians may have the potential for radiation exposure. However, exposure is kept to a minimum by strict adherence to radiation safety guidelines, such as wearing heavy protective aprons while conducting cer­ tain procedures. In addition, those who use sonography can be at an increased risk for musculoskeletal disorders such as carpel tunnel syndrome, neck and back strain, and eye strain. How­ ever, greater use of ergonomic equipment and an increasing awareness will continue to minimize such risks. Technologists and technicians generally work a 5-day, 40hour week that may include weekends. Those in catheterization laboratories tend to work longer hours and may work evenings. They also may be on call during the night and on weekends. About 18 percent worked part-time in 2008.  Training, Other Qualifications, and Advancement Cardiovascular technologists typically need an associate degree for entry-level employment. Most employers also require a pro­ fessional credential. Technicians also receive on-the-job training. Education and training. The majority of cardiovascular technologists, vascular technologists, and cardiac sonographers complete a 2-year junior or community college program result­ ing in an associate degree. However, 4-year programs are in­ creasingly available. The first year is dedicated to core courses and is followed by a year of specialized instruction in either invasive cardiovascular, noninvasive cardiovascular, or nonin­ vasive vascular technology. Those who are qualified in an allied health profession need to complete only the year of specialized instruction. The Commission on Accreditation of Allied Health Pro­ fessionals (CAAHEP) accredits cardiovascular technology education programs. In January 2009, there were 34 accredited programs. Similarly, those who want to study echocardiography or vascular sonography may also attend CAAHEP-accredited programs in diagnostic medical sonography. In 2009, there were 168 such accredited programs. Those who attend these accred­ ited programs are eligible to obtain professional certification. Unlike most other cardiovascular technologists and techni­ cians, most EKG technicians are trained on the job by an EKG supervisor or a cardiologist. On-the-job training for EKG tech­ nicians usually takes about 4 to 6 weeks. Most employers prefer to train people already in the healthcare field—nursing aides, for example. Some EKG technicians are students enrolled in 2-year programs to become technologists, working part time to gain experience and make contact with employers. For techni­ cians who perform Holter monitoring on-the-job training may last around 18 to 24 months. One-year certification programs also exist for basic EKGs, Holter monitoring, and stress testing and can be an alternative to on-the-job training. Licensure and certification. Credentialing is voluntary. However, it is the professional standard and most employ-  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Cardiovascular technologists and technicians..................... .............. 29-2031 49,500 61,400 11,900 24 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  tionFRASER Included in the Handbook. Digitized for https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  410 Occupational Outlook Handbook  ers require credentialing. Credentialing for cardiovascular technologists is available from Cardiovascular Credentialing International (CCI) and the American Registry of Diagnostic Medical Sonographers (ARDMS). Most credentials require that technologists complete an accredited education program to qualify to sit for credentialing examination. Continuing educa­ tion is required in most cases to maintain certification. For spe­ cific requirements, contact the credentialing body. Other qualifications. Cardiovascular technologists and tech­ nicians must be reliable, have mechanical aptitude, and be able to follow detailed instructions. A pleasant, relaxed manner for putting patients at ease is an asset. They must be articulate as they must communicate technically with physicians and also explain procedures simply to patients. Advancement. Technicians may advance to the technolo­ gist level of practice with supplemental formal education and credentialing. Technologists can advance to higher levels of the profession as many institutions structure the occupation with multiple levels, each having an increasing amount of responsibility. Advancement may occur through multiple credentialing in more than one cardiovascular specialty or through work ex­ perience. Technologists may also advance into supervisory or management positions. Other possibilities include working in an educational setting or conducting laboratory work.  The rules governing reimbursement by Medicare and Medic­ aid for medical procedures will affect the frequency of their use and demand for imaging technologists. Job prospects. In addition to job growth, job openings for car­ diovascular technologists and technicians will arise from replace­ ment needs as individuals transfer to other jobs or leave the labor force. Job prospects will be best for those with multiple profes­ sional credentials, trained to perform a wide range of procedures. Those willing to relocate or work irregular hours also will have better job opportunities. It is not uncommon for cardiovascular technologists and tech­ nicians to move between the specialties within the occupation by obtaining certification in more than one specialty. Technologists with multiple credentials will be the most marketable to employ­ ers.  Earnings Median annual wages of cardiovascular technologists and tech­ nicians were $47,010 in May 2008. The middle 50 percent earned between $32,800 and $61,580. The lowest 10 percent earned less than $25,510, and the highest 10 percent earned more than $74,760. Median annual wages of cardiovascular technologists and technicians in 2008 were $48,590 in offices of physicians and $46,670 in general medical and surgical hospitals.  Employment Cardiovascular technologists and technicians held about 49,500 jobs in 2008. About 77 percent of jobs were in hospitals (public and private), primarily in cardiology departments. The remain­ ing jobs were mostly in offices of physicians, including cardi­ ologists, or in medical and diagnostic laboratories, including diagnostic imaging centers.  Job Outlook Employment is expected to grow much faster than the average; technologists and technicians with multiple professional creden­ tials, trained to perform a wide range of procedures, will have the best prospects. Employment change. Employment of cardiovascular technol­ ogists and technicians is expected to increase 24 percent through the year 2018, much faster than the average for all occupations. Demand will stem from the prevalence of heart disease and the aging population, because older people have a higher incidence of heart disease and other complications of the heart and vascular system. Procedures such as ultrasound imaging and radiology are being performed more often as a replacement for more expensive and more invasive procedures. Due to advances in medicine and greater public awareness, signs of vascular disease can be de­ tected earlier, creating demand for cardiovascular technologists and technicians to perform various procedures. Employment of vascular technologists and echocardiographers will grow as advances in vascular technology and sonography re­ duce the need for more costly and invasive procedures. However, fewer EKG technicians will be needed, as hospitals train nursing aides and others to perform basic EKG procedures. Individuals trained in Holter monitoring and stress testing are expected to have more favorable job prospects than those who can perform only basic EKG. Digitized for aFRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Related Occupations Cardiovascular technologists and technicians operate so­ phisticated equipment that helps physicians and other health practitioners to diagnose and treat patients. Similar occupations include: Page Diagnostic medical sonographers........................................... 416 Nuclear medicine technologists.............................................. 426 Radiation therapists..................................................................387 Radiologic technologists and technicians............................... 438 Respiratory therapy technicians.............................................. 446  Sources of Additional Information For general information about a career in cardiovascular tech­ nology, contact: y Alliance of Cardiovascular Professionals, P.O. Box 2007 Midlothian, VAf23113. Internet: http://www.acp-online.org For a list of accredited programs in cardiovascular technology, contact: y Committee on Accreditation for Allied Health Education Programs, 1361 Park St., Clearwater, FL 33756. Internet: http ://www.caahep.org y Society for Vascular Ultrasound, 4601 Presidents Dr., Suite 260, Lanham, MD 20706. Internet: http://www.svunet.org For information regarding registration and certification, contact: y Cardiovascular Credentialing International, 1500 Sunday Dr., Suite 102, Raleigh, NC 27607. Internet: http ://www.cci-online.org  Professional and Related Occupations 411  V American Registry of Diagnostic Medical Sonographers,  Nature of the Work  51 Monroe St., Plaza East One, Rockville, MD 20850-2400. Internet: http://www.ardms.org  Clinical laboratory testing plays a crucial role in the detection, di­ agnosis, and treatment of disease. Clinical laboratory technolo­ gists, also referred to as clinical laboratory scientists or medical technologists, and clinical laboratory technicians, also known as medical technicians or medical laboratory technicians, perform most of these tests. Clinical laboratory personnel examine and analyze body fluids, and cells. They look for bacteria, parasites, and other microor­ ganisms; analyze the chemical content of fluids; match blood for transfusions; and test for drug levels in the blood that show how a patient is responding to treatment. Technologists also prepare specimens for examination, count cells, and look for abnormal cells in blood and body fluids. They use microscopes, cell coun­ ters, and other sophisticated laboratory equipment. They also use automated equipment and computerized instmments capable of performing a number of tests simultaneously. After testing and examining a specimen, they analyze the results and relay them to physicians. With increasing automation and the use of computer technol­ ogy, the work of technologists and technicians has become less hands-on and more analytical. The complexity of tests performed, the level of judgment needed, and the amount of responsibility workers assume depend largely on the amount of education and experience they have. Clinical laboratory technologists usually do more complex tasks than clinical laboratory technicians do. Clinical laboratory technologists perform complex chemical, biological, hematological, immunologic, microscopic, and bac­ teriological tests. Technologists microscopically examine blood and other body fluids. They make cultures of body fluid and tissue samples, to determine the presence of bacteria, fungi, para­ sites, or other microorganisms. Technologists analyze samples for chemical content or a chemical reaction and determine con­ centrations of compounds such as blood glucose and cholesterol levels. They also type and cross match blood samples for transfu­ sions. Clinical laboratory technologists evaluate test results, develop and modify procedures, and establish and monitor programs, to ensure the accuracy of tests. Some technologists supervise clini­ cal laboratory technicians. Technologists in small laboratories perform many types of tests, whereas those in large laboratories generally specialize. Clinical chemistry technologists, for example, prepare speci­ mens and analyze the chemical and hormonal contents of body fluids. Microbiology technologists examine and identify bac­ teria and other microorganisms. Blood bank technologists, or immunohematology technologists, collect, type, and prepare blood and its components for transfusions. Immunology tech­ nologists examine elements of the human immune system and its response to foreign bodies. Cytotechnologists prepare slides of body cells and examine these cells microscopically for abnor­ malities that may signal the beginning of a cancerous growth. Molecular biology technologists perform complex protein and nucleic acid testing on cell samples. Clinical laboratory technicians perform less complex tests and laboratory procedures than technologists do. Technicians may prepare specimens and operate automated analyzers, for example, or they may perform manual tests in accordance with  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl00.htm  Clinical Laboratory Technologists and Technicians Significant Points  • Excellent job opportunities are expected. • Clinical laboratory technologists usually have a bach­ elor’s degree with a major in medical technology or in one of the life sciences; clinical laboratory techni­ cians generally need either an associate degree or a certificate. • Most jobs will continue to be in hospitals, but em­ ployment will grow rapidly in other settings, as well.  ■  :  Clinical laboratory personnel examine and analyze body fluids and Digitized for cells. FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  412 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Number Percent 2018 Clinical laboratory technologists and technicians.............................. 29-2010 328,100 373,600 45,600 14 Medical and clinical laboratory technologists............................... 29-2011 172,400 193,000 20,500 12 Medical and clinical laboratory technicians.................................. 29-2012155,600180,70025,00016 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ______________  Occupational Title  detailed instructions. They usually work under the supervision of medical and clinical laboratory technologists or laboratory man­ agers. Like technologists, clinical laboratory technicians may work in several areas of the clinical laboratory or specialize in just one. Phlebotomists collect blood samples, for example, and histotechnicians cut and stain tissue specimens for microscopic examination by pathologists. Work environment. Clinical laboratory personnel are trained to work with infectious specimens. When proper methods of in­ fection control and sterilization are followed, few hazards exist. Protective masks, gloves, and goggles often are necessary to en­ sure the safety of laboratory personnel. Working conditions vary with the size and type of employment setting. Laboratories usually are well lighted and clean; however, specimens, solutions, and reagents used in the laboratory some­ times produce fumes. Laboratory workers may spend a great deal of time on their feet. Hours of clinical laboratory technologists and technicians vary with the size and type of employment setting. In large hospitals or in independent laboratories that operate continuously, person­ nel usually work the day, evening, or night shift and may work weekends and holidays. Laboratory personnel in small facilities may work on rotating shifts, rather than on a regular shift. In some facilities, laboratory personnel are on call several nights a week or on weekends, in case of an emergency.  Training, Other Qualifications, and Advancement Clinical laboratory technologists generally require a bachelor’s degree in medical technology or in one of the life sciences; clini­ cal laboratory technicians usually need an associate degree or a certificate. Education and training. The usual requirement for an entry-level position as a clinical laboratory technologist is a bachelor’s degree with a major in medical technology or one of the life sciences; however, it is possible to qualify for some jobs with a combination of education and on-the-job and specialized training. Universities and hospitals offer medical technology pro­ grams. Bachelor’s degree programs in medical technology include courses in chemistry, biological sciences, microbiology, math­ ematics, and statistics, as well as specialized courses devoted to knowledge and skills used in the clinical laboratory. Many pro­ grams also offer or require courses in management, business, and computer applications. The Clinical Laboratory Improvement Act requires technologists who perform highly complex tests to have at least an associate degree. Medical and clinical laboratory technicians generally have ei­ ther associate degree from a community or junior college or Digitized for an FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  SOC Code  Employment, 2008  a certificate from a hospital, a vocational or technical school, or the Armed Forces. A few technicians learn their skills on the job. The National Accrediting Agency for Clinical Laboratory Sci­ ences (NAACLS) fully accredits about 479 programs for medi­ cal and clinical laboratory technologists, medical and clinical laboratory technicians, histotechnologists and histotechnicians, cytogenetic technologists, and diagnostic molecular scientists. NAACLS also approves about 60 programs in phlebotomy and clinical assisting. Other nationally recognized agencies that ac­ credit specific areas for clinical laboratory workers include the Commission on Accreditation of Allied Health Education Programs and the Accrediting Bureau of Health Education Schools. Licensure. Some States require laboratory personnel to be licensed or registered. Licensure of technologists often requires a bachelor’s degree and the passing of an exam, but requirements vary by State and specialty. Information on licensure is available from State departments of health or boards of occupational li­ censing. Certification and other qualifications. Many employers pre­ fer applicants who are certified by a recognized professional as­ sociation. Associations offering certification include the Board of Registry of the American Society for Clinical Pathology, the American Medical Technologists, the National Credentialing Agency for Laboratory Personnel, and the Board of Registry of the American Association of Bioanalysts. These agencies have different requirements for certification and different organiza­ tional sponsors. In addition to certification, employers seek clinical labora­ tory personnel with good analytical judgment and the ability to work under pressure. Technologists in particular are expected to be good at problem solving. Close attention to detail is also essential for laboratory personnel because small differences or changes in test substances or numerical readouts can be crucial to a diagnosis. Manual dexterity and normal color vision are highly desirable, and with the widespread use of automated laboratory equipment, computer skills are important. Advancement. Technicians can advance and become tech­ nologists through additional education and experience. Technol­ ogists may advance to supervisory positions in laboratory work or may become chief medical or clinical laboratory technologists or laboratory managers in hospitals. Manufacturers of home di­ agnostic testing kits and laboratory equipment and supplies also seek experienced technologists to work in product development, marketing, and sales. Professional certification and a graduate degree in medical technology, one of the biological sciences, chemistry, manage­ ment, or education usually speeds advancement. A doctorate usu­ ally is needed to become a laboratory director. Federal regulation  Professional and Related Occupations 413  requires directors of moderately complex laboratories to have ei­ ther a master’s degree or a bachelor’s degree, combined with the appropriate amount of training and experience.  Employment Clinical laboratory technologists and technicians held about 328,100 jobs in 2008. More than half of jobs were in hospitals. Most of the remaining jobs were in offices of physicians and in medical and diagnostic laboratories. A small proportion was in educational services and in all other ambulatory health care services.  Job Outlook Rapid job growth and excellent job opportunities are expected. Most jobs will continue to be in hospitals, but employment will grow rapidly in other settings, as well. Employment change. Employment of clinical laboratory workers is expected to grow by 14 percent between 2008 and 2018, faster than the average for all occupations. The volume of laboratory tests continues to increase with both population growth and the development of new types of tests. Technological advances will continue to have opposing effects on employment. On the one hand, new, increasingly powerful diagnostic tests and advances in genomics—the study of the ge­ netic information of a cell or organism—will encourage addi­ tional testing and spur employment. On the other hand, research and development efforts targeted at simplifying and automating routine testing procedures may enhance the ability of nonlabo­ ratory personnel—physicians and patients in particular—to per­ form tests now conducted in laboratories. Although hospitals are expected to continue to be the major employer of clinical laboratory workers, employment is expected also to grow rapidly in medical and diagnostic laboratories, of­ fices of physicians, and all other ambulatory health care services. Job prospects. Job opportunities are expected to be excel­ lent because the number of job openings is expected to continue to exceed the number of jobseekers. Although significant, job growth will not be the only source of opportunities. As in most occupations, many additional openings will result from the need to replace workers who transfer to other occupations, retire, or stop working for some other reason. Willingness to relocate will further enhance one’s job prospects.  Earnings Median annual wages of medical and clinical laboratory tech­ nologists were $53,500 in May 2008. The middle 50 percent earned between $44,560 and $63,420. The lowest 10 percent earned less than $36,180, and the highest 10 percent earned more than $74,680. Median annual wages in the industries em­ ploying the largest numbers of medical and clinical laboratory technologists were: Federal Executive Branch.......................................... $59,800 General medical and surgical hospitals........................54,220 Medical and diagnostic laboratories.............................53,360 Offices of physicians.................................................... 49,080 Colleges, universities, and professional schools......... 47,890 Median annual wages of medical and clinical laboratory Digitizedtechnicians for FRASERwere $35,380 in May 2008. The middle 50 percent https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  earned between $28,420 and $44,310. The lowest 10 percent earned less than $23,480, and the highest 10 percent earned more than $53,520. Median annual wages in the industries em­ ploying the largest numbers of medical and clinical laboratory technicians were: General medical and surgical hospitals..................... $36,840 Colleges, universities, and professional schools......... 36,290 Offices of physicians.................................................... 33,980 Medical and diagnostic laboratories.............................32,630 Other ambulatory health care services.........................31,320 According to the American Society for Clinical Pathology, median hourly wages of staff clinical laboratory technologists and technicians, in various specialties and laboratory types, in 2007 were: Table 1. Median hourly wages by specialties and laborartory type, 2007. Occupation  Hospital  Private clinic  Cytotechnologist................ ..... $27.55 $28.75 Histotechnologist............... ..... 22.93 23.35 Medical technologist.......... ..... 23.45 23.00 Histotechnician.................. ..... 20.00 20.00 Medical laboratory technician ....................... ..... 18.54 17.00 Phlebotomist....................... ..... 12.50 12.50 .SOURCRAmericanSociet^forCIinic^Patholog^  Physician office laboratory $26.24 25.00 20.00 21.00  16.96 13.00  Related Occupations Clinical laboratory technologists and technicians analyze body fluids, tissue, and other substances, using a variety of tests. Sim­ ilar or related procedures are performed by: Page  Chemists and materials scientists.............................................195 Science technicians..................................................................230 Veterinary technologists and technicians................................ 443  Sources of Additional Information For a list of accredited and approved educational programs for clinical laboratory personnel, contact: V National Accrediting Agency for Clinical Laboratory Sciences, 5600 N. River Rd., Suite 720, Rosemont, IL 60018. Internet: http://www.naacls.org Information on certification is available from: y American Association of Bioanalysts, Board of Registry, 906 Olive St., Suite 1200, St. Louis, MO 63101. Internet: http://www.aab.org y American Medical Technologists, 10700 W. Higgins Rd., Suite 150, Rosemont, IL 60018. Internet: http://www.amtl.com y American Society for Clinical Pathology, 33 West Monroe St., Suite 1600, Chicago, IL 60603. Internet: http://www.ascp.org y National Credentialing Agency for Laboratory Personnel, P.O. Box 15945-289, Lenexa, KS 66285. Internet: http ://www.nca-info.org  414 Occupational Outlook Handbook  Additional career information is available from: y American Association of Blood Banks, 8101 Glenbrook Rd„ Bethesda, MD 20814. Internet: http://www.aabb.org y American Society for Clinical Laboratory Science, 6701 Democracy Blvd., Suite 300, Bethesda, MD 20817. Internet: http ://ww w.ascls.org y American Society for Cytopathology, 100 West 10th St., Suite 605, Wilmington, DE 19801. Internet: http ://ww w.cytopathology.org y Clinical Laboratory Management Association, 993 Old Eagle School Rd., Suite 405, Wayne, PA 19087. Internet: http://www.clma.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos096.htm  Dental Hygienists Significant Points  • A degree from an accredited dental hygiene school and a State license are required for this job. • Dental hygienists rank among the fastest growing occupations. • Job prospects are expected to be favorable in most ar­ eas, but strong competition for jobs is likely in some areas. • About half of all dental hygienists work part time, and flexible scheduling is a distinctive feature of this job.  how to select toothbrushes and show them how to brush and floss their teeth. Hygienists sometimes make a diagnosis and other times prepare clinical and laboratory diagnostic tests for the dentist to interpret. Hygienists sometimes work chair-side with the dentist during treatment. Work environment. Dental hygienists work in clean, welllighted offices. Important health safeguards include strict adherence to proper radiological procedures and the use of appropriate protective devices when administering anes­ thetic gas. Dental hygienists also wear safety glasses, surgi­ cal masks, and gloves to protect themselves and patients from infectious diseases. Dental hygienists also should be careful to avoid possible shoulder and neck injury from sitting for long periods of time while working with patients. Flexible scheduling is a distinctive feature of this job. Full­ time, part-time, evening, and weekend schedules are common. Dentists frequently hire hygienists to work only 2 or 3 days a week, so hygienists may hold jobs in more than one dental office. In 2008, about half of all dental hygienists worked part time—less than 35 hours a week.  Training, Other Qualifications, and Advancement A degree from an accredited dental hygiene school and a State license are required for this job. Education and training. A high school diploma and col­ lege entrance test scores are usually required for admission to a dental hygiene program. High school students interested in becoming dental hygienists should take courses in biology, chemistry, and mathematics. Some dental hygiene programs also require applicants to have completed at least one year of college. Specific entrance requirements typically vary from one school to another.  Nature of the Work Dental hygienists remove soft and hard deposits from teeth, teach patients how to practice good oral hygiene, and provide other preventive dental care. They examine patients’ teeth and gums, recording the presence of diseases or abnormalities. Dental hygienists use an assortment of tools to complete their tasks. Hand and rotary instruments and ultrasonic devices are used to clean and polish teeth, which includes removing tartar, stains, and plaque. Hygienists use x-ray machines to take dental pictures, and sometimes develop the film. They may use models of teeth to explain oral hygiene, perform root planning as a periodontal therapy, or apply cavity-preventative agents such as fluorides and pit and fissure sealants. Other tasks hygienists may perform vary by State. In some States, hygienists are allowed to administer anesthetics, while in others they administer local anesthetics using syringes. Some States also allow hygienists to place and carve filling materials, temporary fillings, and periodontal dressings; re­ move sutures; and smooth and polish metal restorations. Dental hygienists also help patients develop and main­ tain good oral health. For example, they may explain the relationship between diet and oral health or inform patients https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  r  Dental hygienists remove soft and hard deposits from teeth and teach patients how to practice good oral hygiene.  Professional and Related Occupations 415  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Dental hygienists.............................................. ..................................... 29-2021 174,100 237,000 62,900 36 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  soc  Employment, 2008  tion Included in the Handbook.  In 2008, there were 301 dental hygiene programs accred­ ited by the Commission on Dental Accreditation. Most dental hygiene programs grant an associate degree, although some also offer a certificate, a bachelor’s degree, or a master’s de­ gree. A minimum of an associate degree or certificate in dental hygiene is generally required for practice in a private dental office. A bachelor’s or master’s degree usually is required for research, teaching, or clinical practice in public or school health programs. Schools offer laboratory, clinical, and classroom instruction in subjects such as anatomy, physiology, chemistry, microbi­ ology, pharmacology, nutrition, radiography, histology (the study of tissue structure), periodontology (the study of gum diseases), pathology, dental materials, clinical dental hygiene, and social and behavioral sciences. Licensure. Dental hygienists must be licensed by the State in which they practice. Nearly all States require candidates to graduate from an accredited dental hygiene school and pass both a written and clinical examination. The American Dental Association’s (ADA) Joint Commission on National Dental Examinations administers the written examination, which is accepted by all States and the District of Columbia. State or regional testing agencies administer the clinical examina­ tion. In addition, most States require an examination on the legal aspects of dental hygiene practice. Alabama is the only State that does not require candidates to take the ADA writ­ ten exam. Instead, they require that candidates meet the re­ quirements of the Alabama Dental Hygiene Program, which mandates taking courses, completing on-the-job training at a dentist’s office, and passing a separate State administered li­ censing examination. Other qualifications. Dental hygienists should work well with others because they work closely with dentists and dental assistants, as well as dealing directly with patients. Hygien­ ists also need good manual dexterity, because they use dental instruments within patients’ mouths, with little room for error. Advancement. Advancement opportunities usually come from working outside a typical dentist’s office, and usually re­ quire a bachelor’s or master’s degree in dental hygiene. Some dental hygienists may choose to pursue a career teaching at a dental hygiene program, working in public health, or working in a corporate setting.  Employment Dental hygienists held about 174,100 jobs in 2008. Because multiple job holding is common in this field, the number of jobs exceeds the number of hygienists. About 51 percent of dental hygienists worked part time. Almost all jobs for dental hygienists—about 96 percent—were in offices of dentists. A very small number worked for employment services, in physi­ offices, or in other industries. Digitizedcians’ for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Job Outlook Dental hygienists rank among the fastest growing occupa­ tions. Job prospects are expected to be favorable in most ar­ eas, but competition for jobs is likely in some areas. Employment change. Employment of dental hygienists is expected to grow 36 percent through 2018, which is much faster than the average for all occupations. This projected growth ranks dental hygienists among the fastest growing oc­ cupations, in response to increasing demand for dental care and more use of hygienists. The demand for dental services will grow because of popu­ lation growth, older people increasingly retaining more teeth, and a growing emphasis on preventative dental care. To help meet this demand, facilities that provide dental care, particu­ larly dentists’ offices, will increasingly employ dental hygien­ ists, often to perform services that have been performed by dentists in the past. Ongoing research indicating a link be­ tween oral health and general health also will spur the demand for preventative dental services, which are typically provided by dental hygienists. Job prospects. Job prospects are expected to be favorable in most areas, but will vary by geographical location. Because graduates are permitted to practice only in the State in which they are licensed, hygienists wishing to practice in areas that have an abundance of dental hygiene programs may experi­ ence strong competition for jobs. Older dentists, who have been less likely to employ dental hygienists, are leaving the occupation and will be replaced by recent graduates, who are more likely to employ one or more hygienists. In addition, as dentists’ workloads increase, they are expected to hire more hygienists to perform preventive dental care, such as cleaning, so that they may devote their own time to more complex procedures.  Earnings Median annual wages of dental hygienists were $66,570 in May 2008. The middle 50 percent earned between $55,220 and $78,990. The lowest 10 percent earned less than $44,180, and the highest 10 percent earned more than $91,470. Earnings vary by geographic location, employment setting, and years of experience. Dental hygienists may be paid on an hourly, daily, salary, or commission basis. Benefits vary substantially by practice setting and may be contingent upon full-time employment. According to a 2009 survey conducted by the American Dental Hygienist Associa­ tion, about half of all hygienists reported receiving some form of employment benefits. Of those receiving benefits, paid va­ cation, sick leave, and retirement plans were the most com­ mon.  416 Occupational Outlook Handbook  Related Occupations Other workers supporting health practitioners in an office set­ ting include: Page Dental assistants....................................................................... 447 Medical assistants.................................................................... 455 Occupational therapist assistants and aides............................ 462 Physical therapist assistants and aides.................................... 465 Physician assistants.................................................................. 379 Registered nurses..................................................................... 392 Others who work with radiation technology include: Radiation therapists.................................................................. 387  Sources of Additional Information For information on a career in dental hygiene, including edu­ cational requirements, and on available accredited programs, contact: y American Dental Hygienists Association, 444 N. Michigan Ave., Suite 3400, Chicago, IL 60611. Internet: http ://www.adha.org For information about accredited programs and educational requirements, contact: y Commission on Dental Accreditation, American Dental Association, 211 E. Chicago Ave., Chicago, IL 60611. Internet: http://www.ada.org/prof/ed7accred/commission/index.asp The State Board of Dental Examiners in each State can sup­ ply information on licensing requirements. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos097.htm  Diagnostic medical sonographers usually use diagnostic imag­ ing machines in dark moms, but may also perform procedures at a patient’s bedside.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Diagnostic Medical Sonographers Significant Points  • Job opportunities should be favorable. • Employment will grow as sonography becomes an increasingly attractive alternative to radiological pro­ cedures. • Hospitals employed about 59 percent of all sono­ graphers. • Sonographers may receive education and training in hospitals, vocational-technical institutions, colleges or universities, or the Armed Forces. Nature of the Work Diagnostic imaging embraces several procedures that aid in diagnosing ailments. The most familiar procedures are the x ray and magnetic resonance imaging; however, not all im­ aging technologies use ionizing, radiation, or radio waves. Sonography, or ultrasonography, is the use of sound waves to generate an image for the assessment and diagnosis of vari­ ous medical conditions. Sonography is commonly associated with obstetrics and the use of ultrasound imaging during preg­ nancy, but this technology has many other applications in the diagnosis and treatment of medical conditions throughout the body. Diagnostic medical sonographers use special equipment to direct high frequency sound waves into areas of the patient’s body. Sonographers operate the equipment, which collects re­ flected echoes and forms an image that may be videotaped, transmitted, or photographed for interpretation and diagnosis by a physician. Sonographers begin by explaining the procedure to the pa­ tient and recording any medical history that may be relevant to the condition being viewed. They then select appropriate equipment settings and direct the patient to move into posi­ tions that will provide the best view. To perform the exam, sonographers use a transducer, which transmits sound waves in a cone-shaped or rectangle-shaped beam. Although tech­ niques vary by the area being examined, sonographers usu­ ally spread a special gel on the skin to aid the transmission of sound waves. Viewing the screen during the scan, sonographers look for subtle visual cues that contrast healthy areas with unhealthy ones. They decide whether the images are satisfactory for di­ agnostic purposes and select which ones to store and show to the physician. Sonographers take measurements, calculate values, and analyze the results in preliminary findings for the physicians. In addition to working directly with patients, diagnostic medical sonographers keep patient records and adjust and maintain equipment. They also may prepare work schedules, evaluate equipment purchases, or manage a sonography or di­ agnostic imaging department. Diagnostic medical sonographers may specialize in obstetric and gynecologic sonography (images of the female reproduc­  Professional and Related Occupations 417  tive system), abdominal sonography (images of the liver, kidneys, gallbladder, spleen, and pancreas), neurosonography (images of the brain and other parts of the nervous system), or breast sonography. In addition, sonographers may spe­ cialize in vascular sonography or cardiac sonography. (Vas­ cular sonographers and cardiac sonographers are covered in the Handbook statement on cardiovascular technologists and technicians.) Obstetric and gynecologic sonographers specialize in the imaging of the female reproductive system. Included in the discipline is one of the more well-known uses of sonography: examining the fetus of a pregnant woman to track the baby’s growth and health. Abdominal sonographers inspect a patient’s abdominal cav­ ity to help diagnose and treat conditions primarily involving the gallbladder, bile ducts, kidneys, liver, pancreas, spleen, and male reproductive system. Abdominal sonographers also are able to scan parts of the chest, although studies of the heart using sonography usually are done by echocardiographers. Neurosonographers focus on the nervous system, including the brain. In neonatal care, neurosonographers study and diag­ nose neurological and nervous system disorders in premature infants. Like other sonographers, neurosonographers operate transducers to perform the sonogram, but they use frequencies and beam shapes different from those used by obstetric and abdominal sonographers. Breast sonographers use sonography to study diseases of the breasts. Sonography aids mammography in the detection of breast cancer. Breast sonography also is used to track tu­ mors, monitor blood supply conditions, and assist in the ac­ curate biopsy of breast tissue. Breast sonographers use highfrequency transducers made exclusively to study breast tissue. Work environment. Sonographers typically work in health­ care facilities that are clean. They usually work at diagnostic imaging machines in darkened rooms, but they also may per­ form procedures at patients’ bedsides. Sonographers may be on their feet for long periods of time and may have to lift or turn disabled patients. Some sonographers work as contract employees and may travel to several healthcare facilities in an area. Similarly, some sonographers work with mobile imaging service provid­ ers and travel to patients and use mobile diagnostic imaging equipment to provide service in areas that otherwise would not have access to such services. Most full-time sonographers work about 40 hours a week. Some sonographers work overtime. Also, sonographers may have evening and weekend hours when the^are"on call and must be ready to report to work on short notice.  Training, Other Qualifications, and Advancement Diagnostic medical sonography is an occupation to which there are multiple paths of entry. Formal education in sonog­ raphy, training, or a combination of these are accepted by em­ ployers. Employers do prefer sonographers who have received education from an accredited program or completed training in an accredited practice, and who are registered. Education and training. There are several avenues for entry into the field of diagnostic medical sonography. Sonog­ raphers may train in hospitals, vocational-technical institu­ tions, colleges or universities, or the Armed Forces. Some training programs prefer applicants with experience in other health care professions or high school graduates with courses in mathematics, health, and science. Colleges and universities offer formal training in both 2-year and 4-year programs, resulting in either an associate or a bachelor’s degree. Two-year programs are the most preva­ lent. Coursework includes classes in anatomy, physiology, in­ strumentation, basic physics, patient care, and medical ethics. In 2008, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited over 150 training programs. Accredited programs are offered by colleges and universities. Some hospital programs are accredited as well. A few 1-year programs that typically result in a vocational certificate also are accepted as proper education by employ­ ers. These programs are useful usually only for workers al­ ready employed in a healthcare occupation who seek to in­ crease their marketability by training in sonography. One-year vocational-certificate programs are not accredited by the CAAHEP. Certification and other qualifications. No States require licensure in diagnostic medical sonography. However, sonog­ raphers may become credentialed by one of the professional certifying bodies. Most employers prefer to hire registered sonographers because registration provides an objective mea­ sure of an individual’s professional standing. To become reg­ istered, one must first become eligible to take the examination by completing the proper education, training, or work experi­ ence. The exam typically includes a physics and instrumenta­ tion exam in a sonography specialty. Typically, sonographers must complete a required number of continuing-education hours to maintain registration. For specific details on credentialing, contact the certifying organization. The American Registry for Diagnostic Medical Sonography (ARDMS) certifies each person who passes the exam as a Registered Diagnostic Medical Sonographer (RDMS). This credential can be obtained for several different specialty ar­ eas like the abdomen, breast, or nervous system. The AR­ DMS also credentials cardiac and vascular sonographers. The American Registry of Radiologic Technologist offers creden­ tials in breast and vascular sonography. The Cardiovascular  Projections data from the National Employment Matrix Occupational Title Diagnostic medical sonographers...............................  soc  Employment,  Code  2008 50,300  Projected Employment,  2018 59.500  Change,  2008-2018 Number  9,200  Percent  18  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  418 Occupational Outlook Handbook  Credentialing International credentials cardiac sonographers. (Vascular sonographers and cardiac sonographers are covered in the Handbook statement on cardiovascular technologists and technicians.) Sonographers should have good communication and inter­ personal skills, because they must be able to explain techni­ cal procedures and results to their patients, some of whom may be nervous. Good hand-eye coordination is particularly important to obtaining quality images. It is very important that sonographers enjoy lifelong learning, because continuing education is crucial to workers in the ever-changing field of diagnostic medicine. Advancement. Sonographers can seek advancement by obtaining competency in more than one specialty. For exam­ ple, obstetric sonographers might seek training in abdominal sonography to broaden their opportunities and increase their marketability. Sonographers also may seek multiple creden­ tials—for example, being both a registered diagnostic medical sonographer and a registered diagnostic cardiac sonographer. Sonographers  may  advance  by  taking  supervisory,  managerial, or administrative positions.  Employment  tiple specialties or multiple credentials also will have good prospects.  Earnings The median annual wage of diagnostic medical sonographers was $61,980 in May 2008. The middle 50 percent of sonogra­ phers earned wages between $52,570 and $73,680 a year. The lowest 10 percent earned less than $43,600, and the highest 10 percent earned more than $83,950. Median annual wages of di­ agnostic medical sonographers in May 2008 were $62,340 in offices of physicians and $61,870 in general medical and surgi­ cal hospitals.  Related Occupations Health care occupations with similar diagnostic and treatment responsibilities include: Page Cardiovascular technologists and technicians......................... 408 Clinical laboratory technologists and technicians................... 411 Nuclear medicine technologists.................................................... 426  Radiologic technologists and technicians............................... 438  Sources of Additional Information  Diagnostic medical sonographers held about 50,300 jobs in 2008. About 59 percent of all sonographer jobs were in pub­ lic and private hospitals. The remaining jobs were typically in offices of physicians, medical and diagnostic laboratories, and outpatient care centers.  For information on a career as a diagnostic medical sonogra­ pher, contact: y Society of Diagnostic Medical Sonography, 2745 Dallas Pkwy., Suite 350, Plano, TX 75093-8730. Internet: http://www.sdms.org  Job Outlook  For information on becoming a registered diagnostic medical sonographer, contact: y American Registry for Diagnostic Medical Sonography, 51 Monroe St., Plaza East One, Rockville, MD 20850-2400. Internet: http://www.ardms.org  Faster than average employment growth is expected. Job op­ portunities should be favorable. Employment change. Employment of diagnostic medi­ cal sonographers is expected to increase by about 18 percent through 2018—faster than the average for all occupations. As the population continues to age, there will be an increas­ ing demand for diagnostic imaging. Additional job growth is expected as healthcare providers increasingly utilize ultra­ sound imaging as a safer and more cost-effective alternative to radiological procedures. Ultrasound imaging technology is expected to evolve rapidly and spawn many new sonography procedures, enabling sonographers to scan and image areas of the body where ultrasound has not traditionally been used. Hospitals will remain the principal employer of diagnostic medical sonographers. However, employment is expected to grow more rapidly in offices of physicians and in medical and diagnostic laboratories. Health care facilities such as these are expected to increase in number because of the strong shift to­ ward outpatient care, encouraged by third-party payers and made possible by technological advances and less expensive ultrasound equipment that permit more procedures to be per­ formed outside of hospitals. Job prospects. Job opportunities should be favorable. In addition to job openings from growth, some openings will arise from the need to replace sonographers who retire or leave the occupation permanently. However, job opportunities will vary by geographic area. Sonographers willing to relocate will the best job opportunities. Sonographers with mul­ Digitized forhave FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  For certification information, contact: y American Registry of Radiologic Technologists, 1255 Northland Dr., St. Paul, MN 55120-1155. Internet: http://www.arrt.org For more information on ultrasound in medicine and accred­ ited practices, contact: y American Institute of Ultrasound in Medicine, 14750 Sweitzer Lane, Suite 100, Laurel, MD 20707. Internet: http://www.aium.org For a current list of accredited education programs in diag­ nostic medical sonography, contact: y Joint Review Committee on Education in Diagnostic Medical Sonography, 2025 Woodlane Dr., St. Paul, MN 55125-2998. Internet: http://www.jrcdms.org y Commission on Accreditation of Allied Health Education Programs, 1361 Park St., Clearwater, FL 33756. Internet: http://www.caahep.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos273.htm  Professional and Related Occupations 419  Emergency Medical Technicians and Paramedics Significant Points  • Employment is projected to grow as fast as the aver­ age for all occupations. • Emergency medical technicians and paramedics need formal training and certification or licensure, but re­ quirements vary by State. • Emergency services function 24 hours a day, so emer­ gency medical technicians and paramedics have ir­ regular working hours. • Opportunities will be best for those who have earned advanced certifications. Nature of the Work People’s lives often depend on the quick reaction and com­ petent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, slips and falls, childbirth, and gunshot wounds require immediate medical attention. EMTs and paramedics provide this vital service as they care for and transport the sick or in­ jured to a medical facility. In an emergency, EMTs and paramedics are typically dis­ patched by a 911 operator to the scene, where they often work with police and fire fighters. (Police and fire fighters are dis­ cussed elsewhere in the Handbook.) Once they arrive, EMTs and paramedics assess the nature of the patient’s condition, while trying to determine whether the patient has any pre­ existing medical conditions. Following protocols and guide­ lines, they provide emergency care and transport the patient to a medical facility. EMTs and paramedics operate in emergency medical services systems where a physician provides medical direction and oversight. EMTs and paramedics use special equipment, such as back­ boards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medi­ cal facility. These workers generally work in teams. During the transport of a patient, one EMT or paramedic drives, while the other monitors the patient’s vital signs and gives additional care, as needed. Some paramedics work as part of a helicopter’s flight crew to quickly transport critically ill or injured patients to hospital trauma centers. At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency department staff, and may provide additional emergency treatment. After each run, EMTs and paramedics document the trip, replace used supplies and check equipment. If a transported patient has a contagious disease, EMTs and paramedics decontaminate the interior of the ambu­ lance and report cases to the proper authorities. EMTs and paramedics also provide transportation for patients from one medical facility to another, particularly if they work for private ambulance services. Patients often need to be trans­ ferred to a hospital that specializes in treating their injury or   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  illness or to facility that provides long-term care, like nursing homes. Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. The National Registry of Emergency Medical Techni­ cians (NREMT) certifies emergency medical service providers at five levels: First Responder; EMT-Basic; EMT-Intermediate (which has two levels called 1985 and 1999) and Paramedic. Some States, however, have their own certification programs and use distinct names and titles. The EMT-Basic represents the first response of the emer­ gency medical system. An EMT trained at this level is prepared to care for patients at the scene of an accident and while trans­ porting patients by ambulance to the hospital under the direc­ tion of more highly trained medical personnel. The EMT-Basic has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies. The EMT-Intermediate has more advanced training. However, the specific tasks that those certified at this level are allowed to perform varies greatly from State to State. Paramedics provide more extensive pre-hospital care than do EMTs. In addition to carrying out the procedures of the other levels, paramedics administer medications orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment. However, like the EMT-Intermediate level, what paramedics are permitted to do varies by State. Work environment. EMTs and paramedics work both in­ doors and out, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers are at a higher risk for contracting illnesses or expe­ riencing injuries on the job than workers in other occupations. They risk noise-induced hearing loss from sirens and back in­ juries from lifting patients. In addition, EMTs and paramedics may be exposed to communicable diseases, such as hepatitis-B and AIDS, as well as to violence from mentally unstable or combative patients. The work is not only physically strenuous but can be stressful, sometimes involving life-or-death situa­ tions and suffering patients. Nonetheless, many people find the  Lives often depend on the quick reaction and competent care of emergency medical technicians and paramedics.  420 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 19,000 9 229,700 29-2041 210,700 Emergency medical technicians and paramedics............................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. _______________________________________  Occupational Title  work exciting and challenging and enjoy the opportunity to help others. These workers experienced a larger than average number of work-related injuries or illnesses Many EMTs and paramedics are required to work more than 40 hours a week. Because emergency services function 24 hours a day, EMTs and paramedics may have irregular working hours.  Training, Other Qualifications, and Advancement Generally, a high school diploma is required to enter a train­ ing program to become an EMT or paramedic. Workers must complete a formal training and certification process. Education and training. A high school diploma is usu­ ally required to enter a formal emergency medical technician training program. Training is offered at progressive levels: EMT-Basic, EMT-Intermediate, and Paramedic. At the EMT-Basic level, coursework emphasizes emer­ gency skills, such as managing respiratory, trauma, and car­ diac emergencies, and patient assessment. Formal courses are often combined with time in an emergency department or ambulance. The program provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest, and emergency childbirth. Students learn how to use and maintain common emergency equipment, such as back­ boards, suction devices, splints, oxygen delivery systems, and stretchers. Graduates of approved EMT-Basic training pro­ grams must pass a written and practical examination adminis­ tered by the State licensing agency or the NREMT. At the EMT-Intermediate level, training requirements vary by State. The nationally defined levels, EMT-Intermediate 1985 and EMT-Intermediate 1999, typically require 30 to 350 hours of training based on scope of practice. Students learn advanced skills such the use of advanced airway devices, in­ travenous fluids, and some medications. The most advanced level of training for this occupation is Paramedic. At this level, the caregiver receives training in anatomy and physiology as well as advanced medical skills. Most commonly, the training is conducted in community col­ leges and technical schools and may result in an associate’s degree. These programs may take up to one to two years. Such education prepares the graduate to take the NREMT exami­ nation to become certified as a Paramedic. Extensive related coursework and clinical and field experience is required. Re­ fresher courses and continuing education are available for EMTs and paramedics at all levels. Licensure. All 50 States require EMTs and Paramedics to be licensed, but the levels and titles vary from State to State. In most States and the District of Columbia certification by the NREMT is required at some or all levels. Some States administer their own certification examination or provide the option of taking either the NREMT or State examination. In most States, licensure renewal is required every two to   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  three years and generally, EMTs and Paramedics must take refresher training courses or complete continuing education requirements. Many States restrict licensure based on an indi­ vidual’s criminal history. Other qualifications. EMTs and paramedics should be emotionally stable, have good dexterity, agility, and physi­ cal coordination, and be able to lift and carry heavy loads. They also need good eyesight (corrective lenses may be used) with accurate color vision. Many employers require a criminal background check. Advancement. Paramedics can become supervisors, op­ erations managers, administrative directors, or executive di­ rectors of emergency services. Some EMTs and paramedics become instructors, dispatchers, or physician assistants; oth­ ers move into sales or marketing of emergency medical equip­ ment. A number of people become EMTs and paramedics to test their interest in health care before training as registered nurses, physicians, or other health workers.  Employment EMTs and paramedics held about 210,700 jobs in 2008. Most career EMTs and paramedics work in metropolitan areas. Volunteer EMTs and paramedics are more common in small cities, towns, and rural areas. These individuals volunteer for fire departments, emergency medical services, or hospitals and may respond to only a few calls per month. Paid EMTs and paramedics were employed in a number of industries. About 45 percent worked as employees of ambu­ lance services. About 29 percent worked in local government. Another 20 percent worked in hospitals.  Job Outlook Employment for EMTs and paramedics is expected to grow about as fast as the average for all occupations through 2018. Job prospects should be good, particularly in cities and private ambulance services. Employment change. Employment of emergency medical technicians and paramedics is expected to grow 9 percent between 2008 and 2018, which is about as fast as the aver­ age for all occupations. Growth in this occupation is due in large part to increasing call volume due to aging population. As a large segment of the population—aging members of the baby boom generation—becomes more likely to have medical emergencies, demand will increase for EMTs and paramedics. In addition, the time that EMTs and paramedics must spend with each patient is increasing as emergency departments across the country are experiencing overcrowding. As a re­ sult, when an ambulance arrives, it takes longer to transfer the patient from the care of the EMTs and paramedics to the staff of the emergency department. In addition, some emergency departments divert ambulances to other hospitals when they  Professional and Related Occupations 421  are too busy to take on new patients. As a result, ambulances may not be able to go to the nearest hospital, which increases the amount of time spent in transit. Both these factors result in EMTs and paramedics spending more time with each patient, which means more workers are needed to meet demand. In addition, hospitals are increasingly specializing in treat­ ing a particular illness or injury. This results in more patients needing to be transferred to the hospital best able to treat them. Most patients must be transferred by ambulance, so their condition can be monitored en route. Therefore, more demand for transfers between hospitals increases the demand for the services of EMTs and paramedics. There also still will be demand for part-time, volunteer EMTs and paramedics in rural areas and smaller metropolitan areas. Job prospects. Job prospects should be favorable. Many job openings will arise from growth and from the need to re­ place workers who leave the occupation because of the limited potential for advancement, as well as the modest pay and ben­ efits in private-sector jobs. In addition, full-time paid EMTs and paramedics will be needed to replace unpaid volunteers. Emergency medical service agencies find it increasingly dif­ ficult to recruit and retain unpaid volunteers because of the amount of training and the large time commitment these posi­ tions require. As a result, more paid EMTs and paramedics are needed. Competition will be greater for jobs in local government, including fire, police, and independent third-service rescue squad departments that tend to have better salaries and bene­ fits. EMTs and paramedics who have advanced education and certifications should enjoy the most favorable job prospects, as clients and patients demand higher levels of care before arriving at the hospital.  Earnings Earnings of EMTs and paramedics depend on the employment setting and geographic location of their jobs, as well as their training and experience. Median hourly wages of EMTs and paramedics were $14.10 in May 2008. The middle 50 percent earned between $11.13 and $18.28. The lowest 10 percent earned less than $9.08, and the highest 10 percent earned more than $23.77. Median hourly wages in the industries employing the largest numbers of EMTs and paramedics in May 2008 were $12.99 in other ambulatory health care services and $15.45 in local government. In 2008, about 27 percent of EMTs and paramedics belonged to a union or were covered by a union contract.  Related Occupations Other workers in occupations that require quick and level­ headed reactions to life-or-death situations are:  I ...  Licensed practical nurses may assist patients with bathing, dressing, standing, and walking.  Sources of Additional Information General information about emergency medical technicians and paramedics is available from: y National Association of Emergency Medical Technicians, P.O. Box 1400, Clinton, MS 39060-1400. Internet: http ://www.naemt.org y National Highway Traffic Safety Administration, Office of Emergency Medical Services, 1200 New Jersey Ave., SE, NTI140, Washington, DC 20590. Internet: http://www.ems.gov y National Registry of Emergency Medical Technicians, Rocco V. Morando Bldg., 6610 Busch Blvd., P.O. Box 29233, Columbus, OH 43229. Internet: http://www.nremt.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos 101.htm  Licensed Practical and Licensed Vocational Nurses Significant Points • Most training programs last about 1 year and are of­ fered by vocational or technical schools or commu­ nity or junior colleges. • Overall job prospects are expected to be very good, but job outlook varies by industry. • Replacement needs will be a major source of job openings, as many workers leave the occupation per­ manently.  Page Air traffic controllers........................................................................784 Fire fighters....................................................................................... 470 Physician assistants.......................................................................... 379 Police and detectives........................................................................473 Registered nurses............................................................................. 392   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Licensed practical nurses (LPNs), or licensed vocational nurses (LVNs), care for people who are sick, injured, convalescent, or disabled under the direction of physicians and registered nurses. (The work of physicians and surgeons and of registered nurses  422 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 21 155,600 909,200 753,600 29-2061 Licensed practical and licensed vocational nurses................. ........... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. __________________________  Occupational Title  is described elsewhere in the Handbook.) The nature of the di­ rection and supervision required varies by State and job setting. LPNs care for patients in many ways. Often, they provide basic bedside care. Many LPNs measure and record patients’ vital signs such as height, weight, temperature, blood pressure, pulse, and respiration. They also prepare and give injections and enemas, monitor catheters, dress wounds, and give alco­ hol rubs and massages. To help keep patients comfortable, they assist with bathing, dressing, and personal hygiene, moving in bed, standing, and walking. They might also feed patients who need help eating. Experienced LPNs may supervise nursing as­ sistants and aides. As part of their work, LPNs collect samples for testing, per­ form routine laboratory tests, and record food and fluid intake and output. They clean and monitor medical equipment. Some­ times, they help physicians and registered nurses perform tests and procedures. Some LPNs help to deliver, care for, and feed infants. LPNs also monitor their patients and report adverse reactions to medications or treatments. LPNs gather information from pa­ tients, including their health history and how they are currently feeling. They may use this information to complete insurance forms, pre-authorizations, and referrals, and they share infor­ mation with registered nurses and doctors to help determine the best course of care for a patient. LPNs often teach family members how to care for a relative or teach patients about good health habits. Most LPNs are generalists and will work in any area of healthcare. However, some work in a specialized setting, such as a nursing home, a doctor’s office, or in home health care. LPNs in nursing care facilities help to evaluate residents’ needs, develop care plans, and supervise the care provided by nursing aides. In doctors’ offices and clinics, they may be responsible for making appointments, keeping records, and performing other clerical duties. LPNs who work in home health care may prepare meals and teach family members simple nursing tasks. In some States, LPNs are permitted to administer pre­ scribed medicines, start intravenous fluids, and provide care to ventilator-dependent patients. Work environment. Most licensed practical nurses work a 40-hour week. In some work settings where patients need round-the-clock care, LPNs may have to work nights, week­ ends, and holidays. About 18 percent of LPNs and LVN’s worked part-time in 2008. They often stand for long periods and help patients move in bed, stand, or walk. LPNs may face hazards from caustic chemicals, radiation, and infectious diseases. They are subject to back injuries when moving patients. They often must deal with the stress of heavy workloads. In addition, the patients they care for may be con­ fused, agitated, or uncooperative.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  Training, Other Qualifications, and Advancement Most practical nursing training programs last about 1 year, and are offered by vocational and technical schools or com­ munity or junior colleges. LPNs must be licensed to practice. Education and training. LPNs must complete a Stateapproved training program in practical nursing to be eligible for licensure. Contact your State’s board of nursing for a list of approved programs. Most training programs are avail­ able from technical and vocational schools or community and junior colleges. Other programs are available through high schools, hospitals, and colleges and universities. A high school diploma or its equivalent usually is required for entry, although some programs accept candidates without a diploma, and some programs are part of a high school curriculum. Most year-long practical nursing programs include both classroom study and supervised clinical practice (patient care). Classroom study covers basic nursing concepts and sub­ jects related to patient care, including anatomy, physiology, medical-surgical nursing, pediatrics, obstetrics nursing, phar­ macology, nutrition, and first aid. Clinical practice usually is in a hospital but sometimes includes other settings. Licensure. The National Council Licensure Examination, or NCLEX-PN, is required in order to obtain licensure as an LPN. The exam is developed and administered by the Na­ tional Council of State Boards of Nursing. The NCLEX-PN is a computer-based exam and varies in length. The exam covers four major Client Needs categories: safe and effective care en­ vironment, health promotion and maintenance, psychosocial integrity, and physiological integrity. Eligibility for licensure may vary by State; for details, contact your State’s board of nursing. Other qualifications. LPNs should have a caring, sym­ pathetic nature. They should be emotionally stable because working with the sick and injured can be stressful. They also need to be observant, and to have good decision-making and communication skills. As part of a healthcare team, they must be able to follow orders and work under close supervision. LPNs should enjoy learning because continuing educa­ tion credits are required by some States and/or employers at regular intervals. Career-long learning is a distinct reality for LPNs. Advancement. In some employment settings, such as nurs­ ing homes, LPNs can advance to become charge nurses who oversee the work of other LPNs and nursing aides. LPNs may become credentialed in specialties like IV ther­ apy, gerontology, long-term care, and pharmacology. Some LPNs also choose to become registered nurses through LPN-to-RN training programs.  Employment  Professional and Related Occupations 423  Licensed practical and licensed vocational nurses held about 753,600 jobs in 2008. About 25 percent of LPNs worked in hospitals, 28 percent in nursing care facilities, and another 12 percent in offices of physicians. Others worked for home health care services; employment services; residential care facilities; community care facilities for the elderly; outpatient care cen­ ters; and Federal, State, and local government agencies.  Job Outlook Employment of LPNs is projected to grow much faster than av­ erage. Overall job prospects are expected to be very good, but job outlook varies by industry. The best job opportunities will occur in nursing care facilities and home health care services. Employment change. Employment of LPNs is expected to grow by 21 percent between 2008 and 2018, much faster than the average for all occupations, in response to the long-term care needs of an increasing elderly population and the general increase in demand for healthcare services. Demand for LPNs will be driven by the increase in the share of the older population. Older persons have an increased inci­ dence of injury and illness, which will increase their demand for healthcare services. In addition, with better medical tech­ nology, people are living longer, increasing the demand for long-term healthcare. Job growth will occur over all healthcare settings but especially those that service the geriatric popula­ tion like nursing care facilities, community care facilities, and home health care services. In order to contain healthcare costs, many procedures once performed only in hospitals are being performed in physi­ cians’ offices and in outpatient care centers, largely because of advances in technology. As a result, the number of LPNs should increase faster in these facilities than in hospitals. Nevertheless, hospitals will continue to demand the services of LPNs and will remain one of the largest employer of these workers. Job prospects. In addition to projected job growth, job openings will result from replacement needs, as many work­ ers leave the occupation permanently. Very good job oppor­ tunities are expected. Rapid employment growth is projected in most health care industries, with the best job opportunities occurring in nursing care facilities and in home health care ser­ vices. There is a perceived inadequacy of available healthcare in many rural areas, so LPNs willing to locate in rural areas should have good job prospects.  Earnings Median annual wages of licensed practical and licensed voca­ tional nurses were $39,030 in May 2008. The middle 50 percent earned between $33,360 and $46,710. The lowest 10 percent earned less than $28,260, and the highest 10 percent earned more than $53,580. Median annual wages in the industries em­ ploying the largest numbers of licensed practical and licensed vocational nurses in May 2008 were: Employment services................................................. $44,690 Nursing care facilities.................................................. 40,580 Home health care services............................................ 39,510 General medical and surgical hospitals........................38,080 Offices of physicians.................................................... 35,020   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Related Occupations LPNs work closely with people while helping them. Other healthcare occupations that work closely with patients include: Page Athletic trainers........................................................................405 Emergency medical technicians and paramedics.................. 419 Home health aides and personal andhome care aides............. 449 Medical assistants....................................................................455 Nursing and psychiatric aides................................................. 460 Registered nurses.....................................................................392  Sources of Additional Information For information about practical nursing and specialty credentialing, contact the following organizations: y National Association for Practical Nurse Education and Service, Inc., 1940 Duke St., Suite 200, Alexandria, VA 22314. Internet: http://www.napnes.org >• National Federation of Licensed Practical Nurses, Inc., 605 Poole Dr., Gamer, NC 27529. Internet: http://www.nflpn.org y National League for Nursing, 61 Broadway, 33rd floor, New York, NY 10006. Internet: http://www.nln.org Information on the NCLEX-PN licensing exam is available from: y National Council of State Boards of Nursing, 111 East Wacker Dr., Suite 2900, Chicago, IL 60601. Internet: http://www.ncsbn.org Lists of State-approved LPN programs are available from in­ dividual State boards of nursing. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http ://www.bls.gov/ooh/ocosl 02.htm  Medical Records and Health Information Technicians Significant Points • Employment is expected to grow much faster than the average. • Job prospects should be very good, particularly for technicians with strong computer software skills. • Entrants usually have an associate degree. • This is one of the few health-related occupations in which there is no direct hands-on patient care. Nature of the Work Medical records and health information technicians assemble patients’ health information including medical history, symp­ toms, examination results, diagnostic tests, treatment meth­ ods, and all other healthcare provider services. Technicians organize and manage health information data by ensuring its quality, accuracy, accessibility, and security. They regularly  424 Occupational Outlook Handbook  communicate with physicians and other healthcare profes­ sionals to clarify diagnoses or to obtain additional informa­ tion. The increasing use of electronic health records (EHR) will continue to broaden and alter the job responsibilities of health information technicians. For example, with the use of EHRs, technicians must be familiar with EHR computer software, maintaining EHR security, and analyzing electronic data to improve healthcare information. Health information techni­ cians use EHR software to maintain data on patient safety, patterns of disease, and disease treatment and outcome. Tech­ nicians also may assist with improving EHR software usabil­ ity and may contribute to the development and maintenance of health information networks. Medical records and health information technicians’ duties vary with the size of the facility where they work. Technicians can specialize in many aspects of health information. Some medical records and health information technicians specialize in codifying patients’ medical information for re­ imbursement purposes. Technicians who specialize in coding are called medical coders or coding specialists. Medical cod­ ers assign a code to each diagnosis and procedure by using classification systems software. The classification system de­ termines the amount for which healthcare providers will be reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the system. Coders may use several coding systems, such as those required for ambulatory settings, physician offices, or long-term care. Medical records and health information technicians also may specialize in cancer registry. Cancer (or tumor) registrars maintain facility, regional, and national databases of cancer patients. Registrars review patient records and pathology re­ ports, and assign codes for the diagnosis and treatment of dif­ ferent cancers and selected benign tumors. Registrars conduct annual followups to track treatment, survival, and recovery. This information is used to calculate survivor rates and suc­ cess rates of various types of treatment, to locate geographic areas with high incidences of certain cancers, and to identify potential participants for clinical drug trials. Work environment. Medical records and health informa­ tion technicians work in pleasant and comfortable offices.  Some medical records and health information technicians spe­ cialize in coding medical information for insurance purposes.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  This is one of the few health-related occupations in which there is no direct hands-on patient care. Medical records and health information technicians usually work a typical 40-hour week. Some overtime may be required. In health facilities that are open 24 hours a day, 7 days a week, technicians may work day, evening, and night shifts. About 14 percent of technicians worked part-time in 2008.  Training, Other Qualifications, and Advancement Entry-level medical records and health information techni­ cians usually have an associate degree. Many employers fa­ vor technicians who have a Registered Health Information Technicians (RHIT) credential. Education and training. Medical records and health in­ formation technicians generally have an associate degree. Typical coursework in health information technology in­ cludes medical terminology, anatomy and physiology, health data requirements and standards, clinical classification and coding systems, data analysis, health care reimbursement methods, database security and management, and quality im­ provement methods. Applicants can improve their chances of admission into a postsecondary program by taking biol­ ogy, math, chemistry, health, and computer science courses in high school. Certification and other qualifications. Most employers prefer to hire credentialed medical record and health infor­ mation technicians. A number of organizations offer creden­ tials typically based on passing a credentialing exam. Most credentialing programs require regular recertification and continuing education to maintain the credential. Many cod­ ing credentials require an amount of time in coding experi­ ence in the work setting. The American Health Information Management Association (AHIMA) offers credentialing as a Registered Health Information Technicians (RHIT). To obtain the RHIT credential, an individual must graduate from a 2-year as­ sociate degree program accredited by the Commission on Accreditation for Health Informatics and Information Man­ agement Education (CAHIIM) and pass an AHIMA-administered written examination. In 2008, there were more than 200 CAHIIM-accredited health information technology col­ leges and universities programs. The American Academy of Professional Coders (AAPC) offers coding credentials. The Board of Medical Specialty Coding (BMSC) and Professional Association of Health care Coding Specialists (PAHCS) both offer credentialing in specialty coding. The National Cancer Registrars Associa­ tion (NCRA) offers a credential as a Certified Tumor Reg­ istrar (CTR). To learn more about the credentials available and their specific requirements, contact the credentialing organization. Health information technicians and coders should possess good oral and written communication skills as they often serve as liaisons between healthcare facilities, insurance companies, and other establishments. Candidates proficient with computer software and technology will be appealing to employers as healthcare facilities continue to adopt elec­ tronic health records. Medical records and health informa-  Professional and Related Occupations 425  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 2018 Number Percent Medical records and health information technicians............... ......... 29-2071 172,500 207,600 35,100 20 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  Occupational Title  SOC Code  Employment, 2008  tion Included in the Handbook.  tion technicians should enjoy learning, as continuing educa­ tion is important in the occupation. Advancement. Experienced medical records and health information technicians usually advance their careers by ob­ taining a bachelor’s or master’s degree or by seeking an ad­ vanced specialty certification. Technicians with a bachelor’s or master’s degree can advance and become a health infor­ mation manager. (See the statement on medical and health services managers elsewhere in the Hankdbook for more information on health information managers.) Technicians can also obtain advanced specialty certification. Advanced specialty certification is typically experience-based, but may require additional formal education depending on the certi­ fying organization.  Employment Medical records and health information technicians held about 172,500 jobs in 2008. About 39 percent of jobs were in hospi­ tals. Health information technicians work at a number of health care providers such as offices of physicians, nursing care fa­ cilities, outpatient care centers, and home health care services. Technicians also may be employed outside of health care facili­ ties, such as in Federal Government agencies.  Job Outlook Employment is expected to grow much faster than the aver­ age. Job prospects should be very good; technicians with a strong understanding of technology and computer software will be in particularly high demand. Employment change. Employment of medical records and health information technicians is expected to increase by 20 percent, much faster than the average for all occupa­ tions through 2018. Employment growth will result from the increase in the number of medical tests, treatments, and pro­ cedures that will be performed. As the population continues to age, the occurrence of health-related problems will increase. Cancer registrars should experience job growth as the inci­ dence of cancer increases from an aging population. In addition, with the increasing use of electronic health re­ cords, more technicians will be needed to complete the new responsibilities associated with electronic data management. Job prospects. Job prospects should be very good. In ad­ dition to job growth, numerous openings will result from the need to replace medical record and health information techni­ cians who retire or leave the occupation permanently. Techni­ cians that demonstrate a strong understanding of technology and computer software will be in particularly high demand.  Earnings The median annual wage of medical records and health infor­ mation technicians was $30,610 in May 2008. The middle 50   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  percent earned between $24,290 and $39,490. The lowest 10 percent earned less than $20,440, and the highest 10 percent earned more than $50,060. Median annual wages in the indus­ tries employing the largest numbers of medical records and health information technicians in May 2008 were: Federal Executive Branch..........................................$42,760 General medical and surgical hospitals........................32,600 Nursing care facilities..................................................30,660 Outpatient care centers................................................. 29,160 Offices of physicians.................................................... 26,210  Related Occupations Health care occupations with similar responsibilities include: Page  Medical and health services managers..................................... 73 Medical transcriptionists........................................................ 457  Sources of Additional Information A list of accredited training programs is available from: >• The Commission on Accreditation for Health Informatics and Information Management Education, 233 N. Michigan Ave, 21st Floor, Chicago, IL 60601-5800. Internet: http://www.cahiim.org For information careers and credentialing, contact: y American Health Information Management Association, 233 N. Michigan Ave., 21st Floor, Chicago, IL 60601-5809. Internet: http://www.ahima.org or http://himcareers.ahima.org y American Academy of Professional Coders, 2480 South 3850 West, Suite B, Salt Lake City, UT 84120. Internet: http://www.aapc.com y Practice Management Institute, 9501 Console Dr., Suite 100, San Antonio, TX 78229. Internet: http://www.pmimd.com y Professional Association of Healthcare Coding Specialists, 218 E. Bearss Ave., #354, Tampa, FL 33613. Internet: http://www.pahcs.org y National Cancer Registrars Association, 1340 Braddock Place, Suite 203, Alexandria, VA 22314. Internet: http://www.ncra-usa.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl03.htm  426 Occupational Outlook Handbook  Nuclear Medicine Technologists Significant Points • Keen competition is expected for most positions. • Technologists with training in multiple diagnostic methods, or in nuclear cardiology, should have the best prospects. • Nuclear medicine technology programs range in length from 1 to 4 years and lead to a certificate, an associate degree, or a bachelor’s degree. • About 66 percent of nuclear medicine technologists work in hospitals.  s> m Nuclear medicine technologists operate complicated equipment that requires mechanical ability and manual dexterity.  Nature of the Work Diagnostic imaging embraces several procedures that aid in diagnosing ailments, the most familiar imaging being the x ray. In nuclear medicine, radionuclides—unstable atoms that emit radiation spontaneously—are used to diagnose and treat disease. Radionuclides are purified and compounded to form radiopharmaceuticals. Nuclear medicine technologists administer radiopharmaceuticals to patients and then moni­ tor the characteristics and functions of tissues or organs in which the drugs localize. Abnormal areas show higher-thanexpected or lower-than-expected concentrations of radioactiv­ ity. Nuclear medicine differs from other diagnostic imaging technologies because it determines the presence of disease on the basis of metabolic changes, rather than changes in organ structure. Nuclear medicine technologists operate cameras that detect and map the radioactive drug in a patient’s body to create di­ agnostic images. After explaining test procedures to patients, technologists prepare a dosage of the radiopharmaceutical and administer it by mouth, injection, inhalation, or other means. They position patients and start a gamma scintillation camera, or “scanner,” which creates images of the distribution of a ra­ diopharmaceutical as it localizes in and emits signals from the patient’s body. The images are produced on a computer screen or on film for a physician to interpret. When preparing radiopharmaceuticals, technologists adhere to safety standards that keep the chance of radiation exposure as low as possible to workers and patients. Technologists keep patient records and document the amount and type of radionu­ clides that they receive, use, and discard. There are two areas of specialty for nuclear medicine technologists—nuclear cardiology and positron emission to­ mography (PET). Nuclear cardiology typically involves myo­ cardial perfusion imaging, which, like most nuclear medicine, uses radiopharmaceuticals and cameras to image the body. Myocardial perfusion imaging, however, requires that pa­ tients perform exercise so the technologist can image the heart and blood flow. Technologists specializing in PET operate a special medical imaging device that produces a 3-D image of the body. Work environment. Physical stamina is important because nuclear medicine technologists are on their feet much of the  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  day and may have to lift or turn disabled patients. In addi­ tion, technologists must operate complicated equipment that requires mechanical ability and manual dexterity. Although the potential for radiation exposure exists in this field, it is minimized by the use of shielded syringes, gloves, and other protective devices and by adherence to strict radia­ tion safety guidelines. The amount of radiation in a nuclear medicine procedure is comparable to that received during a diagnostic x ray procedure. Technologists also wear badges that measure radiation levels. Because of safety precautions, badge measurements rarely exceed established safety levels. Nuclear medicine technologists generally work a 40-hour week. Some technologists also may have on-call hours, in­ cluding evening or weekend hours, in departments that oper­ ate on an extended schedule. Opportunities for part-time and shift work also are available. Those employed by mobile im­ aging services may be required to travel to several locations.  Training, Other Qualifications, and Advancement Nuclear medicine technology programs range in length from 1 to 4 years and lead to a certificate, an associate degree, or a bachelor’s degree. Many employers and an increasing number of States require certification or licensure. Aspiring nuclear medicine technologists should check the requirements of the State in which they plan to work. Education and training. Generally, certificate programs are offered in hospitals, associate degree programs in com­ munity colleges, and bachelor’s degree programs in 4-year colleges and universities. Courses cover the physical sciences, biological effects of radiation exposure, radiation protection and procedures, the use of radiopharmaceuticals, imaging techniques, and computer applications. One-year certificate programs are typically for health pro­ fessionals who already possess an associate or bachelor’s degree—especially radiologic technologists and diagnostic medical sonographers—but who wish to specialize in nuclear medicine. The programs also attract medical technologists, registered nurses, and others who wish to change fields or specialize. The Joint Review Committee on Education Programs in Nuclear Medicine Technology accredits associate and bach-  Professional and Related Occupations 427  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 Code 2018 Number Percent Nuclear medicine technologists............................ .......................... 29-2033 21,800 25,400 3,600 16 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  soc  Employment, 2008  tion Included in the Handbook.  dor’s degree training programs in nuclear medicine technol­ ogy. In 2008, there were more than 100 accredited programs available. Licensure. Requirements for licensure of nuclear medicine technologists vary from State to State, so it is important that aspiring technologists check the requirements of the State in which they plan to work. In 2008, 25 States licensed nuclear medicine technologists. In addition, many third-party payers require nuclear medicine technologists to be certified in order for the healthcare facility to receive reimbursement for imag­ ing procedures. Certification and other qualifications. Certification is voluntary but it has become the generally accepted standard for nuclear medicine technologists and those who employ them. Certification is available from the American Registry of Radiologic Technologists (ARRT) and from the Nuclear Medicine Technology Certification Board (NMTCB). Some technologists receive certification from both agencies. ARRT and NMTCB have different eligibility requirements, but both require that workers pass a comprehensive exam to become certified. In addition to the general certification requirements, cer­ tified technologists also must complete a certain number of continuing education hours to retain certification. Continu­ ing education is required primarily because of the frequent technological and innovative changes in the field of nuclear medicine. Technologists must have good communication skills to ef­ fectively interact with patients and their families and should be sensitive to patients’ physical and psychological needs. Nuclear medicine technologists must be able to work indepen­ dently as they may have little direct supervision. Technolo­ gists also need to be detailed-oriented and meticulous when performing procedures to assure that all regulations are being followed. Advancement. Technologists may advance to supervisory positions or to chief technologist with significant work experi­ ence. With advanced education, it is possible for some tech­ nologists to become department administrators or directors. Some technologists specialize in clinical areas, such as nuclear cardiology or PET scanning. Some become instructors in, or directors of, nuclear medicine technology programs, a step that usually requires a bachelor’s or master’s degree in the subject. Others may leave the occupation to work as sales or training representatives for medical equipment or radio­ pharmaceutical manufacturing firms; some become radiation safety officers in regulatory agencies or hospitals.  Employment Nuclear medicine technologists held about 21,800 jobs in 2008. About 66 percent of all nuclear medicine technologist jobs were  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  in hospitals—private and public. A majority of the rest were in offices of physicians or in medical and diagnostic laboratories, including diagnostic imaging centers.  Job Outlook Faster than average job growth is projected. However, keen competition is expected for most positions. Employment change. Employment of nuclear medicine technologists is expected to increase by 16 percent from 2008 to 2018, faster than the average for all occupations. Growth will arise from technological advancement, the development of new nuclear medicine treatments, and an increase in the number of middle-aged and elderly persons, who are the pri­ mary users of diagnostic and treatment procedures. Technological innovations may increase the diagnostic uses of nuclear medicine. New nuclear medical imaging technolo­ gies, including PET and single photon emission computed tomography (SPECT), are expected to be used increasingly. Cost considerations will affect the speed with which these new applications of nuclear medicine grow. Healthcare fa­ cilities contemplating these procedures will have to consider equipment costs, reimbursement policies, and the number of potential users. Although these new imaging technologies will be used more often, they will likely replace older technolo­ gies, not supplement them. Thus, only a small amount of job growth will stem from the adoption of new technologies. Job prospects. In spite of growth in nuclear medicine, the number of openings into the occupation each year will be rela­ tively low. Job competition will be keen because the supply of properly trained nuclear medicine technologists is expected to exceed the number of job openings for technologists. Technol­ ogists who have training in multiple diagnostic methods, such as radiologic technology and diagnostic medical sonography, or in nuclear cardiology, should have the best prospects.  Earnings The median annual wage of nuclear medicine technologists was $66,660 in May 2008. The middle 50 percent earned between $57,270 and $78,240. The lowest 10 percent earned less than $48,450, and the highest 10 percent earned more than $87,770. The median annual wage of nuclear medicine technologists in general medical and surgical hospitals was $66,320.  Related Occupations Other healthcare occupations that use radiation or do diagnostic imaging are: Page Cardiovascular technologists and technicians............................ 408 Clinical laboratory technologists and technicians..................... 411 Diagnostic medical sonographers................................................ 416 Radiation therapists..........................................................................387 Radiologic technologists and technicians...................................438  428 Occupational Outlook Handbook  Sources of Additional Information Additional information on a career as a nuclear medicine tech­ nologist is available from: y Society of Nuclear Medicine Technologists, 1850 Samuel Morse Dr., Reston, VA 20190. Internet: http://www.snm.org For a list of accredited programs in nuclear medicine technol­ ogy, contact: y Joint Review Committee on Educational Programs in Nuclear Medicine Technology, 2000 W. Danforth Rd., Suite 130 #203, Edmond, OK 73003. Internet: http ://www.jrcnmt.org Information on certification is available from: y Nuclear Medicine Technology Certification Board, 3558 Habersham at Northlake, Building 1, Tucker, GA 30084. Internet: http://www.nmtcb.org y American Registry of Radiologic Technologists, 1255 Northland Dr., St. Paul, MN 55120-1155. Internet: http ://www.arrt.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl04.htm  r.  . ■S'.  :  :  is  i/Ji!  Occupational Health and Safety Specialists  SHE  Significant Points • About 41 percent of occupational health and safety specialists work in Federal, State, and local govern­ ment agencies that enforce rules on safety, health, and the environment. • Most jobs require a bachelor’s degree in occupational health, safety, or a related field; some require ad­ vanced degrees. • Projected average employment growth reflects a balance of continuing public demand for a safe and healthy work environment against the desire for smaller government and fewer regulations. • Individuals with a well-rounded breadth of knowl­ edge in more than one health and safety specialty will have the best job prospects. Nature of the Work Occupational health and safety specialists, also known as safety and health professionals or occupational health and safety in­ spectors, help prevent harm to workers, property, the environ­ ment, and the general public. For example, they may design safe work spaces, inspect machines, or test air quality. In addition to making workers safer, specialists aim to increase worker produc­ tivity by reducing absenteeism and equipment downtime—and to save money by lowering insurance premiums and workers’ compensation  payments, and preventing government fines. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Occupational health and safety specialists may conduct inspec­ tions and inform an organization’s managers of areas not in compliance with State and Federal laws and employer policies. Specialists working for governments conduct safety inspections and impose fines. Specialists often work with occupational health and safety technicians to ensure work place safety. (See the state­ ment on occupational health and safety technicians elsewhere in the Handbook.) Occupational health and safety specialists analyze work environments and design programs to control, eliminate, and pre­ vent disease or injury. They look for chemical, physical, radiolog­ ical, and biological hazards. They also work to make more equip­ ment ergonomic—designed to promote proper body positioning, increase worker comfort, and decrease fatigue. Specialists may conduct inspections and inform an organization’s management of areas not in compliance with State and Federal laws or employer policies. They also advise management on the cost and effective­ ness of safety and health programs. Some provide training on new regulations and policies or on how to recognize hazards. Some specialists develop methods to predict hazards from his­ torical data and other information sources. They use these meth­ ods and their own knowledge and experience to evaluate current equipment, products, facilities, or processes and those planned for future use. For example, they might uncover patterns in injury data that show that many injuries are caused by a specific type of system failure, human error, or weakness in procedures. They  Professional and Related Occupations 429  evaluate the probability and severity of accidents and identify where controls need to be implemented to reduce or eliminate risk. If a new program or practice is required, they propose it to management and monitor results if it is implemented. Specialists may also conduct safety training. Training sessions might show how to recognize hazards, for example, or explain new regula­ tions, production processes, and safe work methods. If an injury or illness occurs, occupational health and safety specialists help investigate, studying its causes and recommending remedial ac­ tion. Some occupational health and safety specialists help work­ ers to return to work after accidents and injuries. Some specialists, often called loss prevention specialists, work for insurance companies, inspecting the facilities that they insure and suggesting and helping to implement improvements. Occupational health and safety specialists frequently com­ municate with management about the status of health and safety programs. They also might consult with engineers or physicians. Specialists monitor safety measurements in order to advise management of safety performance to correct existing safety hazards and to avoid future hazards; they write reports, including accident reports, and enter information on Occupational Safety and Health Administration recordkeeping forms. They also may prepare documents used in legal proceedings and give testimony in court. Those who develop expertise in specific areas may de­ velop occupational health and safety systems, including policies, procedures, and manuals. Some specialists plan budgets needed to implement programs that help achieve safe work practices. The responsibilities of occupational health and safety special­ ists vary by industry, workplace, and types of hazards affecting employees. Environmental protection officers evaluate and coor­ dinate the storage and handling of hazardous waste, the cleanup of contaminated soil or water, or other activities that affect the en­ vironment. Ergonomists consider the design of industrial, office, and other equipment to maximize worker comfort, safety, and productivity. Health physicists work in places that use radiation and radioactive material, helping to protect people and the envi­ ronment from hazardous radiation exposure. Industrial hygienists examine the workplace for health hazards, such as exposure to lead, asbestos, noise, pesticides, or communicable diseases. Work environment. Occupational health and safety specialists work in a variety of settings such as offices, factories, and mines. Their jobs often involve considerable fieldwork and travel. Occupational health and safety specialists may be exposed to many of the same strenuous, dangerous, or stressful conditions faced by industrial employees. The majority of occupational health and safety specialist work the typical 40 hour week. Some specialists may work over-time, and often irregular, hours.  Training, Other Qualifications, and Advancement Most jobs require a bachelor’s degree in occupational health, safety, or a related field; some require advanced degrees. All spe­  cialists are trained in the applicable laws or inspection procedures through some combination of classroom and on-the-job training. Education and training. Most employers require occupa­ tional health and safety specialists to have a bachelor’s degree in occupational health, safety, or a related field, such as engi­ neering, biology, or chemistry. For some positions, a master’s degree in industrial hygiene, health physics, or a related subject is required. High school students interested in enrolling in a col­ lege program should complete courses in English, mathematics, chemistry, biology, and physics. College courses may include radiation science, hazardous material management and control, risk communications, principles of ergonomics, and respiratory protection. Course work will vary depending on the degree pur­ sued. For example, course requirements for students seeking a degree in industrial hygiene will differ from course requirements for health physics degree seekers. In order to become credentialed, most accrediting bodies re­ quire that specialists have attended either a regional or nationally accredited educational institution. Work experience is important in this occupation; it is typically beneficial for prospective stu­ dents to select an education program that offers opportunities to complete internships. All occupational health and safety specialists are trained in the applicable laws or inspection procedures through some combina­ tion of classroom and on-the-job training. Certification and other qualifications. Credentialing is vol­ untary, although many employers encourage it. Credentialing is available through several organizations depending on the special­ ists’ field of work. Organizations credentialing health and safety professionals include the American Board of Health Physicists; the American Indoor Air Quality Council; the American Board of Industrial Hygiene; and the Board of Certified Safety Profes­ sionals. Requirements for credentials vary. Most require specific edu­ cation and experience in order to be eligible to sit for the certi­ fication exam. Once certified, specialists are usually required to complete periodic continuing education for recertification. For information on credentials offered and requirements contact the credentialing organization. People interested in this occupation should be responsible and enjoy detailed work. Occupational health and safety specialists also should be able to communicate well. Work experience as an occupational health and safety professional may also be a prereq­ uisite for many positions. Advancement. Occupational health and safety specialists who work for the Federal Government advance through their ca­ reer ladder to a specified full-performance level if their work is satisfactory. For positions above this level, usually supervisory positions, advancement is competitive and based on agency needs and individual merit. Advancement opportunities in State  Projections data from the National Employment Matrix Occupational Title Occupational health and safety specialists........................ ................  soc  Employment,  Code  2008  29-9011  55,800  Projected Employment,  2018 62,000  Change,  2008-2018 Number  6.200  Percent  11  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  430 Occupational Outlook Handbook  and local governments and the private sector are often similar to those in the Federal Government. Specialists with broad education and experience and those who are well versed in numerous business functions usually have the best advancement opportunities. One way to keep up with current professional developments is to join a professional membership society. These organizations offer journals, continuing education courses, and conferences, which provide learning and network­ ing opportunities and can help workers and students to advance. Typically an advanced degree and substantial work experience are needed to compete for leadership or senior roles  Employment Occupational health and safety specialists held about 55,800 jobs in 2008. While the majority of jobs were spread throughout the private sector; about 41 percent of specialists worked for Federal, State, and local government agencies. Within the Federal Government, most jobs are as Occupational Safety and Health Administration inspectors, who enforce U.S. Department of Labor regulations and impose fines. Within the U.S. Department of Health and Human Services, the National Institute of Occupational Safety and Health hires occupational health and safety specialists to offer companies help in evaluating safety without the risk of fines. Most large government agencies also employ occupational health and safety specialists who work to protect agency employees. Most private companies either employ their own occupational health and safety workers or contract with them. Most contract work is done through consulting companies, but some specialists are self-employed. In addition to working for governments, occupational health and safety specialists were employed in manufacturing firms; hospitals; educational services; scientific and technical consult­ ing services; mining, quarrying, and oil and gas extraction, and construction.  Job Outlook Average employment growth is expected; additional opportuni­ ties will arise from the need to replace workers who leave the oc­ cupation. Individuals with a well-rounded breadth of knowledge in more than one health and safety specialty will have the best job prospects. Employment change. Employment of occupational health and safety specialists is expected to increase 11 percent during the 2008-18 decade, about as fast as the average for all occupa­ tions, reflecting a balance of continuing public demand for a safe and healthy work environment against the desire for fewer gov­ ernment regulations. More specialists will be needed to cope with technological advances in safety equipment and threats, changing regulations, and increasing public expectations. In private industry, employ­ ment growth will reflect continuing self-enforcement of govern­ ment and company regulations and policies. Insurance and worker’s compensation costs have become a fi­ nancial concern for many employers and insurance companies. As a result, job growth should be good for those specializing in loss prevention, especially in construction safety and in ergo­ nomics. Growth for occupational health and safety specialists may be hampered by the number of manufacturing and other industry firms offshoring their operations. In addition, the number of  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  workers who telecommute is increasing. Since occupational health and safety specialists do not have access to home offices, their ability to ensure health and safety of workers in home of­ fices is limited. Job prospects. In addition to job openings from growth, job openings will arise from the need to replace workers who transfer to other occupations, retire, or leave for other reasons. As the lines continue to blur between specific health and safety specialties like industrial hygiene, health physics, and loss pre­ vention, individuals with a well-rounded breadth of knowledge in more than one health and safety specialty will have the best job prospects. Employment of occupational health and safety specialists in the private sector is somewhat affected by general economic fluc­ tuations. Federal, State, and local governments provide consider­ able job security; these workers are less likely to be affected by changes in the economy.  Earnings Median annual wages of occupational health and safety special­ ists were $62,250 in May 2008. The middle 50 percent earned between $47,490 and $77,880. The lowest 10 percent earned less than $35,870, and the highest 10 percent earned more than $93,620. Median annual wages in the industries employing the largest numbers of occupational health and safety specialists in May 2008 were: Federal Executive Branch..........................................$73,180 General medical and surgical hospitals........................63,910 Management, scientific, and technicial consulting services................................................... 57,600 Local government......................................................... 56,300 State government.......................................................... 55,600 Most occupational health and safety specialists work in large private firms or for Federal, State, and local governments, most of which generally offer benefits more generous than those of­ fered by smaller firms.  Related Occupations Occupational health and safety specialists help to ensure that safety and health laws and regulations are obeyed. Other occupations that inspect and enforce laws and regulations include: Page Agricultural inspectors.............................................................612 Construction and building inspectors...................................... 628 Fire inspectors and investigators............................................. 525 Occupational health and safety technicians............................ 431  Sources of Additional Information Information about jobs in Federal, State, and local governments and in private industry is available from State employment ser­ vice offices. For information on a career as an industrial hygienist, con­ tact: y American Industrial Hygiene Association, 2700 Prosperity Ave., Suite 250, Fairfax, VA 22031. Internet: http://www.aiha.org  For information on credentialing in industrial hygiene, contact:  Professional and Related Occupations 431  y American Board of Industrial Hygiene, 6015 West St. Joseph Hwy., Suite 102, Lansing, MI 48917. Internet: http ://www.abih.org For more information on professions in safety, a list of safety and related academic programs, and credentialing, contact: y Board of Certified Safety Professionals, 208 Burwash Ave., Savoy, IL 61874. Internet: http://www.bcsp.org  -; S..  " ;  For information on a career as a health physicist, contact: y Health Physics Society, 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101. Internet: http://www.hps.org For additional career information, contact: y U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Institute of Occupational Safety and Health, 395 E Street SW., Suite 9200, Patriots Plaza Building, Washington, DC 20201. Internet: http://www.cdc.gov/niosh  w I’ 1  1  ,1. 831  s II  y U.S. Department of Labor, Occupational Safety and Health Administration, Office of Communication, 200 Constitution Ave. NW., Washington, DC 20210. Internet: http ://www.osha.gov Information on obtaining positions as occupational health and safety specialists with the Federal Government is avail­ able from the Office of Personnel Management through USAJOBS, the Federal Government’s official employment information system. This resource for locating and applying for job opportunities can be accessed through the Internet at http://www.usajobs.gov/or through an interactive voice re­ sponse telephone system at (703) 724-1850, (866) 204-2858 or TDD (978) 461-8404. These numbers are not all toll free, and charges may result. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos323.htm  Occupational Health and Safety Technicians Significant Points • About 22 percent of technicians worked in govern­ ment agencies that enforce rules on safety, health, and the environment. • Technicians attend postsecondary school or enter the occupation through work experience and training. • Individuals with a well-rounded breadth of knowl­ edge in more than one health and safety specialty will have the best job prospects.  Nature of the Work Occupational health and safety technicians work with occupational health and safety specialists to help prevent harm to workers, property, the environment, and the general (See the statement on occupational health and safety Digitized public. for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Occupational health and safety technicians prepare and cali­ brate scientific equipment. specialists elsewhere in the Handbook.) For example, they might help design safe work spaces, inspect machines, or test air quality. In addition to making workers safer, techni­ cians work with specialists to increase worker productivity by reducing absenteeism and equipment downtime, and to save money by lowering insurance premiums and workers’ compensation payments, and preventing government fines. Some technicians work for governments conducting safety inspections and imposing fines. Occupational health and safety technicians take measure­ ments and collect workplace data either for routine inspec­ tion or as directed by a specialist. Technicians often focus on testing air, water, machines, and other elements of the work environment. They collect data that occupational health and safety specialists then analyze. Usually working under the supervision of specialists, they also help to implement and evaluate safety programs. To measure hazards, such as noise or radiation, occupa­ tional health and safety technicians prepare and calibrate scientific equipment. They must properly collect and handle samples of dust, gases, vapors, and other potentially toxic materials to ensure personal safety and accurate test results. To ensure that machinery and equipment complies with ap­ propriate safety regulations, occupational health and safety technicians may examine and test machinery and equipment, such as lifting devices, machine guards, or scaffolding. They may check that personal protective equipment, such as masks, respirators, protective eyewear, or hardhats, is be­ ing used according to regulations. They also check that haz­ ardous materials are stored correctly. They test and identify work areas for potential accident and health hazards, such as toxic vapors, mold, mildew, and explosive gas-air mixtures and help implement appropriate control measures, such as adjustments to ventilation systems. Their inspection of the  432 Occupational Outlook Handbook  workplace might involve talking with workers and observ­ ing their work, as well as inspecting elements in their work environment, such as lighting, tools, and equipment. The responsibilities of occupational health and safety technicians vary by industry, workplace, and types of haz­ ards affecting employees. Mine examiners, for example, are technicians who inspect mines for proper air flow and health hazards such as the buildup of methane or other nox­ ious gases. Environmental protection technicians evaluate and coordinate the storage and handling of hazardous waste, the cleanup of contaminated soil or water, or other activities that affect the environment. Health physics technicians work in places that use radiation and radioactive material, help­ ing to protect people and the environment from hazardous radiation exposure. Industrial hygiene technicians examine the workplace for health hazards, such as exposure to lead, asbestos, pesticides, or communicable diseases. Work environment. Occupational health and safety tech­ nicians work in a variety of settings from offices and facto­ ries to mines. Their jobs often involve considerable field­ work, and some require frequent travel. Occupational health and safety technicians may be ex­ posed to many of the same strenuous, dangerous, or stress­ ful conditions faced by industrial employees. They may find themselves in an adversarial role if an organization disagrees with their recommendations. Most technicians work the typical 40 hour week. Some occupational health and safety technicians may be required to work overtime, and often ir­ regular, hours.  Training, Other Qualifications, and Advancement Technicians attend postsecondary school or enter the occupa­ tion through work experience and training. All occupational health and safety technicians are trained in the applicable laws or inspection procedures through some combination of classroom and on-the-job training. Education and training. There are multiple paths to entry-level employment as an occupational health and safety technicians. Some technicians attend postsecondary school and typically earn an associate degree or certificate. Other technicians enter the occupation through work experience and training. In this case, an individual typically already works in the industry and may volunteer with their employer to take on health and safety responsibilities. These workers then usually receive on-the-job training coupled with some formal education. All occupational health and safety techni­ cians are trained in the applicable laws or inspection proce­ dures through some combination of classroom and on-thejob training.  Recommended high school courses include English, math­ ematics, chemistry, biology, and physics. Certification and other qualifications. Although volun­ tary, many employers encourage credentialing. The Council on Certification of Health, Environmental, and Safety Tech­ nologists offers credentialing at the technician level. For specific requirements for each credential, contact the certi­ fying body. Most certifications require completing periodic continuing education for recertification. In general, people who want to enter this occupation should be responsible and like detailed work. Occupational health and safety technicians also should be able to com­ municate well. Advancement. Occupational health and safety technicians who work for the Federal Government advance through their career ladder to a specified full-performance level if their work is satisfactory. For positions above this level, usually supervisory positions, advancement is competitive and based on agency needs and individual merit. Advancement oppor­ tunities in State and local governments and the private sector are often similar to those in the Federal Government. Technicians with broad education and experience and those who are well versed in numerous business functions usually have the best advancement opportunities. One way to keep up with current professional developments is to join a professional society. These organizations offer journals, continuing education courses, and conferences that provide learning and networking opportunities and can help workers and students to advance. With a bachelor’s or advanced degree, technicians can be­ come occupational health and safety specialists.  Employment Occupational health and safety technicians held about 10,900 jobs in 2008. While the majority of jobs were spread through­ out the private sector, about 22 percent of technicians worked for government agencies. Most private companies either employ their own occupa­ tional health and safety workers or contract with them. Most contract work is done through consulting companies. In addition to working for governments, occupational health and safety technicians were employed in manufacturing firms; public and private hospitals; educational services; scientific and technical consulting services; administrative and support services; and support activity for mining.  Job Outlook Faster than average employment growth is expected; ad­ ditional opportunities will arise from the need to replace workers who leave the occupation. Individuals with a well-  Projections data from the National Employment Matrix Occupational Title  soc Code  Employment, 2008  Projected Employment, 2018 12,500  Change, 2008-2018 Number Percent 1,600 14  29-9012 10,900 Occupational health and safety technicians........................................ (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Professional and Related Occupations 433  rounded breadth of knowledge in more than one health and safety specialty will have the best job prospects. Employment change. Employment of occupational health and safety technicians is expected to increase 14 percent dur­ ing the 2008-18 decade, faster than the average for all oc­ cupations, reflecting a balance of continuing public demand for a safe and healthy work environment against the desire for fewer government regulations. More technicians will be needed to cope with techno­ logical advances in safety equipment and threats, changing regulations, and increasing public expectations. In private industry, employment growth will reflect overall business growth and continuing self-enforcement of government and company regulations and policies. Although most occupational health and safety technicians work under supervision of specialists, technicians can com­ plete many of the routine job tasks with little or no supervi­ sion. As a result in order to contain costs, some employers operate with more technicians and fewer specialists. Growth for occupational health and safety technicians may be hampered by the number of manufacturing and other in­ dustry firms offshoring their operations. Also, the increasing popularity of telecommuting, or working at home, will result in less work space for technicians to inspect. Job prospects. In addition to job openings from growth, job openings will arise from the need to replace workers who transfer to other occupations, retire, or leave for other rea­ sons. Health and safety technicians with a wide breadth of knowledge in more than one area of health and safety along with general business functions will have the best prospects. Employment of occupational health and safety technicians in the private sector is somewhat affected by general eco­ nomic fluctuations. Federal, State, and local governments provide considerable job security; workers are less likely to be affected by changes in the economy.  Earnings Median annual wages of occupational health and safety tech­ nicians were $45,360 in May 2008. The middle 50 percent earned between $35,160 and $57,110. The lowest 10 percent earned less than $26,540, and the highest 10 percent earned more than $73,050. Median annual wages in the industries employing the largest numbers of occupational health and safety specialists and technicians in May 2008 were: Support activities for mining...................................... $56,060 Local government......................................................... 45,320 Colleges, universities, and professional schools..........44,990 General medical and surgical hospitals........................41,490 Management, scientific, and technical consulting....... 41,100 Most occupational health and safety technicians work in large private firms or for Federal, State, and local governments, most of which generally offer benefits more generous than those of­ fered by smaller firms.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Related Occupations Occupational health and safety technicians help to inspect and ensure that safety and health laws and regulations are obeyed. Others who enforce regulations include: Page Agricultural inspectors.............................................................612 Construction and building inspectors...................................... 628 Fire inspectors and investigators............................................. 525 Occupational health and safety specialists.............................. 428  Sources of Additional Information Information about jobs in Federal, State, and local governments and in private industry is available from State employment ser­ vice offices. For information on industrial hygiene, contact: y American Industrial Hygiene Association, 2700 Prosperity Ave., Suite 250, Fairfax, VA 22031. Internet: http://www.aiha.org For more information on careers in safety and a list of safety and related academic programs, contact: y Board of Certified Safety Professionals, 208 Burwash Ave., Savoy, IL 61874. Internet: http://www.bcsp.org For information on credentialing, contact: y Council on Certification of Health, Environmental, and Safety Technologists, 208 Burwash Ave., Savoy, IL 61874. Internet: http://www.cchest.org For information on health physics, contact: y Health Physics Society, 1313 Dolley Madison Blvd., Suite 402, McLean, VA 22101. Internet: http://www.hps.org For additional career information, contact: y U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Institute of Occupational Safety and Health, 395 E Street SW., Suite 9200, Patriots Plaza Building, Washington, DC 20201. Internet: http://www.cdc.gov/niosh > U.S. Department of Labor, Occupational Safety and Health Administration, Office of Communication, 200 Constitution Ave. NW„ Washington, DC 20210. Internet: http://www.osha.gov Information on obtaining positions as occupational health and safety specialists and technicians with the Federal Govern­ ment is available from the Office of Personnel Management through USAJOBS, the Federal Government’s official employ­ ment information system. This resource for locating and apply­ ing for job opportunities can be accessed through the Internet at http://www.usajobs.gov/ or through an interactive voice re­ sponse telephone system at (703) 724-1850, (866) 204-2858 or TDD (978) 461-8404. These numbers are not all toll free, and charges may result. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos324.htm  434 Occupational Outlook Handbook  Opticians, Dispensing Significant Points • Employers increasingly prefer dispensing opticians to complete certification or graduate from an accred­ ited 2-year associate’s degree program in opticianry; some large employers may provide an apprenticeship. • A license to practice is required by 22 States. • Employment growth is projected to be average and reflect the steady demand for corrective lenses and fashionable eyeglass frames. • Job opportunities are likely to be very good. Nature of the Work Helping people see better and look good at the same time is the job of a dispensing optician. Dispensing opticians help select and fit eyeglasses and contact lenses for people with eye prob­ lems, following prescriptions written by ophthalmologists or optometrists. (The work of optometrists is described elsewhere in the Handbook. See the section on physicians and surgeons for information about ophthalmologists.) Dispensing opticians recommend eyeglass frames, lenses, and lens coatings after considering the prescription and the customer’s occupation, habits, and facial features. When fitting new eyeglasses, opti­ cians use sophisticated diagnostic instruments to measure vari­ ous characteristics of a client’s eyes, including the thickness, width, curvature, and surface topography of the cornea. They also obtain a customer’s prescription history to re-make eye­ glasses or contact lenses, or they may verify a prescription with the examining optometrist or ophthalmologist. Dispensing opticians prepare work orders that give ophthal­ mic laboratory technicians the information they need to grind and insert lenses into a frame. (See the section on ophthalmic laboratory technicians elsewhere in the Handbook.) The work order includes prescriptions for lenses and information on their size, material, color, and style. Some dispensing opticians grind and insert lenses themselves. They may also apply tint to lenses. After the glasses are made, dispensing opticians verify that the lenses meet the specifications, and then they may reshape or bend the frames with pliers for a custom fit. Many opticians also spend time fixing and refitting broken frames, as well as instructing clients about wearing or caring for eyeglasses. Additionally, administrative duties have become a major part of their work, including keeping records on cus­ tomers’ prescriptions, work orders, and payments, and tracking inventory and sales. Some dispensing opticians, after additional education and training, specialize in fitting contacts, artificial eyes, or cos­ metic shells to cover blemished eyes. To fit contact lenses, dispensing opticians measure the shape and size of the eye, select the type of contact lens material, and prepare work orders specifying the prescription and lens size. Dispensing opticians observe customers’ eyes, corneas, lids, and contact lenses with sophisticated instruments and microscopes. During several  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  followup visits, opticians teach proper insertion, removal, and care of contact lenses. Work environment. Dispensing opticians work indoors mainly in medical offices, optical stores, or in large depart­ ment or club stores. Opticians spend a fair amount of time on their feet. If they prepare lenses, they need to take precautions against the hazards of glass cutting, chemicals, and machinery. Although most dispensing opticians work during regular busi­ ness hours, those in retail stores may work evenings and week­ ends. Some work part time.  Training, Other Qualifications, and Advancement Many employers increasingly prefer dispensing opticians to complete certification or graduate from an accredited 2-year associate’s degree program in opticianry; some large employ­ ers may provide an apprenticeship that may last two years or longer. Education and training. Although a high school diploma is all that is required to get into this occupation, most work­ ers have completed at least some college courses or a degree. Classes in physics, basic anatomy, algebra, and trigonometry as well as experience with computers are particularly valuable. These classes prepare dispensing opticians to learn job skills, including optical mathematics, optical physics, and the use of precision measuring instruments and other machinery and tools. Structured apprenticeship programs are more commonly available in States where licensing is not mandatory, and these programs are usually offered by large employers. Apprentices receive technical instruction along with training in office man­ agement and sales. Under the supervision of an experienced optician, optometrist, or ophthalmologist, apprentices work di­ rectly with patients, fitting eyeglasses and contact lenses. Formal training in the field is offered in community colleges and in a few 4-year colleges and universities. As of 2008, the Commission on Opticianry Accreditation accredited 22 associ­ ate degree programs in 13 states. Graduation from an accredited program in opticianry can be advantageous as it provides a na­ tionally recognized credential. Licensure. As of 2009, twenty-two States require dispens­ ing opticians to be licensed. States may require individuals to pass one or more of the following for licensure: a State practi■ nwr - f ■  Iff®;! Dispensing opticians deal directly with the public, so they should be tactful, pleasant, and communicate well.  Professional and Related Occupations 435  Projections data from the National Employment Matrix Occupational Title  SOC Code  Employment, 2008  Opticians, dispensing.....................................  59,800  Projected Employment, 2018 67,800  Change, 2008-2018 Number Percent 8,000 13  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  cal examination, a State written examination, and certification examinations offered by the American Board of Opticianry (ABO) and the National Contact Lens Examiners (NCLE). To qualify for the examinations, States often require applicants to complete postsecondary training or work as apprentices for 2 to 4 years. Some States allow graduates of opticianry programs to take the licensure exam immediately upon graduation; others re­ quire a few months to a year of experience. Continuing educa­ tion is commonly required for licensure renewal. Information about specific licensing requirements is available from the State board of occupational licensing. Certification and other qualifications. Any optician can ap­ ply to the ABO and the NCLE for certification of their skills. Certification signifies to customers and employers that an opti­ cian has a certain level of expertise. Certification must be re­ newed every 3 years through continuing education. The State of Texas offers voluntary registration for the occupation. Dispensing opticians deal directly with the public, so they should be tactful, pleasant, and able to communicate well. Fitting contact lenses requires considerable skill, care, and patience, so manual dexterity and the ability to do precision work are essential. Advancement. A few experienced dispensing opticians open their own optical stores. Some become managers of opti­ cal stores or sales representatives for wholesalers or manufac­ turers of eyeglasses or lenses.  Employment Dispensing opticians held about 59,800 jobs in 2008. About 40 percent worked in offices of optometrists. Another 33 per­ cent worked in health and personal care stores, including opti­ cal goods stores. Many of these stores offer one-stop shopping where customers can have their eyes examined, choose frames, and have glasses made on the spot. Some opticians work in opti­ cal departments of department stores or other general merchan­ dise stores, such as warehouse clubs and superstores. About 13 percent worked in offices of physicians, primarily ophthalmolo­ gists, who sell glasses directly to patients. One percent were self-employed and ran their own unincorporated businesses.  Job Outlook Employment of dispensing opticians is expected to grow about as fast as average for all occupations through 2018, as the pop­ ulation ages and demand for corrective lenses increases. Very good job prospects are expected. Employment change. Employment in this occupation is expected to rise 13 percent over the 2008-18 decade. Middle age is a time when many individuals use corrective lenses for the first time, and elderly persons generally require more vision than others. As the share of the population in these older Digitizedcare for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  age groups increases and as people live longer, more opticians will be needed to provide service to them. In addition, aware­ ness of the importance of regular eye exams is increasing across all age groups, especially children and those over the age of 65. Recent trends indicate a movement toward a “low vision” society, where a growing number of people view things that are closer in distance, such as computer monitors, over the course of an average day. This trend is expected to increase the need for eye care services. Fashion also influences demand. Frames come in a growing variety of styles, colors, and sizes, encourag­ ing people to buy more than one pair. Somewhat moderating the need for optician services is the increasing use of laser surgery to correct vision problems. Al­ though the surgery remains relatively more expensive than eye­ wear, patients who successfully undergo this surgery may not require glasses or contact lenses for several years. Also, new technology is allowing workers to make the measurements needed to fit glasses and therefore allowing dispensing opti­ cians to work faster, limiting the need for more workers. Job prospects. Overall, the need to replace dispensing op­ ticians who retire or leave the occupation will result in very good job prospects. Employment opportunities for opticians in offices of optometrists—the largest employer—will be par­ ticularly good as an increasing number of ophthalmologists are expected to utilize better trained opticians to handle more tasks, allowing ophthalmologists to see more patients. Job opportunities also will be good at general merchandise stores because this segment is expected to experience much faster than average growth, as well as high turnover due to less favorable working conditions, such as long hours and manda­ tory weekend shifts. Nonetheless, the number of job openings overall will be somewhat limited because the occupation is small. Also, dis­ pensing opticians are vulnerable to changes in the business cycle because eyewear purchases often can be deferred for a time. Job prospects will be best for those who have certification and those who have completed a formal opticianry program. Job candidates with extensive knowledge of new technology, including new refraction systems, framing materials, and edg­ ing techniques, should also experience favorable conditions. Earnings Median annual wages of dispensing opticians were $32,810 in May 2008. The middle 50 percent earned between $26,170 and $41,930. The lowest 10 percent earned less than $21,250, and the highest 10 percent earned more than $50,580. Median an­  436 Occupational Outlook Handbook  ....  nual wages in the industries employing the largest numbers of dispensing opticians in May 2008 were:  -  Other general merchandise stores..............................$40,080 Health and personal care stores.................................... 34,700 Offices of physicians.................................................... 34,090 Department stores......................................................... 33,750 Offices of optometrists................................................. 30,460 Benefits for opticians are generally determined by the indus­ tries in which they are employed. In general, those who work part-time or in small retail shops have fewer benefits than those who may work for large optical chains or department stores. Self-employed opticians must provide their own benefits.  Related Occupations Other workers who deal with customers and perform delicate work include the following: Page Jewelers and precious stone and metal workers...................... 770 Ophthalmic laboratory technicians..........................................774 Orthotists and prosthetists........................................................ 825  Sources of Additional Information To learn about apprenticeship programs and State licensing re­ quirements, contact: y Opticians Association of America, 4064 E. Fir Hill Drive, Lakeland, TN 38002. Internet: http://www.oaa.org To learn about voluntary certification for opticians who fit eyeglasses, as well as a list of State licensing boards for opti­ cians, contact: y American Board of Opticianry, 6506 Loisdale Rd., Suite 209, Springfield, VA 22150. Internet: http://www.abo.org For information on voluntary certification for dispensing op­ ticians who fit contact lenses, contact: > National Contact Lens Examiners, 6506 Loisdale Rd., Suite 209, Springfield, VA 22150. Internet: http ://ww w.abo-ncle.org For a list of the 22 associate’s degree programs accredited by the Commission on Opticianry Accreditation, contact: y National Federation of Opticianry Schools, 2800 Springport Road, Jackson, MI 49202. Internet: http://www.nfos.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos098.htm  Pharmacy Technicians and Aides Significant Points • Job opportunities are expected to be good, espe­ cially for those with certification or previous work experience. • Many technicians and aides work evenings, week­ ends, and holidays. • FRASER About 75 percent of jobs were in a retail setting. Digitized for https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  —  iPPTti  ,  JK  • • • • ~ » <TV~i~' T-ST-r-.................................  f  Pharmacy technicians and aides answer phones, operate cash registers, and prepare medications for patients.  Nature of the Work Pharmacy technicians and aides help licensed pharmacists prepare prescription medications, provide customer service, and perform administrative duties within a pharmacy setting. Pharmacy technicians generally are responsible for receiving prescription requests, counting tablets, and labeling bottles, while pharmacy aides perform administrative functions such as answering phones, stocking shelves, and operating cash regis­ ters. In organizations that do not have aides, however, pharmacy technicians may be responsible for these clerical duties. Pharmacy technicians who work in retail or mail-order phar­ macies have various responsibilities, depending on State rules and regulations. Technicians receive written prescription re­ quests from patients. They also may receive prescriptions sent electronically from doctors’ offices, and in some States they are permitted to process requests by phone. They must verify that the information on the prescription is complete and accurate. To prepare the prescription, technicians retrieve, count, pour, weigh, measure, and sometimes mix the medication. Then they prepare the prescription labels, select the type of container, and affix the prescription and auxiliary labels to the container. Once the prescription is filled, technicians price and file the prescrip­ tion, which must be checked by a pharmacist before it is given to the patient. Technicians may establish and maintain patient profiles, as well as prepare insurance claim forms. Technicians always refer any questions regarding prescriptions, drug infor­ mation, or health matters to a pharmacist. (See the section on pharmacists elsewhere in the Handbook.) In hospitals, nursing homes, and assisted-living facilities, technicians have added responsibilities, including preparing sterile solutions and delivering medications to nurses or phy­ sicians. Technician may also record the information about the prescribed medication onto the patient’s profile. Pharmacy aides work closely with pharmacy technicians. They primarily perform administrative duties such as answer­ ing telephones, stocking shelves, and operating cash registers. They also may prepare insurance forms and maintain patient profiles. Unlike pharmacy technicians, pharmacy aides do not prepare prescriptions or mix medications. Work environment. Pharmacy technicians and aides work in clean, organized, well-lighted, and well-ventilated areas. Most  Professional and Related Occupations 437  of their workday is spent on their feet. They may be required to lift heavy boxes or to use stepladders to retrieve supplies from high shelves. Technicians and aides often have varying schedules that in­ clude nights, weekends, and holidays. In facilities that are open 24 hours a day, such as hospital pharmacies, technicians and aides may be required to work nights. Many technicians and aides work part time.  Training, Other Qualifications, and Advancement There is no national training standard for pharmacy technicians, but employers favor applicants who have formal training, certi­ fication, or previous experience. There also are no formal train­ ing requirements for pharmacy aides, but a high school diploma may increase an applicant’s prospects for employment. Education and training. There are no standard training re­ quirements for pharmacy technicians, but some States require a high school diploma or its equivalent. Although most pharmacy technicians receive informal on-the-job training, employers fa­ vor those who have completed formal training and certification. On-the-job training generally ranges between 3 and 12 months. Formal technician education programs are available through a variety of organizations, including community colleges, vo­ cational schools, hospitals, and the military. These programs range from 6 months to 2 years and include classroom and laboratory work. They cover a variety of subject areas, such as medical and pharmaceutical terminology, pharmaceutical cal­ culations, pharmacy recordkeeping, pharmaceutical techniques, and pharmacy law and ethics. Technicians also are required to leam the names, actions, uses, and doses of the medications they work with. Many training programs include internships, in which students gain hands-on experience in actual pharmacies. After completion, students receive a diploma, a certificate, or an associate’s degree, depending on the program. There are no formal education requirements for pharmacy aides, but employers may favor applicants with a high school diploma or its equivalent. Experience operating a cash register, interacting with customers, managing inventory, and using computers may be helpful. Pharmacy aides also receive infor­ mal on-the-job training that generally lasts less than 3 months. Certification and other qualifications. In most States, pharmacy technicians must be registered with the State board of pharmacy. Eligibility requirements vary, but in some States applicants must possess a high school diploma or its equivalent and pay an application fee. Most States do not require technicians to be certified, but vol­ untary certification is available through several private organi­ zations. The Pharmacy Technician Certification Board (PTCB) and the Institute for the Certification of Pharmacy Technicians  (ICPT) administer national certification examinations. Certifi­ cation through such programs may enhance an applicant’s pros­ pects for employment and is required by some States and em­ ployers. To be eligible for either exam, candidates must have a high school diploma or its equivalent and no felony convictions of any kind. In addition, applicants for the PTCB exam must not have had any drug-related or pharmacy-related convictions, including misdemeanors. Many employers will reimburse the cost of the exams. Under these programs, technicians must be recertified every 2 years. Recertification requires 20 hours of continuing educa­ tion within the 2-year certification period. Continuing education hours can be earned from several different sources, including colleges, pharmacy associations, and pharmacy technician training programs. Up to 10 hours of continuing education also can be earned on the job under the direct supervision and in­ struction of a pharmacist. Good customer service and communication skills are needed because pharmacy technicians and aides interact with patients, coworkers, and healthcare professionals. Basic mathematics, spelling, and reading skills also are important, as technicians must interpret prescription orders and verify drug doses. Tech­ nicians also must be precise: details are sometimes a matter of life and death. Advancement. Advancement opportunities generally are limited, but in large pharmacies and health systems pharmacy technicians and aides with significant training or experience can be promoted to supervisory positions. Some may advance into specialty positions such as chemotherapy technician or nuclear pharmacy technician. Others may move into sales. With a sub­ stantial amount of formal training, some technicians and aides go on to become pharmacists.  Employment Pharmacy technicians and aides held about 381,200 jobs in 2008. Of these, about 326,300 were pharmacy technicians and about 54,900 were pharmacy aides. About 75 percent of jobs were in a retail setting, and about 16 percent were in hospitals.  Job Outlook Employment is expected to increase much faster than the aver­ age, and job opportunities are expected to be good. Employment change. Employment of pharmacy technicians and aides is expected to increase by 25 percent from 2008 to 2018, which is much faster than the average for all occupations. The increased number of middle-aged and elderly people— who use more prescription drugs than younger people—will spur demand for pharmacy workers throughout the projection period. In addition, as scientific advances lead to new dmgs,  Projections data from the National Employment Matrix Occunational Title Occupational title Pharmacy technicians and aides........................................................... Pharmacy technicians........................................................................ __ Pharmacy aides..................................................................................  S0C Employment, Projected Change, Codg Employment, 2008-2018 ________________________________________________________________ 20 _ 381,200 477,500 96,300 25 29-2052 326,300 426,000 99,800 31 31-909554,90051,500 -3^500-6  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  438 Occupational Outlook Handbook  and as more people obtain prescription drug coverage, phar­ macy workers will be needed in growing numbers. Employment of pharmacy technicians is expected to increase by 31 percent. As cost-conscious insurers begin to use phar­ macies as patient-care centers and pharmacists become more involved in patient care, pharmacy technicians will continue to see an expansion of their role in the pharmacy. In addition, they will increasingly adopt some of the administrative duties that were previously performed by pharmacy aides, such as an­ swering phones and stocking shelves. As a result of this de­ velopment, demand for pharmacy aides should decrease, and employment is expected to decline moderately, decreasing by 6 percent over the projection period. Job prospects. Job opportunities for pharmacy technicians are expected to be good, especially for those with previous experience, formal training, or certification. Job openings will result from employment growth, as well as the need to replace workers who transfer to other occupations or leave the labor force. Despite declining employment, job prospects for pharmacy aides also are expected to be good. As people leave this occu­ pation, new applicants will be needed to fill the positions that remain.  Earnings Median hourly wages of wage and salary pharmacy technicians in May 2008 were $13.32. The middle 50 percent earned be­ tween $10.95 and $15.88. The lowest 10 percent earned less than $9.27, and the highest 10 percent earned more than $18.98. Median hourly wages of wage and salary pharmacy aides were $9.66 in May 2008. The middle 50 percent earned be­ tween $8.47 and $11.62. The lowest 10 percent earned less than $7.69, and the highest 10 percent earned more than $14.26. Certified technicians may earn more than non-certified tech­ nicians. Some technicians and aides belong to unions represent­ ing hospital or grocery store workers.  Related Occupations Other occupations related to healthcare include the following: Page Dental assistants.......................................................................447 Medical assistants....................................................................455 Medical records and health information technicians.............. 423 Medical transcriptionists..........................................................457 Pharmacists.............................................................................. 374  Sources of Additional Information For information on pharmacy technician certification programs, contact: V Pharmacy Technician Certification Board, 2215 Constitution Ave. NW., Washington DC 20037-2985. Internet: http ://www.ptcb.org > Institute for the Certification of Pharmacy Technicians, 2536 S. Old Hwy. 94, Suite 224, St. Charles, MO 63303. Internet: http://www.nationaltechexam.org For a list of accredited pharmacy technician training pro­ grams, contact:  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  > American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Internet: http://www.ashp.org For pharmacy technician career information, contact: y National Pharmacy Technician Association, P.O. Box 683148, Houston, TX 77268. Internet: http://www.pharmacytechnician.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos325.htm  Radiologic Technologists and Technicians Significant Points • Employment is projected to grow faster than average; those with knowledge of more than one diagnostic imaging procedure will have the best employment opportunities. • Formal training programs in radiography are offered in hospitals or colleges and universities and lead to a certificate, an associate degree, or a bachelor’s de­ gree. • Most States require licensure, and requirements vary. • Although hospitals will remain the primary employer, a number of new jobs will be found in physicians’ of­ fices and diagnostic imaging centers. Nature of the Work Radiologic technologists and technicians perform diagnostic imaging examination. Radiologic technicians perform imaging examinations like x rays while technologists use other imaging modalities such as computed tomography, magnetic resonance imaging, and mammography. Radiologic technicians, sometimes referred to as radiographers, produce x-ray films (radiographs) of parts of the human body for use in diagnosing medical problems. They prepare patients for radiologic examinations by explaining the procedure, removing jewelry and other articles through which x rays cannot pass, and positioning patients so that the parts of the body can be appropriately radiographed. To prevent unneces­ sary exposure to radiation, these workers surround the exposed area with radiation protection devices, such as lead shields, or limit the size of the x-ray beam. Radiographers position radio­ graphic equipment at the correct angle and height over the ap­ propriate area of a patient’s body. Using instruments similar to a measuring tape they may measure the thickness of the sec­ tion to be radiographed and set controls on the x-ray machine to produce radiographs of the appropriate density, detail, and contrast. Radiologic technologists and technicians must follow physi­ cians’ orders precisely and conform to regulations concerning  Professional and Related Occupations 439  the use of radiation to protect themselves, their patients, and their coworkers from unnecessary exposure. In addition to preparing patients and operating equipment, ra­ diologic technologists and technicians keep patient records and adjust and maintain equipment. They also may prepare work schedules, evaluate purchases of equipment, or manage a radi­ ology department. Radiologic technologists perform more complex imaging procedures. When performing fluoroscopies, for example, radiologic technologists prepare a solution for the patient to drink, allowing the radiologist (a physician who interprets radiographs) to see soft tissues in the body. Some radiologic technologists specialize in computed to­ mography (CT), as CT technologists. CT scans produce a sub­ stantial amount of cross-sectional x rays of an area of the body. From those cross-sectional x rays, a three-dimensional image is made. The CT uses ionizing radiation; therefore, it requires the same precautionary measures that are used with x rays. Radiologic technologists also can specialize in Magnetic Res­ onance Imaging (MR) as MR technologists. MR, like CT, pro­ duces multiple cross-sectional images to create a 3-dimensional image. Unlike CT and x rays, MR uses non-ionizing radio fre­ quency to generate image contrast. Radiologic technologists might also specialize in mammog­ raphy. Mammographers use low dose x-ray systems to produce images of the breast. In addition to radiologic technologists, others who conduct diagnostic imaging procedures include cardiovascular technol­ ogists and technicians, diagnostic medical sonographers, and nuclear medicine technologists. (Each is discussed elsewhere in the Handbook.) Work environment. Physical stamina is important in this occupation because technologists and technicians are on their feet for long periods and may lift or turn disabled patients. Technologists and technicians work at diagnostic machines but also may perform some procedures at patients’ bedsides. Some travel to patients in large vans equipped with sophisticated di­ agnostic equipment. Although radiation hazards exist in this occupation, they are minimized by the use of lead aprons, gloves, and other shielding devices, and by instruments monitoring exposure to radiation. Technologists and technicians wear badges measuring radiation levels in the radiation area, and detailed records are kept on their cumulative lifetime dose. Most full-time radiologic technologists and technicians work about 40 hours a week. They may, however, have evening, weekend, or on-call hours. Some radiologic technologists and technicians work part time for more than one employer; for those, travel to and from facilities must be considered.  Training, Other Qualifications, and Advancement There are multiple paths to entry into this profession offered in hospitals or colleges and universities. Most States require licen­ sure, and requirements vary. Education and training. Formal training programs in radi­ ography lead to a certificate, an associate degree, or a bachelor’s degree. An associate degree is the most prevalent form of edu­ cational attainment among radiologic technologists and tech https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  1  ililill  :  Radiologic technologists prepare patients for radiologic exami­ nations by explaining the procedures, removing jewelry, and positioning patients. nicians. Some may receive a certificate. Certificate programs typically last around 21-24 months. The Joint Review Committee on Education in Radiologic Technology accredits formal training programs in radiography. The committee accredited 213 programs resulting in a cer­ tificate, 397 programs resulting in an associate degree, and 35 resulting in a bachelor’s degree in 2009. The programs provide both classroom and clinical instruction in anatomy and physiol­ ogy, patient care procedures, radiation physics, radiation protec­ tion, principles of imaging, medical terminology, positioning of patients, medical ethics, radiobiology, and pathology. Students interested in radiologic technology should take high school courses in mathematics, physics, chemistry, and biology. Licensure. Federal legislation protects the public from the hazards of unnecessary exposure to medical and dental radia­ tion by ensuring that operators of radiologic equipment are properly trained. However, it is up to each State to require licen­ sure of radiologic technologists. Most States require licensure for practicing radiologic technologists. Licensing requirements vary by State; for specific requirements contact your State’s health board. Certification and other qualifications. The American Reg­ istry of Radiologic Technologists (ARRT) offers voluntary cer­ tification for radiologic technologists. In addition, a number of States use ARRT-administered exams for State licensing pur­ poses. To be eligible for certification, technologists must gradu­ ate from an ARRT-approved accredited program and pass an examination. Many employers prefer to hire certified radiologic technologists. In order to maintain an ARRT certification, 24 hours of continuing education must be completed every 2 years. Radiologic technologists should be sensitive to patients’ physical and psychological needs. They must pay attention to detail, follow instructions, and work as part of a team. In ad­  440 Occupational Outlook Handbook  dition, operating complicated equipment requires mechanical ability and manual dexterity. Advancement. With experience and additional training, staff technologists may become specialists, performing CT scan­ ning, MR, mammography, or bone densitometry. Technologists also may advance, with additional education and certification, to become a radiologist assistant. The ARRT offers specialty certification in many radiologic specialties as well as a credentialing for radiologist assistants. Experienced technologists also may be promoted to supervi­ sor, chief radiologic technologist, and, ultimately, department administrator or director. Depending 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 specializing in the occupa­ tion to become instructors or directors in radiologic technology educational programs; others take jobs as sales representatives or instructors with equipment manufacturers.  nology advances many imaging modalities are becoming less expensive and more feasible to have in a physician’s office Job prospects. In addition to job growth, job openings also will arise from the need to replace technologists who leave the occupation. Those with knowledge of more than one diagnostic imaging procedure—such as CT, MR, and mammography— will have the best employment opportunities as employers seek to control costs by using multi-credentialed employees. Demand for radiologic technologists and technicians can tend to be regional with some areas having large demand, while other areas are saturated. Technologists and technicians willing to relocate may have better job prospects. CT is continuing to become a frontline diagnosis tool. Instead of taking x rays to decide whether a CT is needed, as was the practice before, it is often the first choice for imaging because of its accuracy. MR also is increasingly used. Technologists with credentialing in either of these specialties will be very marketable to employers.  Earnings Employment Radiologic technologists held about 214,700 jobs in 2008. About 61 percent of all jobs were in hospitals. Most other jobs were in offices of physicians; medical and diagnostic laborato­ ries, including diagnostic imaging centers; and outpatient care centers.  Job Outlook Employment is projected to grow faster than average. Those with knowledge of more than one diagnostic imaging procedure—such as CT, MR, and mammography—will have the best employment opportunities. Employment change. Employment of radiologic technolo­ gists is expected to increase by about 17 percent from 2008 to 2018, faster than the average for all occupations. As the popu­ lation grows and ages, there will be an increasing demand for diagnostic imaging. With age comes increased incidence of ill­ ness and injury, which often requires diagnostic imaging for di­ agnosis. In addition to diagnosis, diagnostic imaging is used to monitor the progress of disease treatment. With the increasing success of medical technologies in treating disease, diagnos­ tic imaging will increasingly be needed to monitor progress of treatment. The extent to which diagnostic imaging procedures are performed depends largely on cost and reimbursement consid­ erations. However, accurate early disease detection allows for lower cost of treatment in the long run, which many third-party payers find favorable. Although hospitals will remain the principal employer of ra­ diologic technologists, a number of new jobs will be found in offices of physicians and diagnostic imaging centers. As tech­  The median annual wage of radiologic technologists was $52,210 in May 2008. The middle 50 percent earned between $42,710 and $63,010. The lowest 10 percent earned less than $35,100, and the highest 10 percent earned more than $74,970. Median annual wages in the industries employing the largest numbers of radiologic technologists in 2008 were: Medical and diagnostic laboratories...........................$55,210 Federal Executive Branch............................................53,650 General medical and surgical hospitals........................52,890 Outpatient care centers................................................. 50,840 Offices of physicians.................................................... 48,530  Related Occupations Radiologic technologists operate sophisticated equipment to help physicians, dentists, and other health practitioners diag­ nose and treat patients. Workers in related healthcare occupa­ tions include: Page Cardiovascular technologists and technicians......................... 408 Diagnostic medical sonographers........................................... 416 Nuclear medicine technologists.............................................. 426 Radiation therapists..................................................................387  Sources of Additional Information For information on careers in radiologic technology, contact: 'y American Society of Radiologic Technologists, 15000 Central Ave. SE., Albuquerque, NM 87123. Internet: http://www.asrt.org For the current list of accredited education programs in radi­ ography, contact:  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Number Percent 2018 17 37,000 251,700 214,700 Radiologic technologists and technicians........................................... 29-2034 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook. _________  Occupational Title   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  SOC Code  Employment, 2008  Professional and Related Occupations 441  >• Joint Review Committee on Education in Radiologic Technology, 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606-3182. Internet: http://www.jrcert.org For certification information, contact: > American Registry of Radiologic Technologists, 1255 Northland Dr., St. Paul, MN 55120-1155. Internet: http://www.arrt.org  U  %  If ;£ 5.  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl05.htm  Surgical Technologists Significant Points • Employment is expected to grow much faster than average. • Job opportunities will be best for technologists who are certified and for those who are willing to relocate. • Training programs last 9 to 24 months and lead to a certificate, diploma, or associate’s degree. • Hospitals will continue to be the primary employer, although much faster employment growth is expected in other healthcare industries. Nature of the Work Surgical technologists, also called scrubs and surgical or operating room technicians, assist in surgical operations under the supervision of surgeons, registered nurses, or other surgi­ cal personnel. Surgical technologists are members of operating room teams, which most commonly include surgeons, anesthe­ siologists, and circulating nurses. Before an operation, surgical technologists help prepare the operating room by setting up surgical instruments and equip­ ment, sterile drapes, and sterile solutions. They assemble both sterile and nonsterile equipment, as well as check and adjust it to ensure that it is working properly. Technologists also get patients ready for surgery by washing, shaving, and disinfect­ ing 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’ vi­ tal signs, check charts, and help the surgical team put on sterile gowns and gloves. During surgery, technologists pass instruments and other sterile supplies to surgeons and surgical assistants. They may hold retractors, cut sutures, and help count sponges, needles, supplies, and instruments. Surgical technologists help prepare, care for, and dispose of specimens taken for laboratory analysis and help apply dressings. Some operate sterilizers, lights, or suction machines and help operate diagnostic equipment. After an operation, surgical technologists may help transfer patients to the recovery room and clean and restock the operat­ ingFRASER room. Digitized for https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Before an operation, surgical technologists help prepare the operating room by setting up surgical instruments and equip­ ment, sterile drapes, and sterile solutions. Certified surgical technologists with additional specialized education or training also may act in the role of the surgical first assistant or circulator. Under the surgeon’s direction, the surgical first assistant, as defined by the American College of Surgeons (ACS), provides aid in exposure, hemostasis (controlling blood flow and stopping or preventing hemorrhage), and other techni­ cal functions that help the surgeon carry out a safe operation. A circulating technologist is the “unsterile” member of the surgi­ cal team who interviews the patient before surgery, prepares the patient for surgery, helps with anesthesia, obtains and opens packages for the “sterile” people to remove the sterile contents during the procedure, keeps a written account of the surgical procedure, and answers the surgeon’s questions about the pa­ tient during the surgery. Work environment. Surgical technologists work in clean, well-lighted, cool environments. They must stand for long pe­ riods and remain alert during operations. At times, they may be exposed to communicable diseases and unpleasant sights, odors, and materials. Most surgical technologists work a regular 40-hour week, although they may be on call or work nights, weekends, and holidays on a rotating basis.  Training, Other Qualifications, and Advancement Training programs last 9 to 24 months and lead to a certificate, diploma, or associate’s degree. Professional certification can help in getting jobs and promotions. Education and training. Surgical technologists receive their training in formal programs offered by community and junior colleges, vocational schools, universities, hospitals, and the military. In 2008, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) recognized more than 450 accredited training programs. Programs last from 9 to 24 months and lead to a certificate, diploma, or associate’s degree. High school graduation normally is required for admission. Recommended high school courses include health, biology, chemistry, and mathematics. Programs provide classroom education and supervised clini­ cal experience. Students take courses in anatomy, physiology, microbiology, pharmacology, professional ethics, and medical  442 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Occupational Title Code Number Percent 2018 23,200 25 114,700 91,500 29-2055 Surgical technologists........................................................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ________  soc  terminology. Other topics covered include the care and safety of patients during surgery, sterile techniques, and surgical proce­ dures. Students also learn to sterilize instruments; prevent and control infection; and handle special drugs, solutions, supplies, and equipment. Certification and other qualifications. Most employers pre­ fer to hire certified technologists. Technologists may obtain vol­ untary professional certification from the Liaison Council on Certification for the Surgical Technologist by graduating from a CAAHEP-accredited program and passing a national certifi­ cation examination. They may then use the Certified Surgical Technologist (CST) designation. In order to maintain certifi­ cation, certified surgical technologists must earn 60 hours of approved continuing education over a 4-year period or retake and pass the certifying exam at the end of the 4-year period. Certification also may be obtained from the National Center for Competency Testing (NCCT). To qualify to take the exam, candidates follow one of three paths: complete an accredited training program, undergo a 2-year hospital on-the-job train­ ing program, or acquire 7 years of experience working in the field. After passing the exam, individuals may use the designa­ tion Tech in Surgery-Certified, TS-C (NCCT). This certification must be renewed every 5 years through either continuing educa­ tion or reexamination. Surgical technologists need manual dexterity to handle instru­ ments quickly. They also must be conscientious, orderly, and emotionally stable to handle the demands of the operating room environment. Technologists must respond quickly and must be familiar with operating procedures in order to have instruments ready for surgeons without having to be told to do so. They are expected to keep abreast of new developments in the field. Advancement. Technologists advance by specializing in a particular area of surgery, such as neurosurgery or open-heart surgery. They also may work as circulating technologists. With additional training, some technologists advance to first assis­ tant. Some surgical technologists manage central supply depart­ ments in hospitals or take positions with insurance companies, sterile supply services, and operating equipment firms.  Employment Surgical technologists held about 91,500 jobs in 2008. About 71 percent of jobs for surgical technologists were in hospitals, mainly in operating and delivery rooms. Other jobs were in of­ fices of physicians or dentists who perform outpatient surgery and in outpatient care centers, including ambulatory surgical centers. A few technologists, known as private scrubs, are em­ ployed directly by surgeons who have special surgical teams, as those for liver transplants. Digitizedsuch for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Employment, 2008  Job Outlook Employment is expected to grow much faster than average. Job opportunities will be best for technologists who are certified and for those who are willing to relocate. Employment change. Employment of surgical technologists is expected to grow 25 percent between 2008 and 2018, much faster than the average for all occupations, as the volume of sur­ geries increases. The number of surgical procedures is expected to continue to rise as the population grows and ages. Older people, including the baby-boom generation, which generally requires more surgical procedures, will continue to account for a larger portion of the U.S. population. In addition, technologi­ cal advances, such as fiber optics and laser technology, have permitted an increasing number of new surgical procedures to be performed and also have allowed surgical technologists to assist with a greater number of procedures. Hospitals will continue to be the primary employer of surgi­ cal technologists, as they try to reduce costs by replacing nurses in the operating room. However, because of better paying op­ portunities, much faster employment growth is expected in offices of physicians and in outpatient care centers, including ambulatory surgical centers. Job prospects. Job opportunities will be best for technolo­ gists who are certified and for those who are willing to relocate.  Earnings Median annual wages of wage-and-salary surgical technolo­ gists were $38,740 in May 2008. The middle 50 percent earned between $32,490 and $46,910. The lowest 10 percent earned less than $27,510, and the highest 10 percent earned more than $54,300. Median annual wages in the industries employing the largest numbers of surgical technologists were as follows: Specialty (except psychiatric and substance abuse) hospitals......................................$40,880 Outpatient care centers................................................. 39,660 General medical and surgical hospitals........................38,640 Offices of physicians.................................................... 38,520 Offices of dentists......................................................... 36,380 Wages of surgical technologists vary with their experience and education, the responsibilities of the position, the working hours, and the economy of a given region of the country. Ben­ efits provided by most employers include paid vacation and sick leave; health, medical, vision, dental, and life insurance; and a retirement program. A few employers also provide tuition reim­ bursement and child care benefits.  Professional and Related Occupations 443  Related Occupations Other health occupations requiring approximately 1 year of training after high school include the following:  mm  ■',i’ 1  Page Clinical laboratory technologists and technicians................... 411 Dental assistants....................................................................... 447 Licensed practical and licensed vocational nurses................. 421 Medical assistants.................................................................... 455  Sources of Additional Information For additional information on a career as a surgical technolo­ gist, and for a list of CAAHEP-accredited programs, contact: y Association of Surgical Technologists, 6 West Dry Creek Circle, Suite 200, Littleton, CO 80120. Internet: http://www.ast.org For information on becoming a Certified Surgical Technolo­ gist, contact: y Liaison Council on Certification for the Surgical Technologist, 6 West Dry Creek Circle, Suite 100, Littleton, CO 80120. Internet: http://www.lcc-st.org For information on becoming a Tech in Surgery-Certified, contact: y National Center for Competency Testing, 7007 College Blvd., Suite 705, Overland Park, KS 66211. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl06.htm  Veterinary Technologists and Technicians Significant Points • Animal lovers get satisfaction from this occupation, but aspects of the work can be unpleasant, physically and emotionally demanding, and sometimes danger­ ous. • There are primarily two levels of education and train­ ing for entry to this occupation: a 2-year program for veterinary technicians and a 4-year program for vet­ erinary technologists. • Employment is expected to grow much faster than average. • Overall job opportunities should be excellent; how­ ever, keen competition is expected for jobs in zoos and aquariums. Nature of the Work Owners of pets and other animals today expect superior veteri­ nary care. To provide this service, veterinarians use the skills of veterinary technologists and technicians, who perform many of FRASER the same duties for a veterinarian that a nurse would for a Digitized for https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Veterinary technologists and technicians often assist veterinar­ ians by conducting tests. physician. Although specific job duties vary by employer, there is often little difference between the tasks carried out by techni­ cians and technologists, despite differences in formal education and training. However, most technicians work in private clinical practice while many technologists have the option to work in more advanced research-related jobs. Veterinary technologists and technicians typically conduct clinical work in a private practice under the supervision of a licensed veterinarian. Veterinary technologists and techni­ cians often perform various medical tests and treat and diag­ nose medical conditions and diseases in animals. For example, they may perform laboratory tests such as urinalysis and blood counts, assist with dental care, prepare tissue samples, take blood samples, and assist veterinarians in a variety of other di­ agnostic tests. While most of these duties are performed in a laboratory setting, many are not. For example, some veterinary technicians record patients’ case histories, expose and develop x rays and radiographs, and provide specialized nursing care. In addition, experienced veterinary technicians may discuss a pet’s condition with its owners and train new clinic personnel. Veterinary technologists and technicians assisting small-animal practitioners usually care for small pets, such as cats and dogs, but can perform a variety of duties with mice, rats, sheep, pigs, cattle, monkeys, birds, fish, and frogs. Very few veterinary tech­ nologists work in mixed animal practices where they care for both small pets and large, nondomestic animals. Besides working in private clinics and animal hospitals, some veterinary technologists and technicians work in research facili­ ties under the guidance of veterinarians or physicians. In this role, they may administer medications, prepare samples for laboratory examinations, or record information on an animal’s genealogy, diet, weight, medications, food intake, and clini­ cal signs of pain and distress. Some may sterilize laboratory and surgical equipment and provide routine postoperative care. Occasionally, veterinary technologists vaccinate newly admit­ ted animals and may have to euthanize seriously ill, severely injured, or unwanted animals. While the goal of most veterinary technologists and techni­ cians is to promote animal health, some contribute to human health, as well. Veterinary technologists occasionally assist vet­ erinarians in implementing research projects as they work with  444 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Code Number Percent 2018 28,500 36 108,100 79,600 29-2056 Veterinary technologists and technicians............................................ (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ Occupational Title  soc  Employment, 2008  tion Included in the Handbook.  other scientists in medical-related fields such as gene therapy and cloning. Some find opportunities in biomedical research, wildlife medicine, livestock management, pharmaceutical sales, and increasingly, in biosecurity and disaster preparedness. Work environment. While people who love animals get sat­ isfaction from helping them, some of the work may be unpleas­ ant, physically and emotionally demanding, and sometimes dangerous. Data from the U.S. Bureau of Labor Statistics show that full-time veterinary technologists and technicians expe­ rienced a work-related injury and illness rate that was much higher than the national average. At times, veterinary techni­ cians must clean cages and lift, hold, or restrain animals, risking exposure to bites or scratches. These workers must take pre­ cautions when treating animals with germicides or insecticides. The work setting can be noisy. Veterinary technologists and technicians who witness abused animals or who euthanize unwanted, aged, or hopelessly in­ jured animals may experience emotional stress. Those working for humane societies and animal shelters often deal with the public, some of whom might react with hostility to any implica­ tion that the owners are neglecting or abusing their pets. Such workers must maintain a calm and professional demeanor while they enforce the laws regarding animal care. In some animal hospitals, research facilities, and animal shel­ ters, a veterinary technician is on duty 24 hours a day, which means that some work night shifts. Most full-time veterinary technologists and technicians work about 40 hours a week, al­ though some work 50 or more hours a week.  Training, Other Qualifications, and Advancement There are primarily two levels of education and training for en­ try to this occupation: a 2-year program for veterinary techni­ cians and a 4-year program for veterinary technologists. Education and training. Most entry-level veterinary tech­ nicians have a 2-year associate degree from an American Veterinary Medical Association (AVMA)-accredited commu­ nity college program in veterinary technology in which courses are taught in clinical and laboratory settings using live animals. Currently, about 20 colleges offer veterinary technology pro­ grams that are longer and that culminate in a 4-year bachelor’s degree in veterinary technology. These 4-year colleges, in ad­ dition to some vocational schools, also offer 2-year programs in laboratory animal science. About 10 schools offer distance learning. In 2009, about 160 veterinary technology programs in 45 States were accredited by the American Veterinary Medical Association (AVMA). Graduation from an AVMA-accredited veterinary technology program allows students to take the credentialing exam in any State in the country. Those interested in careers as veterinary technologists and technicians should take as many high school science, biology, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  and math courses as possible. Science courses taken beyond high school, in an associate or bachelor’s degree program, should emphasize practical skills in a clinical or laboratory setting. Technologists and technicians usually begin work as train­ ees under the direct supervision of a veterinarian. Entry-level workers whose training or educational background encom­ passes extensive hands-on experience with diagnostic and med­ ical equipment usually require a shorter period of on-the-job training. Licensure and certification. Each State regulates veterinary technicians and technologists differently; however, all States re­ quire them to pass a credentialing exam following coursework. Passing the State exam assures the public that the technician or technologist has sufficient knowledge to work in a veteri­ nary clinic or hospital. Candidates are tested for competency through an examination that includes oral, written, and practical portions and that is regulated by the State Board of Veterinary Examiners or the appropriate State agency. Depending on the State, candidates may become registered, licensed, or certified. Most States, however, use the National Veterinary Technician (NVT) exam. Prospects usually can have their passing scores transferred from one State to another, so long as both States use the same exam. Employers recommend American Association for Laboratory Animal Science (AALAS) certification for those seeking em­ ployment in a research facility. AALAS offers certification for three levels of technician competence, with a focus on three principal areas—animal husbandry, facility management, and animal health and welfare. Those who wish to become certi­ fied must satisfy a combination of education and experience requirements prior to taking the AALAS examination. Work experience must be directly related to the maintenance, health, and well-being of laboratory animals and must be gained in a laboratory animal facility as defined by AALAS. Candidates who meet the necessary criteria can begin pursuing the desired certification on the basis of their qualifications. The lowest level of certification is Assistant Laboratory Animal Technician (ALAT), the second level is Laboratory Animal Technician (LAT), and the highest level of certification is Laboratory Animal Technologist (LATG). The AALAS examination con­ sists of multiple-choice questions and is longer and more dif­ ficult for higher levels of certification, ranging from 2 hours and 120 multiple choice questions for the ALAT, to 3 hours and 180 multiple choice questions for the LATG. Other qualifications. As veterinary technologists and technicians often deal with pet owners, communication skills are very important. In addition, technologists and technicians should be able to work well with others, because teamwork with veterinarians and other veterinary technicians is common.  Professional and Related Occupations 445  Organizational ability and the ability to pay attention to detail also are important. Advancement. As they gain experience, technologists and technicians take on more responsibility and carry out more as­ signments with little veterinary supervision. Some eventually may become supervisors.  Employment Veterinary technologists and technicians held about 79,600 jobs in 2008. About 91 percent worked in veterinary services. The remainder worked in boarding kennels, animal shelters, rescue leagues, and zoos.  Job Outlook Excellent job opportunities will stem from the need to replace veterinary technologists and technicians who leave the occupa­ tion and from the limited output of qualified veterinary techni­ cians from 2-year programs, which are not expected to meet the demand over the 2008-18 period. Employment is expected to grow much faster than average. Employment change. Employment of veterinary technolo­ gists and technicians is expected to grow 36 percent over the 2008-18 projection period, which is much faster than the aver­ age for all occupations. Pet owners are becoming more affluent and more willing to pay for advanced veterinary care because many of them consider their pet to be part of the family. This growing affluence and view of pets will continue to increase the demand for veterinary care. The vast majority of veterinary technicians work at private clinical practices under veterinar­ ians. As the number of veterinarians grows to meet the demand for veterinary care, so will the number of veterinary technicians needed to assist them. The number of pet owners who take advantage of veterinary services for their pets is expected to grow over the projection period, increasing employment opportunities. The availability of advanced veterinary services, such as preventive dental care and surgical procedures, also will provide opportunities for workers specializing in those areas as they will be needed to assist licensed veterinarians. The growing number of cats kept as companion pets is expected to boost the demand for feline medicine and services. Further demand for these workers will stem from the desire to replace veterinary assistants with more highly skilled technicians in animal clinics and hospitals, shel­ ters, boarding kennels, animal control facilities, and humane societies. Continued support for public health, food and animal safety, and national disease control programs, as well as biomedical research on human health problems, also will contribute to the demand for veterinary technologists, although the number of positions in these areas is fewer than in private practice Job prospects. Excellent job opportunities are expected because of the relatively few veterinary technology gradu­ ates each year. The number of 2-year programs has recently grown to about 160, but due to small class sizes, fewer than 3,800 graduates are anticipated each year, a number that is not expected to meet demand. Additionally, many veterinary tech­ nicians remain in the field less than 10 years, so the need to replace workers who leave the occupation each year also will produce many job opportunities.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Veterinary technologists also will enjoy excellent job op­ portunities due to the relatively few graduates from 4- year programs—about 500 annually. However, unlike veterinary technicians who usually work in private clinical practice, vet­ erinary technologists will have better opportunities for research jobs in a variety of settings, including biomedical facilities, di­ agnostic laboratories, wildlife facilities, drug and food manu­ facturing companies, and food safety inspection facilities. Despite the relatively few number of graduates each year, keen competition is expected for veterinary technician jobs in zoos and aquariums, due to expected slow growth in facility capacity, low turnover among workers, the limited number of positions, and the fact that the work in zoos and aquariums at­ tracts many candidates. Employment of veterinary technicians and technologists is relatively stable during periods of economic recession. Lay­ offs are less likely to occur among veterinary technologists and technicians than in some other occupations because animals will continue to require medical care.  Earnings Median annual wages of veterinary technologists and techni­ cians were $28,900 in May 2008. The middle 50 percent earned between $23,580 and $34,960. The bottom 10 percent earned less than $19,770, and the top 10 percent earned more than $41,490. Veterinary technologists in research jobs may earn more than veterinary technicians in other types of jobs.  Related Occupations Others who work extensively with animals include: Page Animal care and service workers..................................................504 Veterinarians......................................................................................402 Veterinary assistants and laboratory animal caretakers.............826  Sources of Additional Information For information on certification as a laboratory animal techni­ cian or technologist, contact: y American Association for Laboratory Animal Science, 9190 Crestwyn Hills Dr., Memphis, TN 38125. Internet: http://www.aalas.org For information on careers in veterinary medicine and a list­ ing of AVMA-accredited veterinary technology programs, con­ tact: > American Veterinary Medical Association, 1931 N. Meacham Rd., Suite 100, Schaumburg, IL 60173-4360. Internet: http://www.avma.org  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl83.htm  446 Occupational Outlook Handbook  Other Professional and Related Occupations Respiratory Therapy Technicians  Epidemiologists Nature of the Work  Nature of the Work  Epidemiologists investigate and describe the causes and spread of disease, and develop the means for prevention or control. Applied epidemiologists, who usually work for State health agencies, re­ spond to disease outbreaks, determining their causes and helping to contain them. Research epidemiologists study diseases in laborato­ ries and in the field to determine how to prevent future outbreaks.  Respiratory therapy technicians follow specific, well-defined respiratory care procedures under the direction of respiratory therapists and physicians. They help to evaluate, treat, and care for patients with breathing or other cardiopulmonary disorders.  Education and Training  An associate degree generally is required to work as a respira­ tory therapy technician. However, the entry-level requirement is  Most applied epidemiologists are required to have a master’s degree from a school of public health. Some research epidemi­ ologists may need a Ph.D. or medical degree, depending on the work they perform.  Job Outlook Current and projected employment: 2008 Employment.......................................................... 4,800 2018 Employment.......................................................... 5,500 Employment change.......................................................... 700 Growth rate....................................................................... 15% Employment change. Faster than average employment growth is projected for epidemiologists. A heightened aware­ ness of bioterrorism and rare but infectious diseases, such as West Nile Virus or Avian flu, should spur demand for these workers. Job prospects. Epidemiologists can expect excellent oppor­ tunities. Many States report shortages of qualified workers for applied epidemiology positions. There is greater competition for jobs as research epidemiologists.  Earnings Median annual wages for epidemiologists were $61,360 in May 2008.  Education and Training  a postsecondary certificate from an accredited school.  Job Outlook Current and projected employment: 2008 Employment........................................................ 16,500 2018 Employment.........................................................16,400 Employment change.........................................................-200 Growth rate........................................................................-1% Employment change. Little or no change in employment growth is projected for respiratory therapy technicians. Most work in respiratory care is being done by respiratory thera­ pists, resulting in limited demand for respiratory therapy technicians. Job prospects. Respiratory therapy technicians can expect keen competition. Very few openings for respiratory therapy technicians are expected, as the work is increasingly performed by respiratory therapists.  Earnings Median annual wages for respiratory therapy technicians were $42,430 in May 2008.  Related Occupations Biological scientists...... Health educators............ Medical scientists.......... Physicians and surgeons  Page .. 181 ..238 .. 189 ..381  Sources of Additional Information > Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333. Internet: http://www.cdc.gov/phtrain/epidemiology.html  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at  http://www.bls.gov/ooh/ocos310.htm https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Related Occupations Physicians and surgeons Respiratory therapists....  Page ..381 ..397  Sources of Additional Information > American Association for Respiratory Care, 9425 N. MacArthur Blvd., Suite 100, Irving, TX 75063. Internet: http://www.aarc.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos322.htm  Service Occupations Healthcare Support Occupations Dental Assistants Significant Points • Job prospects should be excellent. • Dentists are expected to hire more assistants to per­ form routine tasks so dentists may devote their time to more complex procedures. • Many assistants learn their skills on the job, although an increasing number are trained in dental-assisting programs; most programs take 1 year or less to com­ plete. • More than one-third of dental assistants worked part time in 2008. Nature of the Work Dental assistants perform a variety of patient care, office, and laboratory duties. They sterilize and disinfect instruments and equipment, prepare and lay out the instruments and materials re­ quired to treat each patient, and obtain and update patients’ dental records. Assistants make patients comfortable in the dental chair and prepare them for treatment. During dental procedures, assis­ tants work alongside the dentist to provide assistance. They hand instruments and materials to dentists and keep patients’ mouths dry and clear by using suction hoses or other devices. They also instmct patients on postoperative and general oral health care. Dental assistants may prepare materials for impressions and restorations, and process dental x rays as directed by a den­ tist. They also may remove sutures, apply topical anesthetics to gums or cavity-preventive agents to teeth, remove excess cement used in the filling process, and place dental dams to isolate teeth for treatment. Many States are expanding dental assistants’ duties to include tasks such as coronal polishing and restorative dentistry functions for those assistants who meet specific training and experience requirements. Dental assistants with laboratory duties make casts of the teeth and mouth from impressions, clean and polish removable appliances, and make temporary crowns. Those with office du­ ties schedule and confirm appointments, receive patients, keep treatment records, send bills, receive payments, and order den­ tal supplies and materials. Dental assistants must work closely with, and under the su­ pervision of, dentists. (See the statement on dentists elsewhere in the Handbook.) Additionally, dental assistants should not be confused with dental hygienists, who are licensed to perform a different set of clinical tasks. (See the statement on dental hygienists elsewhere in the Handbook.) Work environment. Dental assistants work in a well-lighted, clean environment. Their work area is usually near the den­ tal chair so that they can arrange instruments, materials, and  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  medication and hand them to the dentist when needed. Dental assistants must wear gloves, masks, eyewear, and protective clothing to protect themselves and their patients from infectious diseases. Assistants also follow safety procedures to minimize the risks associated with the use of x-ray machines. Almost half of dental assistants had a 35- to 40-hour work­ week in 2008. More than one-third worked part time, or less than 35 hours per week, and many others have variable schedules. Depending on the hours of the dental office where they work, assistants may have to work on Saturdays or evenings. Some dental assistants hold multiple jobs by working at dental offices that are open on different days or by scheduling their work at a second office around the hours they work at their primary office.  Training, Other Qualifications, and Advancement Many assistants learn their skills on the job, although an increasing number are trained in dental-assisting programs of­ fered by community and junior colleges, trade schools, techni­ cal institutes, or the Armed Forces. Most programs take 1 year to complete. For assistants to perform more advanced functions, or to have the ability to complete radiological procedures, many States require assistants to obtain a license or certification. Education and training. In most States, there are no for­ mal education or training requirements to become an entry-level dental assistant. High school students interested in a career as a dental assistant should take courses in biology, chemistry, health, and office practices. For those wishing to pursue further educa­ tion, the Commission on Dental Accreditation (CODA) approved 281 dental-assisting training programs in 2009. Programs in­ clude classroom, laboratory, and preclinical instruction in dentalassisting skills and related theory. Most programs take close to 1 year to complete and lead to a certificate or diploma. Two-year programs offered in community and junior colleges lead to an as­ sociate degree. All programs require a high school diploma or its equivalent, and some require science or computer-related courses for admission. A number of private vocational schools offer 4- to 6-month courses in dental assisting, but the Commission on Den­ tal Accreditation does not accredit these programs. A large number of dental assistants learn through on-the-job training. In these situations, the employing dentist or other den­ tal assistants in the dental office teach the new assistant dental terminology, the names of the instruments, how to perform daily duties, how to interact with patients, and other things necessary to help keep the dental office running smoothly. While some things can be picked up easily, it may be a few months before new dental assistants are completely knowledgeable about their duties and comfortable doing all their tasks without assistance. A period of on-the-job training is often required even for those who have completed a dental-assisting program or have some pre­ vious experience. Different dentists may have their own styles of doing things that need to be learned before an assistant can be comfortable working with them. Office-specific information, such 447  448 Occupational Outlook Handbook  Dental assistants sterilize and disinfect instruments and equipment. as where files and instruments are kept, will need to be learned at each new job. Also, as dental technology changes, dental assistants need to stay familiar with the instruments and procedures that they will be using or helping dentists to use. On-the-job training may be sufficient to keep assistants up-to-date on these matters. Licensure and certification. Most States regulate the du­ ties that dental assistants are allowed to perform. Some States require licensure or registration to perform expanded functions or to perform radiological procedures within a dentist’s office. Licensure may include attending an accredited dental assisting program and passing a written or practical examination. Many States also require continuing education to maintain licensure or registration. However, a few States allow dental assistants to perform any function delegated to them by the dentist. Since re­ quirements vary widely by State, it is recommended to contact the appropriate State board directly for specific requirements. The Certified Dental Assistant (CDA) credential, adminis­ tered by the Dental Assisting National Board (DANB), is recog­ nized or required in more than 37 States toward meeting various requirements. Candidates may qualify to take the DANB certi­ fication examination by graduating from a CODA-accredited dental assisting education program or by having 2 years of full­ time, or 4 years of part-time, experience as a dental assistant. In addition, applicants must have current certification in cardio­ pulmonary resuscitation. For annual recertification, individuals must earn continuing education credits. Other organizations of­ fer registration, most often at the State level. Individual States have also adopted different standards for dental assistants who perform certain advanced duties. In some States, dental assistants who perform radiological procedures must complete additional training distinct from that required to perform other expanded functions. Completion of the Ra­ diation Health and Safety examination or the Certified Dental  Assistant examination offered by Dental Assisting National Board (DANB) meets the standards in 30 States and the Dis­ trict of Columbia. Some States require completion of a Stateapproved course in radiology as well. Twelve States have no formal requirements to perform radiological procedures. Other qualifications. Dental assistants must be a second pair of hands for a dentist; therefore, dentists look for people who are reliable, work well with others, and have good manual dexterity. Certification and advancement. Without further education, advancement opportunities are limited. Some dental assistants be­ come office managers, dental-assisting instructors, dental product sales representatives, or insurance claims processors for dental insurance companies. Others go back to school to become dental hygienists. For many, this entry-level occupation provides basic training and experience and serves as a steppingstone to more highly skilled and higher paying jobs. Assistants wishing to take on expanded functions or perform radiological procedures may choose to complete coursework in those functions allowed under State regulation or, if required, obtain a State-issued license.  Employment Dental assistants held about 295,300 jobs in 2008. About 93 percent of all jobs for dental assistants were in offices of dentists. A small number of jobs were in the Federal, State, and local governments or in offices of physicians.  Job Outlook Employment is expected to increase much faster than average; job prospects are expected to be excellent. Employment change. Employment is expected to grow 36 percent from 2008 to 2018, which is much faster than the av­ erage for all occupations. In fact, dental assistants are expected to be among the fastest growing occupations over the 2008-18 projection period. Population growth, greater retention of nat­ ural teeth by middle-aged and older people, and an increased focus on preventative dental care for younger generations will fuel demand for dental services. Older dentists, who have been less likely to employ assistants or have employed fewer, are leaving the occupation and will be replaced by recent graduates, who are more likely to use one or more assistants. In addition, as dentists’ workloads increase, they are expected to hire more assistants to perform routine tasks, so that they may devote their own time to more complex procedures. Job prospects. Job prospects should be excellent, as dentists continue to need the aid of qualified dental assistants. There will be many opportunities for entry-level positions, but some dentists prefer to hire experienced assistants, those who have completed a dental-assisting program, or have met State re­ quirements to take on expanded functions within the office.  Projections data from the National Employment Matrix Projected Change, 2008-2018 Employment, Code Number Percent 2018 105,600 36 295,300 400,900 31-9091 Dental assistants..................................................................................... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ____________________________________ _  Occupational Title   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc  Employment, 2008  Service Occupations 449  In addition to job openings due to employment growth, some job openings will arise out of the need to replace assistants who transfer to other occupations, retire, or leave for other reasons.  Earnings Median annual wages of dental assistants were $32,380 in May 2008. The middle 50 percent earned between $26,980 and $38,960. The lowest 10 percent earned less than $22,270, and the highest 10 percent earned more than $46,150. Benefits vary substantially by practice setting and may be contingent upon full-time employment. According to a 2008 survey conducted by the Dental Assisting National Board (DANB), 86 percent of Certified Dental Assistants (CDA)  Home Health Aides and Personal and Home Care Aides Significant Points • Job opportunities are expected to be excellent be­ cause of rapid growth in home healthcare and high replacement needs. • Training requirements vary from State to State, the type of home services agency, and funding source covering the costs of services. • Many of these workers work part time and weekends or evenings to suit the needs of their clients.  reported receiving paid vacation from their employers, and  Nature of the Work  more than half of CDAs received health benefits.  Home health aides and personal and home care aides help people who are disabled, chronically ill, or cognitively im­ paired and older adults, who may need assistance, live in their own homes or in residential facilities instead of in health facilities or institutions. They also assist people in hospices and day programs and help individuals with disabilities go to work and remain engaged in their communities. Most aides work with elderly or physically or mentally disabled clients who need more care than family or friends can provide. Oth­ ers help discharge hospital patients who have relatively short­ term needs. Aides provide light housekeeping and homemaking tasks such as laundry, change bed linens, shop for food, plan and pre­ pare meals. Aides also may help clients get out of bed, bathe, dress, and groom. Some accompany clients to doctors’ appoint­ ments or on other errands. Home health aides and personal and home care aides pro­ vide instruction and psychological support to their clients. They may advise families and patients on nutrition, cleanliness, and household tasks. Aides’ daily routine may vary. They may go to the same home every day or week for months or even years, and often visit four or five clients on the same day. However, some aides may work solely with one client who is in need of more care and attention . In some situations, this may involve working with other aides in shifts so that the client has an aide throughout the day and night. Aides also work with clients, particularly younger adults at schools or at the client’s work site. In general, home health aides and personal and home care aides have similar job duties. However, there are some small differences. Home health aides typically work for certified home health or hospice agencies that receive government funding and therefore must comply with regulations from to receive funding. This means that they must work under the direct supervision of a medical professional, usually a nurse. These aides keep records of services performed and of clients’ condition and progress. They report changes in the client’s condition to the supervi­ sor or case manager. Aides also work with therapists and other medical staff. Home health aides may provide some basic health-related services, such as checking patients’ pulse rate, temperature, and  Related Occupations Other workers support health practitioners, including: Page Dental hygienists...................................................................... 414 Medical assistants.................................................................... 455 Occupational therapist assistants andaides............................462 Pharmacy technicians and aides...............................................436 Physical therapist assistants and aides.................................... 465 Surgical technologists.............................................................. 441  Sources of Additional Information Information about career opportunities and accredited dental assistant programs is available from: y Commission on Dental Accreditation, American Dental Association, 211 East Chicago Ave., Suite 1900, Chicago, IL 60611. Internet: http://www.ada.org/prof/ed/accred/commission/index.asp For information on becoming a Certified Dental Assistant and a list of State boards of dentistry, contact: y Dental Assisting National Board, Inc., 444 N. Michigan Ave., Suite 900, Chicago, IL 60611. Internet: http ://www.danb.org For more information on a career as a dental assistant and general information about continuing education, contact: y American Dental Assistants Association, 35 East Wacker Dr., Suite 1730, Chicago, IL 60601. Internet: http ://www.dentalassistant.org  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl63.htm  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  450 Occupational Outlook Handbook  i: . . . . . X?  Home health aides and personal and home care aides help peo­ ple in their own homes or in residential facilities. respiration rate. They also may help with simple prescribed ex­ ercises and assist with medications administration. Occasion­ ally, they change simple dressings, give massages, provide skin care, or assist with braces and artificial limbs. With special train­ ing, experienced home health aides also may assist with medical equipment such as ventilators, which help patients breathe. Personal and home care aides—also called homemakers, caregivers, companions, and personal attendants—work for various public and private agencies that provide home care ser­ vices. In these agencies, caregivers are likely supervised by a licensed nurse, social worker, or other non-medical managers. Aides receive detailed instructions explaining when to visit cli­ ents and what services to perform for them. However, personal and home care aides work independently, with only periodic visits by their supervisors. These caregivers may work with only one client each day or five or six clients once a day every week or every 2 weeks. Some aides are hired directly by the patient or the patient’s family. In these situations, personal and home care aides are supervised and assigned tasks directly by the patient or the pa­ tient’s family. Aides may also work with individuals who are developmen­ tally or intellectually disabled. These workers are often called direct support professionals and they may assist in implement­ ing a behavior plan, teaching self-care skills and providing employment support, as well as providing a range of other per­ sonal assistance services. Work environment. Work as an aide can be physically de­ manding. Aides must guard against back injury because they may have to move patients into and out of bed or help them to stand or walk. Aides also may face hazards from minor infec­ tions and exposure to communicable diseases, such as hepati­ tis, but can avoid infections by following proper procedures. Because mechanical lifting devices available in institutional  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  settings are not as frequently available in patients’ homes, home health aides must take extra care to avoid injuries result­ ing from overexertion when they assist patients. These workers experienced a larger than average number of work-related inju­ ries or illnesses Aides also perform tasks that some may consider unpleasant, such as emptying bedpans and changing soiled bed linens. The patients they care for may be disoriented, irritable, or uncoop­ erative. Although their work can be emotionally demanding, many aides gain satisfaction from assisting those in need. Most aides work with a number of different patients, each job lasting a few hours, days, or weeks. They often visit multiple patients on the same day. Surroundings differ by case. Some homes are neat and pleasant, whereas others are untidy and de­ pressing. Some clients are pleasant and cooperative; others are angry, abusive, depressed, or otherwise difficult. Home health aides and personal and home care aides gener­ ally work alone, with periodic visits from their supervisor. They receive detailed instructions explaining when to visit patients and what services to perform. Aides are responsible for getting to patients’ homes, and they may spend a good portion of the work day traveling from one patient to another. Many of these workers work part time and weekends or eve­ nings to suit the needs of their clients.  Training, Other Qualifications, and Advancement Home health aides must receive formal training and pass a com­ petency test to work for certified home health or hospice agen­ cies that receive reimbursement from Medicare or Medicaid. Personal and home care aides, however, face a wide range of requirements, which vary from State to State. Education and training. Home health aides and personal and home care aides are generally not required to have a high school diploma. They usually are trained on the job by reg­ istered nurses, licensed practical nurses, experienced aides, or their supervisor. Aides are instructed on how to cook for a client, including on special diets. Furthermore, they may be trained in basic housekeeping tasks, such as making a bed and keeping the home sanitary and safe for the client. Generally, they are taught how to respond to an emergency, learning basic safety techniques. Employers also may train aides to conduct themselves in a professional and courteous manner while in a client’s home. Some clients prefer that tasks are done a certain way and will teach the aide. A competency evaluation may be required to ensure that the aide can perform the required tasks. Licensure. Home health aides who work for agencies that receive reimbursement from Medicare or Medicaid must re­ ceive a minimum level of training. They must complete both a training program consisting of a minimum of 75 hours and a competency evaluation or state certification program. Training includes information regarding personal hygiene, safe transfer techniques, reading and recording vital signs, infection control, and basic nutrition. Aides may take a competency exam to be­ come certified without taking any of the training. At a mini­ mum, 16 hours of supervised practical training are required before an aide has direct contact with a resident. These certifi­ cation requirements represent the minimum, as outlined by the Federal Government. Some States may require additional hours of training to become certified. Personal and home care aides are not required to be certified.  Service Occupations 451  Other qualifications. Aides should have a desire to help people. They should be responsible, compassionate, patient, emotionally stable, and cheerful. In addition, aides should be tactful, honest, and discreet, because they work in private homes. Aides also must be in good health. A physical examina­ tion, including State-mandated tests for tuberculosis and other diseases, may be required. A criminal background check and a good driving record also may be required for employment. Certification and advancement. The National Association for Home Care and Hospice (NAHC) offers national certifica­ tion for aides. Certification is a voluntary demonstration that the individual has met industry standards. Certification requires the completion of 75 hours of training; observation and documenta­ tion of 17 skills for competency, assessed by a registered nurse; and the passing of a written exam developed by NAHC. Advancement for home health aides and personal and home care aides is limited. In some agencies, workers start out per­ forming homemaker duties, such as cleaning. With experience and training, they may take on more personal care duties. Some aides choose to receive additional training to become nursing aides, licensed practical nurses, or registered nurses. Some may start their own home care agency or work as a self-employed aide. Self-employed aides have no agency affiliation or super­ vision and accept clients, set fees, and arrange work schedules on their own.  Employment Home health aides and personal and home care aides held about 1.7 million jobs in 2008. The majority of jobs were in home healthcare services, individual and family services, residential care facilities, and private households.  Job Outlook Excellent job opportunities are expected for this occupation be­ cause rapid employment growth and high replacement needs are projected to produce a large number of job openings. Employment change. Employment of home health aides is projected to grow by 50 percent between 2008 and 2018, which is much faster than the average for all occupations. Employ­ ment of personal and home care aides is expected to grow by 46 percent from 2008 to 2018, which is much faster than the average for all occupations. For both occupations, the expected growth is due, in large part, to the projected rise in the number of elderly people, an age group that often has mounting health problems and that needs some assistance with daily activities. The elderly and other clients, such as the mentally disabled, increasingly rely on home care. This trend reflects several developments. Inpatient care in hospitals and nursing homes can be extremely expensive, so  more patients return to their homes from these facilities as quickly as possible in order to contain costs. Patients, who need assistance with everyday tasks and household chores rather than medical care, can reduce medical expenses by returning to their homes. Furthermore, most patients—particularly the el­ derly—prefer care in their homes rather than in nursing homes or other in-patient facilities. This development is aided by the realization that treatment can be more effective in familiar sur­ roundings. Job prospects. In addition to job openings created by the increased demand for these workers, replacement needs are expected to lead to many openings. The relatively low skill re­ quirements, low pay, and high emotional demands of the work result in high replacement needs. For these same reasons, many people are reluctant to seek jobs in the occupation. Therefore, persons who are interested in and suited for this work—particu­ larly those with experience or training as personal care, home health, or nursing aides—should have excellent job prospects.  Earnings Median hourly wages of wage-and-salary personal and home care aides were $9.22 in May 2008. The middle 50 percent earned between $7.81 and $10.98 an hour. The lowest 10 per­ cent earned less than $6.84, and the highest 10 percent earned more than $12.33 an hour. Median hourly wages in the indus­ tries employing the largest numbers of personal and home care aides were as follows: Individual and family services............................................$9.77 Employment services..............................................................9.76 Residential mental retardation, mental health and substance abuse facilities................................................... 9.70 Vocational rehabilitation services......................................... 9.58 Home health care services...................................................... 7.94  Median hourly wages of home health aides were $9.84 in May 2008. The middle 50 percent earned between $8.52 and $11.69 an hour. The lowest 10 percent earned less than $7.65, and the highest 10 percent earned more than $13.93 an hour. Median hourly wages in the industries employing the largest numbers of home health aides in May 2008 were: Nursing care facilities........................................................$10.20 Residential mental retardation, mental health and substance abuse facilities..................................................10.02 Home health care services......................................................9.70 Individual and family services..............................................9.48 Community care facilities for the elderly............................9.44  Projections data from the National Employment Matrix Projected Change, Employment, 2008-2018 2018 Number Percent Home health aides and personal and home care aides.............. 1,738,800 2.575.600 836,700 48 Home health aides........................................ 5i-irti i 921,700 1.382.600 460,900 JU Personal and home care aides..................................... ........ 39-9021 817,200 1.193.000 375.800 40 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational InformaOccupational Title  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  soc Code  Employment, 2008  452 Occupational Outlook Handbook  Aides receive slight pay increases with experience and added responsibility. Usually, they are paid only for the time worked in the home, not for travel time between jobs, and must pay for their travel costs from their earnings. Most employers hire only on-call hourly workers.  Related Occupations Home health aides and personal and home care aides combine the duties of caregivers and social service workers. Workers in related occupations that involve personal contact to help others include: Page Child care workers................................................................... 510 Licensed practical and licensed vocational nurses.................. 421 Medical assistants....................................................................455 Nursing aides, orderlies, and attendants.................................. 460 Occupational therapist assistants and aides............................ 462 Physical therapist assistants and aides.................................... 465 Psychiatric aides....................................................................... 460 Radiation therapists.................................................................. 387 Registered nurses..................................................................... 392 Social and human service assistants.........................................244  Sources of Additional Information Information on licensing requirements for nursing and home health aides, as well as lists of State-approved nursing aide pro­ grams, are available from State departments of public health, departments of occupational licensing, boards of nursing, and home care associations. For information about voluntary credentials for personal and home care aides, contact: > National Association for Home Care and Hospice, 228 Seventh St. SE., Washington, DC 20003. Internet: http://www.nahc.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos326.htm  Massage Therapists  sports injuries, and promoting general health. Clients often seek massage for its medical benefit and for relaxation purposes, and there is a wide range of massage treatments available. Massage therapists can specialize in more than 80 different types of massage, called modalities. Swedish massage, deeptissue massage, reflexology, acupressure, sports massage, and neuromuscular massage are just a few of the many approaches to massage therapy. Most massage therapists specialize in several modalities, which require different techniques. Some use exag­ gerated strokes ranging the length of a body part, while others use quick, percussion-like strokes with a cupped or closed hand. A massage can be as long as 2 hours or as short as 5 or 10 min­ utes. Usually, the type of massage given depends on the client’s needs and physical condition. For example, therapists may use special techniques for elderly clients that they would not use for athletes, and they would use approaches for clients with inju­ ries that would not be appropriate for clients seeking relaxation. Also, some forms of massage are given solely to one type of cli­ ent; for example, prenatal massage and infant massage are given to pregnant women and new mothers, respectively. Massage therapists work by appointment. Before begin­ ning a massage therapy session, therapists conduct an infor­ mal interview with the client to learn the person’s medical history and desired results from the massage. This interview gives therapists a chance to discuss which techniques could be beneficial to the client and which could be harmful. Be­ cause massage therapists tend to specialize in only a few ar­ eas of massage, customers will often be referred to or seek a therapist with a certain type of massage in mind. Based on the person’s goals, ailments, medical history, and stress-related or pain-related problem areas, a massage therapist will conclude whether a massage would be harmful and if not, move forward with the session. While giving the massage, therapists alter their approach or concentrate on areas of particular discomfort as necessary. Many modalities of massage therapy use massage oils, lo­ tions, or creams to massage and rub the client’s muscles. Most massage therapists, particularly those who are self-employed, supply their own table or chair, sheets, pillows, and body lo­ tions or oils. Most modalities of massage require clients to be covered in a sheet or blanket and to be undressed or wear loose-  Significant Points • This occupation includes a large percentage of part­ time and self-employed workers. • Many States require formal training and licensure in order to practice massage therapy. • Employment is expected to grow faster than average as more people learn about the benefits of massage therapy.  s. »  Nature of the Work Massage therapy is the practice of using touch to manipulate the soft-tissue muscles of the body. It is performed for a variety of reasons, including treating painful ailments, decompressing tired and overworked muscles, reducing stress, rehabilitating   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  _______  Massage therapists apply pressure to relieve stress and promote health.  Service Occupations 453  fitting clothing. The therapist exposes only the body part being massaged. Some types of massage are done without oils or lo­ tions and are performed with the client fully clothed. Massage therapists must develop a rapport with their clients if repeat customers are to be secured. Because those who seek a therapist tend to make regular visits, developing a loyal clien­ tele is an important part of becoming successful. Work environment. Massage therapists work in an array of settings, both private and public: private offices, studios, hos­ pitals, nursing homes, fitness centers, sports medicine facili­ ties, airports, and shopping malls, for example. Some massage therapists also travel to clients’ homes or offices to provide a massage. It is common for full-time massage therapists to di­ vide their time among several different settings, depending on the clients and locations scheduled. Most massage therapists give massages in dimly lit settings. Using candles and/or incense is not uncommon. Ambient or other calm, soothing music is often played. The dim lighting, smells, and background noise are meant to put clients at ease. However, when visiting a client’s office, a massage therapist may not have those amenities. The working conditions depend heavily on a therapist’s location and what the client wants. Because massage is physically demanding, massage thera­ pists can succumb to injury if the proper technique is not used. Repetitive-motion problems and fatigue from standing for ex­ tended lengths of time are most common. These risks can be limited by the use of good techniques, proper spacing between sessions, exercise, and, in many cases, by the therapists them­ selves receiving a massage on a regular basis. Because of the physical nature of the work and the time needed in between sessions, massage therapists typically work less than 40 hours per week. Most therapists who work 15 to 30 hours per week consider themselves to be full-time work­ ers, because when time for travel, for setting up equipment, and for completing business functions, such as billing, are added, a massage therapist’s hours per week may very well be more than 40 hours. About 48 percent of all massage therapists worked part time and 19 percent had variable schedules in 2008. Training, Other Qualifications, and Advancement In 2009, 42 States and the District of Columbia had laws regu­ lating massage therapy in some way. Most of the boards govern­ ing massage therapy in these States require practicing massage therapists to complete a formal education program and pass an examination. As of 2009, States without licensure requirements were Alaska, Idaho, Kansas, Minnesota, Montana, Oklahoma, Vermont, and Wyoming. In these States, massage therapy may be regulated at the local level. Because laws often change, it is best to check information on licensing, certification, and ac­ creditation on a State-by-State basis. Education and training. Training standards and require­ ments for massage therapists vary greatly by State and locality. Education programs are typically found in private or public postsecondary institutions and can require 500 hours of study or more to complete. A high school diploma or equivalent de­ gree is usually required for admission. Massage therapy pro­ grams generally cover subjects such as anatomy; physiology, the study of organs and tissues; kinesiology, the study of mo­ tion and body mechanics; business management; ethics; and the   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  hands-on practice of massage techniques. Training programs may concentrate on certain modalities of massage. Several pro­ grams also provide alumni services such as post-graduate job placement and continuing educational services. Both full-time and part-time programs are available. Massage therapy programs vary in accreditation. Generally, they are approved by a State board, and they also may be ac­ credited by an independent accrediting agency. In States that regulate massage therapy, graduation from an approved school or training program usually is required in order to practice. Some State regulations require that therapists keep up on their knowledge and technique through continuing education. Licensure. In States with massage therapy regulations, workers must obtain a license after graduating from a training program and prior to practicing massage. Passage of an exami­ nation is usually required for licensure. The examination may be solely a State exam or one of two nationally recognized tests: the National Certification Examination for Therapeu­ tic Massage and Bodywork (NCETMB) and the Massage and Bodywork Licensing Examination (MBLEx). Massage therapy licensure boards decide which certifications and tests to accept on a State-by-State basis. Therefore, those wishing to practice massage therapy should look into legal requirements for the State and locality in which they intend to practice. A fee and periodic renewal of licensure also may be required. Other qualifications. Strong communication skills and a friendly, empathetic personality are extremely helpful qualities for fostering a trusting relationship with clients and, in turn, expanding one’s client base. Massage can be a delicate issue for some clients, and because of this, making clients feel comfort­ able is one of the most important skills for massage therapists. Advancement. Because of the nature of massage therapy, opportunities for advancement are limited. However, with in­ creased experience and an expanding client base, there are op­ portunities for therapists to increase client fees and, therefore, income. Therapists also may become managers of the office in which they work and may teach in a training program. In addi­ tion, those who are well organized and have an entrepreneurial spirit may go into business for themselves. Self-employed mas­ sage therapists with a large client base have the highest earnings. Employment Massage therapists held about 122,400 jobs in 2008. About 57 percent were self-employed. Many more people practice massage therapy as a secondary source of income. Of those who were self-employed, most owned their own businesses or worked as independent contractors. Others found employment in personal care services establishments, the offices of physi­ cians and chiropractors, fitness and recreational sports centers and hotels. Although massage therapists can find jobs through­ out the country, employment is concentrated in metropolitan areas, as well as resort and destination locales. Job Outlook Employment of massage therapists is expected to grow faster than average. Opportunities should be available to those who complete formal training programs and pass a professionally recognized examination, but new massage therapists should ex-  454 Occupational Outlook Handbook  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Occupational Title Code Number Percent 2018 23,200 19 145,600 122,400 31-9011 Massage therapists................................................................................. (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. _____________________________________________ ___________  soc  pect to work only part time until they can build a client base of their own. Employment change. Employment of massage therapists is expected to increase by 19 percent from 2008 to 2018, faster than the average for all occupations. Employment will grow as more people learn about the benefits of massage therapy. Continued growth in the demand for massage services will lead to new openings for massage therapists. The number of spas, which employ a large number of therapists, has in­ creased in recent years and will continue to do so. At the same time, there are an increasing number of massage clinic fran­ chises, many of which offer massages cheaper than at spas and resorts, making them available to a wider range of customers. In addition, as an increasing number of States adopt licensing requirements and standards for therapists, the practice of mas­ sage is likely to be respected and accepted by more and more people. Massage also offers specific benefits to particular groups of people, whose continued demand for massage services will lead to overall growth for the occupation. For example, as workplaces try to distinguish themselves as employee-friendly, providing professional in-office, seated massages for employ­ ees is becoming a popular on-the-job benefit. Older citizens in nursing homes or assisted-living facilities also are finding benefits from massage, such as increased energy levels and re­ duced health problems. Demand for massage therapy should grow among older age groups because they increasingly are enjoying longer, more active lives and persons aged 55 years and older are projected to be the most rapidly growing segment of the U.S. population over the next decade. However, demand for massage therapy is presently greatest among young adults, who lack the concerns about massage that previous genera­ tions had. Job prospects. In States that regulate massage therapy, op­ portunities should be available to those who complete formal training programs and pass a professionally recognized ex­ amination. However, new massage therapists should expect to work only part time in spas, hotels, hospitals, physical therapy centers, and other businesses until they can build a client base of their own. Because referrals are a very important source of work for massage therapists, networking will increase the num­ ber of job opportunities. Joining a professional association also can help build strong contacts and further increase the likeli­ hood of steady work.  Earnings Median hourly wages of massage therapists, including gratu­ ities, were $16.78 in May 2008. The middle 50 percent earned between $11.36 and $25.14. The lowest 10 percent earned less than $8.01, and the highest 10 percent earned more than $33.47.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Employment, 2008  Because many therapists work part time, yearly earnings can vary considerably, depending on the therapist’s schedule. Gen­ erally, massage therapists earn some portion of their income as gratuities. For those who work in a hospital or other clinical setting, however, tipping is not common. As is typical for most workers who are self-employed and work part time, few benefits are provided.  Related Occupations Massage therapists provide services that promote relaxation or physical well-being for clients. Other workers who provide similar services include: Page Athletic trainers........................................................................405 Chiropractors............................................................................ 360 Physical therapist assistants and aides.................................... 465 Physical therapists....................................................................377  Sources of Additional Information General information on becoming a massage therapist is avail­ able from State regulatory boards. For more information on becoming a massage therapist, contact: y Associated Bodywork & Massage Professionals, 25188 Genesee Trail Road, Suite 200 Golden, CO 80401. Internet: http://www.massagetherapy.com/careers/index.php y American Massage Therapy Association, 500 Davis St., Suite 900, Evanston, IL 60201. Internet: http://www.amtamassage.org For a directory of schools providing accredited massage ther­ apy training programs, contact: y Accrediting Commission of Career Schools and Colleges, 2101 Wilson Blvd., Suite 302, Arlington, VA 22201. Internet: http ://www.accsc.org y Commission on Massage Therapy Accreditation, 5335 Wisconsin Ave. NW., Suite 440, Washington, DC, 20015. Internet: http://www.comta.org Information on national testing and national certification is available from: > Federation of State Massage Therapy Boards, 7111 W 151st St., Suite 356, Overland Park, Kansas 66223. Internet: http://www.fsmtb.org y National Certification Board for Therapeutic Massage and Bodywork, 1901 S. Meyers Rd., Suite 240, Oakbrook Terrace, IL 60181. Internet: http://www.ncbtmb.org  The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos295.htm  Service Occupations 455  Medical Assistants Significant Points  • Employment is projected to grow much faster than average, ranking medical assistants among the fastest growing occupations over the 2008-18 decade. • Job prospects should be excellent. • About 62 percent of medical assistants work in of­ fices of physicians. • Some medical assistants are trained on the job, but many complete 1-year or 2-year programs. Nature of the Work Medical assistants perform administrative and clinical tasks to keep the offices of physicians, podiatrists, chiropractors, and other health practitioners running smoothly. The duties of medical assistants vary from office to office, depending on the location and size of the practice and the practitioner’s specialty. In small practices, medical assistants usually do many different kinds of tasks, handling both administrative and clinical duties and reporting directly to an office manager, physician, or other health practitioner. Those in large practices tend to specialize in a particular area, under the supervision of department adminis­ trators. Medical assistants should not be confused with physi­ cian assistants, who examine, diagnose, and treat patients under the direct supervision of a physician. (Physician assistants are discussed elsewhere in the Handbook.) Administrative medical assistants update and file patients’ medical records, fill out insurance forms, and arrange for hospi­ tal admissions and laboratory services. They also perform tasks less specific to medical settings, such as answering telephones, greeting patients, handling correspondence, scheduling ap­ pointments, and handling billing and bookkeeping. Clinical medical assistants have various duties, depending on State law. Some common tasks include taking medical histories and recording vital signs, explaining treatment procedures to pa­ tients, preparing patients for examinations, and assisting physi­ cians during examinations. Medical assistants collect and prepare  '  '  Medical assistants often take medical histories and record vital signs ofpatients.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  laboratory specimens and sometimes perform basic laboratory tests, dispose of contaminated supplies, and sterilize medical instruments. As directed by a physician, they might instruct pa­ tients about medications and special diets, prepare and adminis­ ter medications, authorize drug refills, telephone prescriptions to a pharmacy, draw blood, prepare patients for x rays, take elec­ trocardiograms, remove sutures, and change dressings. Medical assistants also may arrange examining room instruments and equipment, purchase and maintain supplies and equipment, and keep waiting and examining rooms neat and clean. Ophthalmic medical assistants, optometric assistants, and podiatric medical assistants are examples of specialized assis­ tants who have additional duties. Ophthalmic medical assistants help ophthalmologists provide eye care. They conduct diagnos­ tic tests, measure and record vision, and test eye muscle func­ tion. They apply eye dressings and also show patients how to insert, remove, and care for contact lenses. Under the direction of the physician, ophthalmic medical assistants may administer eye medications. They also maintain optical and surgical instru­ ments and may assist the ophthalmologist in surgery. Optomet­ ric assistants also help provide eye care, working with optome­ trists. They provide chair-side assistance, instruct patients about contact lens use and care, conduct preliminary tests on patients, and otherwise provide assistance while working directly with an optometrist. Podiatric medical assistants make castings of feet, expose and develop x rays, and assist podiatrists in surgery. Work environment. Medical assistants work in well-lighted, clean environments. They constantly interact with other people and may have to handle several responsibilities at once. Most full­ time medical assistants work a regular 40-hour week. However, medical assistants may work part time, evenings, or weekends. Training, Other Qualifications, and Advancement Some medical assistants are trained on the job, but many com­ plete 1- or 2-year programs. Almost all medical assistants have at least a high school diploma, although there are no formal education or training requirements. Education and training. Medical assisting programs are offered in vocational-technical high schools, postsecondary vo­ cational schools, and community and junior colleges. Postsecond­ ary programs usually last either 1 year and result in a certificate or diploma, or 2 years and result in an associate degree. Courses cover anatomy, physiology, and medical terminology, as well as keyboarding, transcription, recordkeeping, accounting, and insur­ ance processing. Students learn laboratory techniques, clinical and diagnostic procedures, pharmaceutical principles, the admin­ istration of medications, and first aid. They study office practices, patient relations, medical law, and ethics. There are two accredit­ ing bodies that accredit medical assisting programs. Accredited programs often include an internship that provides practical expe­ rience in physicians’ offices or other healthcare facilities. Formal training in medical assisting, while generally pre­ ferred, is not required. Many medical assistants are trained on the job, and usually only need to have a high school diploma or the equivalent. Recommended high school courses include mathematics, health, biology, keyboarding, bookkeeping, com­ puters, and office skills. Volunteer experience in the healthcare field also is helpful. Medical assistants who are trained on the  456 Occupational Outlook Handbook  job usually spend their first few months attending training ses­ sions and working closely with more experienced workers. Some States allow medical assistants to perform more ad­ vanced procedures, such as giving injections or taking x rays, after passing a test or taking a course. Other qualifications. Medical assistants deal with the pub­ lic; therefore, they must be neat and well groomed and have a courteous, pleasant manner and they must be able to put patients at ease and explain physicians’ instructions. They must respect the confidential nature of medical information. Clinical duties require a reasonable level of manual dexterity and visual acuity. Certification and advancement. Although not required, cer­ tification indicates that a medical assistant meets certain stan­ dards of knowledge. It may also help to distinguish an experi­ enced or formally trained assistant from an entry-level assistant, which may lead to a higher salary or more employment oppor­ tunities. There are various associations—such as the American Association of Medical Assistants (AAMA) and Association of Medical Technologists (AMT)—that award certification cre­ dentials to medical assistants. The certification process varies by association. It is also possible to become certified in a spe­ cialty, such as podiatry, optometry, or ophthalmology. Medical assistants may also advance to other occupations through experience or additional training. For example, some may go on to teach medical assisting, and others pursue addi­ tional education to become nurses or other healthcare workers. Administrative medical assistants may advance to office manag­ ers, or qualify for a variety of administrative support occupations.  Employment Medical assistants held about 483,600 jobs in 2008. About 62 percent worked in offices of physicians; 13 percent worked in public and private hospitals, including inpatient and outpatient facilities; and 11 percent worked in offices of other health prac­ titioners, such as chiropractors and optometrists. Most of the remainder worked in other health care industries, such as out­ patient care centers and nursing and residential care facilities.  Job Outlook Employment is projected to grow much faster than average, rank­ ing medical assistants among the fastest growing occupations over the 2008-18 decade. Job opportunities should be excellent, particu­ larly for those with formal training or experience, and certification. Employment change. Employment of medical assistants is expected to grow 34 percent from 2008 to 2018, much faster than the average for all occupations. As the health care industry expands because of technological advances in medicine and the growth and aging of the population, there will be an increased need for all health care workers. The increasing prevalence of certain conditions, such as obesity and diabetes, also will in­ crease demand for health care services and medical assistants.  Increasing use of medical assistants to allow doctors to care for more patients will further stimulate job growth. Helping to drive job growth is the increasing number of group practices, clinics, and other health care facilities that need a high proportion of support personnel, particularly medical as­ sistants who can handle both administrative and clinical duties. In addition, medical assistants work mostly in primary care, a consistently growing sector of the health care industry. Job prospects. Jobseekers who want to work as a medical assistant should find excellent job prospects. Medical assistants are projected to account for a very large number of new jobs, and many other opportunities will come from the need to re­ place workers leaving the occupation. Medical assistants with formal training or experience—particularly those with certifica­ tion—should have the best job opportunities, since employers generally prefer to hire these workers.  Earnings The earnings of medical assistants vary, depending on their experience, skill level, and location. Median annual wages of wage-and-salary medical assistants were $28,300 in May 2008. The middle 50 percent earned between $23,700 and $33,050. The lowest 10 percent earned less than $20,600, and the highest 10 percent earned more than $39,570. Median annual wages in the industries employing the largest numbers of medical assis­ tants in May 2008 were: General medical and surgical hospitals......................$29,720 Colleges, universities, and professional schools......... 28,820 Offices of physicians.................................................... 28,710 Outpatient care centers.................................................28,570 Offices of other health practitioners.............................25,240  Related Occupations Medical assistants perform work similar to the tasks completed by other workers in medical support occupations. Administra­ tive medical assistants do work similar to that of: Page Medical records and health information technicians.............. 423 Medical secretaries...................................................................583 Medical transcriptionists..........................................................457 Clinical medical assistants perform duties similar to those of: Dental assistants.......................................................................447 Dental hygienists......................................................................414 Licensed practical and licensed vocational nurses.................. 421 Nursing and psychiatric aides................................................. 460 Occupational therapist assistants and aides............................ 462 Pharmacy technicians and aides.............................................. 436 Physical therapist assistants and aides.................................... 465 Surgical technologists..............................................................441  Projections data from the National Employment Matrix Occupational Title  soc  Code  Employment, 2008  Projected Employment, 2018 647,500  Change, 2008-2018 Number Percent 163.900 34  483,600 31-9092 Medical assistants.................................................................................. (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Service Occupations 457  Sources of Additional Information  Nature of the Work  Information about career opportunities and certification for medical assistants is available from: y American Association of Medical Assistants, 20 North  Medical transcriptionists listen to dictated recordings made by physicians and other healthcare professionals and transcribe them into medical reports, correspondence, and other adminis­ trative material. They generally listen to recordings on a head­ set, using a foot pedal to pause the recording when necessary, and key the text into a personal computer or word processor, editing as necessary for grammar and clarity. The documents they produce include discharge summaries, medical history and physical examination reports, operative reports, consul­ tation reports, autopsy reports, diagnostic-imaging studies, progress notes, and referral letters. Medical transcriptionists return transcribed documents to the physicians or other health­ care professionals who dictated them for review and signature or correction. These documents eventually become part of pa­ tients’ permanent files. To understand and accurately transcribe dictated reports, medical transcriptionists must understand medical terminol­ ogy, anatomy and physiology, diagnostic procedures, pharma­ cology, and treatment assessments. They also must be able to translate medical jargon and abbreviations into their expanded forms. To help identify terms appropriately, transcriptionists refer to standard medical reference materials—both printed and electronic; some of these are available over the Internet. Medical transcriptionists must comply with specific stan­ dards that apply to the style of medical records and to the le­ gal and ethical requirements for keeping patient information confidential. Experienced transcriptionists spot mistakes or inconsisten­ cies in a medical report and check to correct the information. Their ability to understand and correctly transcribe patient assessments and treatments reduces the chance of patients receiving ineffective or even harmful treatments and ensures high-quality patient care. Currently, most healthcare providers use either digital or analog dictating equipment to transmit dictation to medical transcriptionists. The Internet has grown to be a popular mode for transmitting documentation. Many transcriptionists re­ ceive dictation over the Internet and are able to quickly return transcribed documents to clients for approval. Also, because of the popularity of using the Internet to transmit documenta­ tion, many medical transcription departments are beginning to work closely with programmers and information systems staff to stream in voice communication that provides seamless data transfers through network interfaces. This practice allows medi­ cal transcriptionists the convenience of having hand-held per­ sonal computers or personal data assistants (PDAs) that utilize software for dictation. Another increasingly popular method uses speech recog­ nition technology, which electronically translates sound into text and creates drafts of reports. Transcriptionists then format the reports; edit them for mistakes in translation, punctuation, or grammar; and check for consistency and any wording that doesn’t make sense medically. Transcriptionists working in specialties such as radiology or pathology, which have stan­ dardized terminology, are more likely to use speech recogni­ tion technology, a medium that will become more widespread in all specialties as it becomes more sophisticated and is better  Wacker Dr., Suite 1575, Chicago, IL 60606. Internet: http ://www.aama-ntl.org y American Medical Technologists, 10700 West Higgins Rd., Suite 150, Rosemont, IL 60018. Internet: http://www.amtl.com y National Healthcareer Association, 7 Ridgedale Ave., Suite 203, Cedar Knolls, NJ 07927. Internet: http ://www.nhanow.com For lists of accredited educational programs in medical as­ sisting, contact: y Accrediting Bureau of Health Education Schools, 7777 Leesburg Pike, Suite 314 N, Falls Church, VA 22043. Internet: http://www.abhes.org y Commission on Accreditation of Allied Health Education Programs, 1361 Park St., Clearwater, FL 33756. Internet: http://www.caahep.org Information about career opportunities, training programs, and certification for ophthalmic medical personnel is available from: > Joint Commission on Allied Health Personnel in Ophthalmology, 2025 Woodlane Dr., St. Paul, MN 55125. Internet: http://www.jcahpo.org Information about career opportunities, training programs, and certification for optometric assistants is available from: y American Optometric Association, 243 N. Lindbergh Blvd., St. Louis, MO 63141. Internet: http://www.aoa.org Information about certification for podiatric assistants is available from: y American Society of Podiatric Medical Assistants, 2124 South Austin Blvd., Cicero, IL 60804. Internet: http ://www.aspma.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl64.htm  Medical Transcriptionists Significant Points • Job opportunities will be good, especially for those who are certified. • Employers prefer medical transcriptionists who have completed a postsecondary training program. • Many medical transcriptionists telecommute from home-based offices. • About 36 percent worked in hospitals, and another 23 percent worked in offices of physicians.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  458 Occupational Outlook Handbook  '  -<s§ ;■ •  |  Transcriptionists receive dictation over the Internet and are able to quickly return transcribed documents to clients for approval. able to recognize and more accurately transcribe diverse modes of speech. Medical transcriptionists who work in physicians’ offices may have other office duties, such as receiving patients, sched­ uling appointments, answering the telephone, and handling incoming and outgoing mail. Medical secretaries, discussed in the statement on secretaries and administrative assistants else­ where in the Handbook, also may perform transcription as part of their jobs. Work environment. The majority of these workers are employed in comfortable settings, such as hospitals, physi­ cians’ offices, transcription service offices, clinics, laborato­ ries, medical libraries, government medical facilities, or their own homes. Many medical transcriptionists telecommute from home-based offices. Workers usually sit in the same position for long periods. They can suffer wrist, back, neck, or eye problems caused by strain and risk repetitive motion injuries such as carpal tunnel syndrome. The constant pressure to be accurate and productive also can be stressful. Many medical transcriptionists work a standard 40-hour week. Self-employed medical transcriptionists are more likely to work irregular hours—including part time, evenings, and weekends. Some may be on call at any time. Training, Other Qualifications, and Advancement Postsecondary training in medical transcription is preferred by employers; writing and computer skills also are important. Education and training. Employers prefer to hire transcrip­ tionists who have completed postsecondary training in medical transcription offered by many vocational schools, community colleges, and distance-learning programs.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Completion of a 2-year associate’s degree or 1-year certificate program—including coursework in anatomy, medical terminology, legal issues relating to healthcare docu­ mentation, and English grammar and punctuation—is highly recommended, but not always required. Many of these pro­ grams include supervised on-the-job experience. Some tran­ scriptionists, especially those already familiar with medical terminology from previous experience as a nurse or medical secretary, become proficient through refresher courses and training. Formal accreditation is not required for medical transcrip­ tion programs. However, the Approval Committee for Cer­ tificate Programs (AACP)—established by the Association for Healthcare Documentation Integrity (AHDI) and the American Health Information Management Association— offers voluntary accreditation for medical transcription pro­ grams. Although voluntary, the completion of an ACCPapproved program may be required for transcriptionists seeking certification. Certification and other qualifications. The AHDI awards two voluntary designations; Registered Medical Transcriptionist (RMT) and Certified Medical Transcriptionist (CMT). Medical transcriptionists who are recent graduates of medical transcription educational programs or who have fewer than 2 years’ experience in acute care may become a registered RMT. The credential is awarded upon successfully passing the AHDI level-1 registered medical transcription exam. The CMT designation requires at least 2 years of acute care ex­ perience using different format, report, and dictation types in multiple-specialty surgery areas. Candidates also must earn a passing score on a certification examination. Because medicine is constantly evolving, medical transcriptionists are encouraged to update their skills regularly. In order to be recertified, RMTs and CMTs must pay a recertification fee. In addition to the fee, RMTs must earn a minimum of 30 continuing education credits in required categories dur­ ing their 3-year cycle. CMTs must successfully complete an online course and final exam during the 3-year cycle. As in many other fields, certification is recognized as a sign of competence. Graduates of an ACCP-approved program who earn the RMT credential are eligible to participate in the Registered Appren­ ticeship Program sponsored by the Medical Transcription In­ dustry Association through the U.S. Department of Labor. The program offers structured on-the-job learning and related tech­ nical instruction for qualified medical transcriptionists entering the profession. In addition to understanding medical terminology, transcrip­ tionists must have good English grammar and punctuation skills and proficiency with personal computers and word-processing software. Normal hearing acuity and good listening skills also are necessary. Employers usually require applicants to take pre­ employment tests. Advancement. With experience, medical transcriptionists can advance to supervisory positions, home-based work, edit­ ing, consulting, or teaching. Some become owners of medical transcription businesses. With additional education or training, some become medical records and health information techni-  Service Occupations 459  cians, medical coders, or medical records and health informa­ tion administrators.  Employment Medical transcriptionists held about 105,200 jobs in 2008. About 36 percent worked in hospitals and another 23 percent worked in offices of physicians. Others worked for business support services; medical and diagnostic laboratories; outpa­ tient care centers; offices of physical, occupational, and speech therapists; and offices of audiologists.  Job Outlook Employment of medical transcriptionists is projected to grow about as fast as the average; job opportunities should be good, especially for those who are certified. Employment change. Employment of medical transcrip­ tionists is projected to grow by 11 percent from 2008 to 2018, about as fast as the average for all occupations. Demand for medical transcription services will continue to be spurred by a growing and aging population. Older age groups receive pro­ portionally greater numbers of medical tests, treatments, and procedures that require documentation. A high level of demand for transcription services also will be sustained by the contin­ ued need for electronic documentation that can be shared eas­ ily among providers, third-party payers, regulators, consumers, and health information systems. Growing numbers of medical transcriptionists will be needed to amend patients’ records, edit documents from speech recognition systems, and identify dis­ crepancies in medical reports. Contracting out transcription work overseas and advance­ ments in speech recognition technology are not expected to significantly reduce the need for well-trained medical transcrip­ tionists. Outsourcing transcription work abroad—to countries such as India, Pakistan, Philippines, Barbados, and Canada— has grown more popular as transmitting confidential health in­ formation over the Internet has become more secure; however, the demand for overseas transcription services is expected only to supplement the demand for well-trained domestic medical transcriptionists. In addition, reports transcribed by overseas medical transcription services usually require editing for ac­ curacy by domestic medical transcriptionists before they meet U.S. quality standards. Speech recognition technology allows physicians and other health professionals to dictate medical reports to a computer, which immediately creates an electronic document. In spite of the advances in this technology, the software has been slow to grasp and analyze the human voice, the English language, and the medical vernacular with all its diversity. As a result, there will continue to be a need for skilled medical transcrip­ tionists to identify and appropriately edit the inevitable errors  created by speech recognition systems and to create a final document. Job prospects. Job opportunities will be good, especially for those who are certified. Hospitals will continue to employ a large percentage of medical transcriptionists, but job growth will be in other industries. An increasing demand for standard­ ized records should result in rapid employment growth in phy­ sicians’ offices, especially in large group practices.  Earnings Wage-and-salary medical transcriptionists had median hourly wages of $15.41 in May 2008. The middle 50 percent earned between $13.02 and $18.55. The lowest 10 percent earned less than $10.76, and the highest 10 percent earned more than $21.81. Median hourly wages in the industries employ­ ing the largest numbers of medical transcriptionists were as follows: Medical and diagnostic laboratories.............................$17.26 General medical and surgical hospitals..........................15.88 Outpatient care centers....................................................15.46 Offices of physicians...................................................... 15.02 Business support services............................................... 14.52 Compensation arrangements for medical transcriptionists vary. Some are paid on the basis of the number of hours they work or the number of lines they transcribe. Others receive a base pay per hour, with incentives for extra production. Em­ ployees of transcription services and independent contractors almost always receive production-based pay. Independent contractors earn more than do transcriptionists who work for others, but independent contractors have higher expenses than their corporate counterparts, receive no benefits, and may face a higher risk of termination than do wage-and-salary transcriptionists.  Related Occupations Workers in other occupations also type, record information, and process paperwork. Among these workers are the following: Page Court reporters.........................................................................250 Human resources assistants, except payroll and timekeeping...................................................................592 Receptionists and information clerks...................................... 570 Secretaries and administrative assistants................................ 583 Other workers who provide medicalsupport include the following: Medical assistants....................................................................455 Medical records and health information technicians..............423  Projections data from the National Employment Matrix Occupational Title Medical transcriptionists.......................................................................  SOC Code 31-9094  Employment, 2008 105,200  Projected Employment, 2018 116,900  Change, 2008-2018 Number Percent 11,700 11  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  460 Occupational Outlook Handbook  Sources of Additional Information For information on a career as a medical transcriptionist, contact: > Association for Healthcare Documentation Integrity, 4230 Kiernan Ave., Suite 130, Modesto, CA 95356. Internet: http://www.ahdionline.org State employment service offices can provide information about job openings for medical transcriptionists. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http ://www.bls.gov/ooh/ocos271.htm  Nursing and Psychiatric Aides Significant Points • Numerous job openings and excellent job opportuni­ ties are expected. • Most jobs are in nursing and residential care facilities and in hospitals. • A high school diploma is required for many jobs; specific qualifications vary by occupation, State laws, and work setting. • This occupation is characterized by modest entry re­ quirements, low pay, high physical and emotional de­ mands, and limited advancement opportunities. Nature of the Work Nursing and psychiatric aides help care for physically or men­ tally ill, injured, disabled, or infirm individuals in hospitals, nursing care facilities, and mental health settings. Nursing aides and home health aides are among the occupations commonly referred to as direct care workers, due to their role in working with patients who need long-term care. The specific care they give depends on their specialty. Nursing aides, also known as nurse aides, nursing assistants, certified nursing assistants, geriatric aides, unlicensed assistive personnel, orderlies, or hospital attendants, provide hands-on care and perform routine tasks under the supervision of nurs­ ing and medical staff. Specific tasks vary, with aides handling many aspects of a patient’s care. They often help patients to eat, dress, and bathe. They also answer calls for help, deliver messages, serve meals, make beds, and tidy up rooms. Aides sometimes are responsible for taking a patient’s temperature, pulse rate, respiration rate, or blood pressure. They also may help provide care to patients by helping them get out of bed and walk, escorting them to operating and examining rooms, or providing skin care. Some aides help other medical staff by set­ ting up equipment, storing and moving supplies, and assisting with some procedures. Aides also observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff. Nursing aides employed in nursing care facilities often are the principal caregivers and have more contact with residents  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  than do other members of the staff. Because some residents may stay in a nursing care facility for months or even years, aides develop positive, caring relationships with their patients. Psychiatric aides, also known as mental health assistants or psychiatric nursing assistants, care for mentally impaired or emotionally disturbed individuals. They work under a team that may include psychiatrists, psychologists, psychiatric nurses, social workers, and therapists. In addition to helping patients to dress, bathe, groom themselves, and eat, psychiat­ ric aides socialize with them and lead them in educational and recreational activities. Psychiatric aides may play card games or other games with patients, watch television with them, or participate in group activities, such as playing sports or going on field trips. They observe patients and report any physical or behavioral signs that might be important for the professional staff to know. They accompany patients to and from therapy and treatment. Because they have such close contact with patients, psychiatric aides can have a great deal of influence on their out­ look and treatment. Work environment. Work as an aide can be physically de­ manding. Aides spend many hours standing and walking, and they often face heavy workloads. Aides must guard against back injury, because they may have to move patients into and out of bed or help them stand or walk. It is important for aides to be trained in and to follow the proper procedures for lifting and moving patients. Aides also may face hazards from minor infections and major diseases, such as hepatitis, but can avoid infections by following proper procedures. Nursing aides, or­ derlies, and attendants and psychiatric aides have some of the highest non-fatal injuries and illness rates for all occupations, in the 98th and 99th percentiles in 2007. Aides also perform tasks that some may consider unpleasant, such as emptying bedpans and changing soiled bed linens. The patients they care for may be disoriented, irritable, or uncoop­ erative. Psychiatric aides must be prepared to care for patients whose illnesses may cause violent behavior. Although their work can be emotionally demanding, many aides gain satisfac­ tion from assisting those in need. Most full-time aides work about 40 hours per week, but be­ cause patients need care 24 hours a day, some aides work eve­ nings, nights, weekends, and holidays. In 2008 about 24 percent  HHH Nursing aides often help patients to eat, dress, and bathe.  Service Occupations 461  of nursing aides, orderlies, and attendants and psychiatric aides worked part-time.  Training, Other Qualifications, and Advancement In many cases, a high school diploma or equivalent is necessary for a job as a nursing or psychiatric aide. Specific qualifications vary by occupation, State laws, and work setting. Advancement opportunities are limited. Education and training. Nursing and psychiatric aide training is offered in high schools, vocational-technical cen­ ters, some nursing care facilities, and some community col­ leges. Courses cover body mechanics, nutrition, anatomy and physiology, infection control, communication skills, and resident rights. Personal care skills, such as how to help pa­ tients bathe, eat, and groom themselves, also are taught. Hos­ pitals may require previous experience as a nursing aide or home health aide. Some States also require psychiatric aides to complete a formal training program. However, most psy­ chiatric aides learn their skills on the job from experienced workers. Some employers provide classroom instruction for newly hired aides, while others rely exclusively on informal on-thejob instruction by a licensed nurse or an experienced aide. Such training may last from several days to a few months. Aides also may attend lectures, workshops, and in-service training. Licensure and certification. Federal Government require­ ments exist for nursing aides who work in nursing care fa­ cilities. These aides must complete a minimum of 75 hours of State-approved training and pass a competency evaluation. Aides who complete the program are known as certified nurse assistants (CNAs) and are placed on the State registry of nurse aides. Additional requirements may exist, but vary by State. Therefore, individuals should contact their State board directly for applicable information. Other qualifications. Aides must be in good health. A physi­ cal examination, including State-regulated disease tests, may be required. A criminal background check also is usually required for employment. Applicants should be tactful, patient, understanding, emo­ tionally stable, and dependable and should have a desire to help people. They also should be able to work as part of a team, have good communication skills, and be willing to perform repeti­ tive, routine tasks. Advancement. Opportunities for advancement within these occupations are limited. Aides generally need additional for­ mal training or education to enter other health occupations. The most common healthcare occupations for former aides are li­ censed practical nurse, registered nurse, and medical assistant.  For some individuals, these occupations serve as entry-level jobs. For example, some high school and college students gain experience working in these occupations while attending school. And experience as an aide can help individuals decide whether to pursue a career in healthcare.  Employment Nursing and psychiatric aides held about 1.5 million jobs in 2008. Nursing aides, orderlies, and attendants held the most jobs—approximately 1.5 million, and psychiatric aides held about 62,500 jobs. About 41 percent of nursing aides, order­ lies, and attendants worked in nursing care facilities and an­ other 29 percent worked in hospitals. About 50 percent of all psychiatric aides worked in hospitals. Others were employed in residential care facilities, government agencies, outpatient care centers, and individual and family services.  Job Outlook Employment is projected to grow faster than the average. Ex­ cellent job opportunities are expected. Employment change. Overall employment of nursing and psychiatric aides is projected to grow 18 percent between 2008 and 2018, faster than the average for all occupations. However, growth will vary for individual occupations. Employment for nursing aides, orderlies, and attendants will grow 19 percent, faster than the average for all occupations, predominantly in response to the long-term care needs of an increasing elderly population. Financial pressures on hospitals to discharge pa­ tients as soon as possible should boost admissions to nursing care facilities. As a result, new jobs will be more numerous in nursing and residential care facilities than in hospitals, and growth will be especially strong in community care facilities for the elderly. Modem medical technology will also drive de­ mand for nursing aides, because as the technology saves and extends more lives, it increases the need for long-term care provided by aides. However, employment growth is not ex­ pected to be as fast as for other healthcare support occupations, largely because nursing aides are concentrated in the relatively slower growing nursing and residential care facilities industry sector. In addition, growth will be hindered by nursing facili­ ties’ reliance on government funding, which does not increase as fast as the cost of patient care. Government funding lim­ its the number of nursing aides nursing facilities can afford to have on staff. Psychiatric aides are expected to grow 6 percent, more slowly than average. Psychiatric aides are a small occupation compared to nursing aides, orderlies, and attendants. Most psychiatric aides currently work in hospitals, but the industries most likely to see growth will be residential facilities for people with developmental  Projections data from the National Employment Matrix Occupational Title Nursing and psychiatric aides............................. Nursing aides, orderlies, and attendants..................... ................. Psychiatric aides........................................  soc  Code  Employment, 2008  Projected Employment, 2018 1,811,800 1,745,800  Change, 2008-2018 Number Percent 279,600 276,000 3.600  1,532,300 1,469,800 62,500 66.100 (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa-  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  31-1012  462 Occupational Outlook Handbook  disabilities, mental illness, and substance abuse problems. There is a long-term trend toward treating psychiatric patients outside of hospitals, because it is more cost effective and allows patients greater independence. Demand for psychiatric aides in residential facilities will rise in response to increases in the number of older persons, many of whom will require mental health services. De­ mand for these workers will also grow as an increasing number of mentally disabled adults, formerly cared for by their elderly par­ ents, will need care. Job growth also could be affected by changes in government funding of programs for the mentally ill. Job prospects. High replacement needs for nursing and psy­ chiatric aides reflect modest entry requirements, low pay, high physical and emotional demands, and limited opportunities for advancement within the occupation. For these same reasons, the number of people looking to enter the occupation will be limited. Many aides leave the occupation to attend training programs for other healthcare occupations. Therefore, people who are interested in, and suited for, this work should have ex­ cellent job opportunities.  Earnings Median hourly wages of nursing aides, orderlies, and attendants were $11.46 in May 2008. The middle 50 percent earned be­ tween $9.71 and $13.76 an hour. The lowest 10 percent earned less than $8.34, and the highest 10 percent earned more than $15.97 an hour. Median hourly wages in the industries employ­ ing the largest numbers of nursing aides, orderlies, and atten­ dants in May 2008 were: Employment services................................................... $12.10 General medical and surgical hospitals.......................... 12.05 Nursing care facilities.....................................................11.13 Commumity care facilities for the elderly..................... 10.91 Home health care services.............................................. 10.58 Median hourly wages of psychiatric aides were $12.77 in May 2008. The middle 50 percent earned between $10.00 and $15.63 an hour. The lowest 10 percent earned less than $8.35, and the highest 10 percent earned more than $18.77 an hour. Median hourly wages in the industries employing the largest numbers of psychiatric aides in May 2008 were: Psychiatric and substance abuse hospitals...................$13.43 General medical and surgical hospitals.......................... 13.29 Nursing care facilities.....................................................11.66 Individual and family services....................................... 10.78 Residential mental retardation, mental health and substance abuse facilities.............................................. 9.89  Related Occupations Other occupations that help people who need routine care or treatment include: Page Child care workers.................................................................. 510 Home health aides and personal and home care aides........... 449 Licensed practical and licensedvocational nurses................... 421 Medical assistants....................................................................455 Occupational therapist assistants and aides............................462 Registered nurses..................................................................... 392 and human service assistants.........................................244 DigitizedSocial for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Sources of Additional Information Information about employment opportunities may be obtained from local hospitals, nursing care facilities, home healthcare agencies, psychiatric facilities, State boards of nursing, and lo­ cal offices of the State employment service. Information on licensing requirements for nursing aides, and lists of State-approved nursing aide programs are available from State departments of public health, departments of occupational licensing, and boards of nursing. For more information on nursing aides, orderlies, and atten­ dants, contact: y National Association of Health Care Assistants, 1201 L St. NW., Washington, DC 20005. Internet: http://www.nahcacares.org V National Network of Career Nursing Assistants 3577 Easton Rd., Norton, OH 44203. Internet: http://www.cna-network.org For more information on the assisted living, nursing facility, developmentally-disabled, and subacute care provider industry, contact: > American Health Care Association, 1201 L St. NW., Washington, DC 20005. Internet: http://www.ahca.org/ The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos327.htm  Occupational Therapist Assistants and Aides Significant Points • Typical entry-level education for occupational thera­ pist assistants is an associate degree; in contrast, oc­ cupational therapist aides usually receive their train­ ing on the job. • Many States regulate the practice of occupational therapist assistants either by licensing, registration, or certification; requirements vary by State. • Employment is projected to grow much faster than average as demand for occupational therapist services rises and as occupational therapists increasingly use assistants and aides. • Job prospects should be very good for occupational therapist assistants; jobseekers holding only a high school diploma might face keen competition for oc­ cupational therapist aide jobs. Nature of the Work Occupational therapist assistants and aides work under the supervision of occupational therapists to provide rehabilitative services to persons with mental, physical, emotional, or devel­ opmental impairments. The ultimate goal is to improve clients’  Service Occupations 463  quality of life and ability to perform daily activities. For ex­ ample, occupational therapist assistants help injured workers re-enter the labor force by teaching them how to compensate for lost motor skills or help individuals with learning disabili­ ties increase their independence. Occupational therapist assistants help clients with rehabilita­ tive activities and exercises outlined in a treatment plan devel­ oped in collaboration with an occupational therapist. Activities range from teaching the proper method of moving from a bed into a wheelchair to the best way to stretch and limber the mus­ cles of the hand. Assistants monitor an individual’s activities to make sure that they are performed correctly and to provide en­ couragement. They also record their client’s progress for the oc­ cupational therapist. If the treatment is not having the intended effect, or the client is not improving as expected, the therapist may alter the treatment program in hopes of obtaining better results. In addition, occupational therapist assistants document the billing of the client’s health insurance provider. Occupational therapist aides typically prepare materials and assemble equipment used during treatment. They are re­ sponsible for a range of clerical tasks, including scheduling appointments, answering the telephone, restocking or ordering depleted supplies, and filling out insurance forms or other pa­ perwork. Aides are not regulated by States, so the law does not allow them to perform as wide a range of tasks as occupational therapist assistants. Work environment. Occupational therapist assistants and aides need to have a moderate degree of strength because of the physical exertion required to assist patients. For example, as­ sistants and aides may need to lift patients. Constant kneeling, stooping, and standing for long periods also are part of the job. The hours and days that occupational therapist assistants and aides work vary by facility and whether they are full time or part time. For example, many outpatient therapy offices and clinics have evening and weekend hours to coincide with pa­ tients’ schedules.  Training, Other Qualifications, and Advancement An associate degree from an accredited academic program is generally required to qualify for occupational therapist assistant jobs. In contrast, occupational therapist aides usually receive most of their training on the job. Many States regulate the prac­ tice of occupational therapist assistants either by licensing, reg­ istration, or certification; requirements vary by State. Education and training. Occupational therapist assistants must attend a school accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) in order to sit for the national certifying exam for occupational therapist assis­ tants. There were 135 ACOTE accredited occupational therapist assistant programs in 2009. The first year of study typically involves an introduction to healthcare, basic medical terminology, anatomy, and physiol­ ogy. In the second year, courses are more rigorous and usually include occupational therapy courses in areas such as mental health, adult physical disabilities, gerontology, and pediatrics. Students also must complete at least 16 weeks of supervised fieldwork in a clinic or community setting. Applicants to occupational therapist assistant programs can improve their chances of admission by taking high school in biology and health and by performing volunteer Digitized courses for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  4 i  Occupational therapy assistants and aides need a moderate de­ gree of strength because of the physical exertion required to assist patients. work in nursing care facilities, occupational or physical thera­ pists’ offices, or other healthcare settings. Occupational therapist aides usually receive most of their training on the job. Qualified applicants must have a high school diploma, strong interpersonal skills, and a desire to help people in need. Applicants may increase their chances of getting a job by volunteering their services, thus displaying initiative and ap­ titude to the employer. Licensure. Forty States, Guam, Puerto Rico, and the Dis­ trict of Columbia regulate the practice of occupational therapist assistants either by licensing, registration, or certification. In addition, eligibility requirements vary by State. Contact your State’s licensing board for specific regulatory requirements on occupational therapist assistants. Some States have additional requirements for therapist as­ sistants who work in schools or early intervention programs. These requirements may include education-related classes, an education practice certificate, or early intervention certification. Certification and other qualifications. Certification is voluntary. The National Board for Certifying Occupational Therapy certifies occupational therapist assistants through a national certifying exam. Those who pass the test are awarded the title Certified Occupational Therapy Assistant (COTA). In some States, the national certifying exam meets requirements for regulation, but other States have their own licensing exam.  464 Occupational Outlook Handbook  centage of trauma victims to survive, creating added demand for therapy services. Demand for therapy may be dampened by Federal legislation imposing limits on reimbursement for therapy services. Demand from adolescents will increase due to expansion of the school-age population and Federal legislation mandating funding for education for the disabled. Occupational therapists are expected to increasingly employ assistants to reduce the cost of occupational therapy services. Once a patient is evaluated and a treatment plan is designed by the therapist, the occupational therapist assistant can provide many aspects of treatment, as prescribed by the therapist. Job prospects. Opportunities for occupational therapist as­ sistants should be very good. However, individuals with only a high school diploma may face keen competition for occupational therapist aide jobs. Occupational therapist assistants and aides with prior experience working in an occupational therapy office or other healthcare setting will have the best job opportunities. In addition to employment growth, job openings will result from the need to replace occupational therapist assistants and aides who leave the occupation permanently over the 2008-18 period.  Occupational therapist assistants are expected to continue their professional development by participating in continuing education courses and workshops in order to maintain certifi­ cation. A number of States require continuing education as a condition of maintaining licensure. Assistants and aides must be responsible, patient, and willing to take directions and work as part of a team. Furthermore, they should be caring and want to help people who are not able to help themselves. Advancement. Occupational therapist assistants may ad­ vance into administration positions. They might organize all the assistants in a large occupational therapy department or act as the director for a specific department such as sports medicine. Some assistants go on to teach classes in accredited occupa­ tional therapist assistant academic programs or lead health risk reduction classes for the elderly. With proper formal education, occupational therapist aides can become occupational therapist assistants.  Employment Occupational therapist assistants and aides held about 34,400 jobs in 2008, with assistants holding about 26,600 jobs and aides holding approximately 7,800 jobs. About 28 percent of jobs for assistants and aides were in offices of other health prac­ titioners, 27 percent were in hospitals, and 20 percent were in nursing care facilities. The rest were primarily in community care facilities for the elderly, home healthcare services, indi­ vidual and family services, and government agencies.  Earnings Median annual wages of occupational therapist assistants were $48,230 in May 2008. The middle 50 percent earned between $39,240 and $57,810. The lowest 10 percent earned less than $31,150, and the highest 10 percent earned more than $65,160. Median annual wages in the industries employ­ ing the largest numbers of occupational therapist assistants in May 2008 were:  Job Outlook Employment is expected to grow much faster than average as demand for occupational therapy services rises and as occupa­ tional therapists increasingly use assistants and aides. Job pros­ pects should be very good for occupational therapist assistants. Jobseekers holding only a high school diploma might face keen competition for occupational therapist aide jobs. Employment change. Employment of occupational thera­ pist assistants and aides is expected to grow by 30 percent from 2008 to 2018, much faster than the average for all occupations. Demand for occupational therapist assistants and aides will continue to rise because of the increasing number of individu­ als with disabilities or limited function. The growing elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeu­ tic services. These patients often need additional assistance in their treatment, making the roles of assistants and aides vital. Also, the large baby-boom generation is entering the prime age for heart attacks and strokes, further increasing the demand for cardiac and physical rehabilitation. In addition, future medical developments should permit an increased per-  Home health care services.......................................... $53,090 Offices of other health practitioners.............................50,810 Nursing care facilities.................................................. 50,790 General medical and surgical hospitals........................45,760 Elementary and secondary schools..............................41,850 Median annual wages of occupational therapist aides were $26,960 in May 2008. The middle 50 percent earned between $21,930 and $33,340. The lowest 10 percent earned less than $17,850, and the highest 10 percent earned more than $46,910. Median annual wages in the industries employing the largest numbers of occupational therapist aides in May 2008 were: Specialty (except psychiatric and substance abuse) hospitals......................................$30,400 General medical and surgical hospitals........................27,750 Offices of other health practitioners.............................26,850 Elementary and secondary schools..............................26,820 Nursing care facilities..................................................25,790  Projections data from the National Employment Matrix Occupational Title Occupational therapist assistants and aides........................................ Occupational therapist assistants..................................................... Occupational therapist aides............................................................  Projected Change, Employment, 2008-2018 0(1_________________________________________________________________ 31-2010 34,400 44,800 10,300 30 31-2011 26,600 34,600 7,900 30 31-20127,80010.2002,40031_ f  ,  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. ____________________________________________________ ___  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Service Occupations 465  Related Occupations Occupational therapist assistants and aides work under the su­ pervision and direction of occupational therapists. Other work­ ers in the healthcare field who work under similar supervision include: Page Dental assistants....................................................................... 447 Medical assistants.................................................................... 455 Pharmacy technicians andaides................................................436 Physical therapist assistantsand aides......................................465  Sources of Additional Information For information on a career as an occupational therapist assis­ tant or aide, and a list of accredited programs, contact: > American Occupational Therapy Association, 4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20824­ 1220. Internet: http://www.aota.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl66.htm  Physical Therapist Assistants and Aides Significant Points • Employment is projected to grow much faster than average. • Physical therapist assistants should have very good job prospects; on the other hand, aides may face keen competition from the large pool of qualified appli­ cants. • Aides usually learn skills on the job, while physical therapist assistants have an associate degree; most States require licensing for assistants.  apist assistants record the patient’s responses to treatment and report the outcome of each treatment to the physical therapist. Physical therapist aides help make therapy sessions produc­ tive, under the direct supervision of a physical therapist or phys­ ical therapist assistant. They usually are responsible for keeping the treatment area clean and organized and for preparing for each patient’s therapy. When patients need assistance moving to or from a treatment area, aides assist in their transport. Be­ cause they are not licensed, aides do not perform the clinical tasks of a physical therapist assistant in States where licensure is required. The duties of aides include some clerical tasks, such as or­ dering depleted supplies, answering the phone, and filling out insurance forms and other paperwork. The extent to which an aide or an assistant performs clerical tasks depends on the needs and organization of the facility. Work environment. Physical therapist assistants and aides need a moderate degree of strength because of the physical exertion required in assisting patients with their treatment. In some cases, assistants and aides need to lift patients. Frequent kneeling, stooping, bending, and standing for long periods also are part of the job. The hours and days that physical therapist assistants and aides work vary with the facility. About 28 percent of all physical therapist assistants and aides work part-time. Many outpatient physical therapy offices and clinics have evening and weekend hours, to coincide with patients’ personal schedules.  Training, Other Qualifications, and Advancement Most physical therapy aides are trained on the job, while almost all physical therapist assistants earn an associate degree from an accredited physical therapist assistant program. Most States require licensing for physical therapist assistants. Education and training. Employers typically require physical therapy aides to have a high school diploma. They are trained on the job, and most employers provide clinical on-thejob training. In most States, physical therapist assistants are required by law to hold an associate degree. The American Physical Ther­ apy Association’s Commission on Accreditation in Physical  • Most jobs are in offices of other health practitioners and in hospitals. Nature of the Work Physical therapist assistants and aides help physical therapists to provide treatment that improves patient mobility, relieves pain, and prevents or lessens physical disabilities of patients. A physical therapist might ask a physical therapist assistant to help patients exercise or learn to use crutches, for example, or an aide to gather and prepare therapy equipment. Patients include accident victims and individuals with disabling condi­ tions such as lower-back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy. Physical therapist assistants assist physical therapists in pro­ viding care to patients. Under the direction and supervision of physical therapists, they provide exercise, instruction; therapeutic methods like electrical stimulation, mechanical traction, and ul­ massage; and gait and balance training. Physical ther­ Digitizedtrasound; for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Physical therapist assistants and aides provide treatment that improves patient mobility, relieves pain, and prevents or lessens physical disabilities, under the direction ofphysical therapists.  466 Occupational Outlook Handbook  Therapy Education accredits postsecondary physical therapy assistant programs. In 2009, there were 223 accredited pro­ grams, which usually last 2 years and culminate in an associate degree. Programs are divided into academic coursework and handson clinical experience. Academic coursework includes algebra, English, anatomy and physiology, and psychology. Clinical work includes certifications in cardiopulmonary resuscitation (CPR) and other first aid, and field experience in treatment cen­ ters. Both educators and prospective employers view clinical experience as essential to ensuring that students understand the responsibilities of a physical therapist assistant. Licensure. Licensing is not required to practice as a physi­ cal therapy aide. However, most States regulate physical thera­ pist assistants through licensure, registration, or certification. Most States require physical therapist assistants to graduate from an accredited education program and pass the National Physical Therapy Exam. Some States may require physical therapy assistants to pass State exams. Many States also require continuing education credits for physical therapist assistants to maintain licensure. Complete information on regulations can be obtained from State licensing boards. Other qualifications. Physical therapist assistants and aides should be well-organized, detail oriented, and caring. They should be able to take direction and work well in a team situa­ tion. They usually have strong interpersonal skills and a desire to help people in need. Advancement. Some physical therapist aides advance to be­ come therapist assistants after gaining experience and complet­ ing an accredited education program. Some physical therapist assistants advance their knowledge and skills in a variety of clinical areas after graduation. The American Physical Therapy Association recognizes physical therapist assistants who have gained additional skills in geriat­ ric, pediatric, musculoskeletal, neuromuscular, integumentary, and cardiopulmonary physical therapy. Physical therapist as­ sistants may also advance in non-clinical areas, like admin­ istrative positions. These positions might include organizing all the assistants in a large physical therapy organization or acting as the director for a specific department such as aquatic therapy. Physical therapist assistants may also pursue a career in teaching at an accredited physical therapist assistant aca­ demic program.  in offices of other health practitioners and in hospitals. Others worked primarily in nursing care facilities, home health care services, and outpatient care centers.  Job Outlook  Employment  Employment is expected to grow much faster than average be­ cause of increasing demand for physical therapy services. Job prospects for physical therapist assistants are expected to be very good. Aides may experience keen competition for jobs. Employment change. Employment of physical therapist as­ sistants and aides is expected to grow by 35 percent from 2008 through 2018, much faster than the average for all occupations. Changes to restrictions on reimbursement for physical therapy services by third-party payers will increase patient access to services and, thus, increase demand. The increasing number of people who need therapy reflects, in part, the increasing elderly population. The elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic ser­ vices. These patients often need additional assistance in their treatment, making the roles of assistants and aides vital. In ad­ dition, the large baby-boom generation is entering the prime age for heart attacks and strokes, further increasing the demand for cardiac and physical rehabilitation. Medical and technological developments should permit an increased percentage of trauma victims and newborns with birth defects to survive, creating added demand for therapy and rehabilitative services. Physical therapists are expected to increasingly use assistants and aides to reduce the cost of physical therapy services. Once a patient is evaluated and a treatment plan is designed by the physical therapist, the physical therapist assistant can provide many parts of the treatment, as directed by the therapist. Job prospects. Opportunities for individuals interested in becoming physical therapist assistants are expected to be very good; with help from physical therapist assistants, physical therapists are able to manage more patients. However, physical therapy aides may face keen competition from the large pool of qualified individuals. In addition to employment growth, job openings will result from the need to replace workers who leave the occupation permanently. Job opportunities should be par­ ticularly good in acute hospital, skilled nursing, and orthopedic settings, where the elderly are most often treated. Job prospects should be especially favorable in rural areas, as many physi­ cal therapists tend to cluster in highly populated urban and suburban areas.  Physical therapist assistants and aides held about 109,900 jobs in 2008. Physical therapist assistants held about 63,800 jobs; physical therapist aides held 46,100. Both work with physical therapists in a variety of settings. About 72 percent of jobs were  Median annual wages of physical therapist assistants were $46,140 in May 2008. The middle 50 percent earned between  Earnings  Projections data from the National Employment Matrix Occupational Title Physical therapist assistants and aides........................................... Physical therapist assistants....................................................... Physical therapist aides.............................................................  Projected Change, Employment, 2008-2018 2018Number Percent 31-2020 109,900 147,800 37,900 35 31-2021 63,800 85,000 21,200 33 31 -202246.10062,80016,70036 AT  ’  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook. _____________________________________  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Service Occupations 467  $37,170 and $54,900. The lowest 10 percent earned less than $28,580, and the highest 10 percent earned more than $63,830. Median annual wages in the industries employing the largest numbers of physical therapist assistants in May 2008 were: Home health care services.......................................... $51,950 Nursing care facilities.................................................. 51,090 General medical and surgical hospitals........................45,510 Offices of other health practitioners.............................44,580 Offices of physicians.................................................... 43,390 Median annual wages of physical therapist aides were $23,760 in May 2008. The middle 50 percent earned between $19,910 and $28,670. The lowest 10 percent earned less than $17,270, and the highest 10 percent earned more than $33,540. Median annual wages in the industries employing the largest numbers of physical therapy aides in May 2008 were: Nursing care facilities................................................ $26,530 General medical and surgical hospitals........................24,780 Specialty (except psychiatric and substance abuse) hospitals........................................ 24,590 Offices of physicians.................................................... 23,730 Offices of other health practitioners.............................22,550  Related Occupations Physical therapist assistants and aides work under the super­ vision of physical therapists. Other workers in the health care field who work under similar supervision include: Page Dental assistants.......................................................................447 Medical assistants............................................................................455  Nursing and psychiatric aides................................................. 460 Occupational therapist assistants and aides............................ 462 Pharmacy technicians and aides.............................................. 436  Sources of Additional Information Career information on physical therapist assistants and a list of schools offering accredited programs can be obtained from: ^ The American Physical Therapy Association, 1111 North Fairfax St., Alexandria, VA 22314-1488. Internet: http://www.apta.org The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl67.htm  Protective Service Occupations Correctional Officers Significant Points • The work can be stressful and hazardous; correctional officers have one of the highest rates of nonfatal onthe-job injuries. • Most jobs are in State and local government prisons and jails. • Job opportunities are expected to be favorable.  Nature of the Work Correctional officers, also known as detention officers when they work in pretrial detention facilities, are responsible for overseeing individuals who have been arrested and are awaiting trial or who have been convicted of a crime and sentenced to serve time in a jail, reformatory, or penitentiary. The jail population changes constantly as some prisoners are released, some are convicted and transferred to prison, and new offenders are arrested and enter the system. Correctional offi­ cers in local jails admit and process about 13 million people a year, with nearly 800,000 offenders in jail at any given time. Correctional officers in State and Federal prisons watch over the approximately 1.6 million offenders who are incarcerated there at any given time. Typically, offenders serving time at county jails are sentenced to a year or less. Those serving a year or more are usually housed in state or federal prisons. Correctional officers maintain security and inmate account­ to prevent disturbances, assaults, and escapes. Officers Digitized ability for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  have no law enforcement responsibilities outside of the institu­ tion where they work. (For more information on related occupa­ tions, see the statements on police and detectives and on proba­ tion officers and correctional treatment specialists, elsewhere in the Handbook.) Regardless of the setting, correctional officers maintain or­ der within the institution and enforce rules and regulations. To help ensure that inmates are orderly and obey rules, correctional officers monitor the activities and supervise the work assign­ ments of inmates. Sometimes, officers must search inmates and their living quarters for contraband like weapons or drugs, settle disputes between inmates, and enforce discipline. Correctional officers periodically inspect the facilities, checking cells and other areas of the institution for unsanitary conditions, con­ traband, fire hazards, and any evidence of infractions of rules. In addition, they routinely inspect locks, window bars, grilles, doors, and gates for signs of tampering. Finally, officers inspect mail and visitors for prohibited items. Correctional officers report orally and in writing on inmate conduct and on the quality and quantity of work done by in­ mates. Officers also report security breaches, disturbances, violations of rules, and any unusual occurrences. They usually keep a daily log or record of their activities. Correctional of­ ficers cannot show favoritism and must report any inmate who violates the rules. If a crime is committed within their institu­ tion or an inmate escapes, they help the responsible law en­ forcement authorities investigate or search for the escapee. In jail and prison facilities with direct supervision of cellblocks, officers work unarmed. They are equipped with communica­ tions devices so that they can summon help if necessary. These  468 Occupational Outlook Handbook  Because prison and jail security must be provided around the clock, officers work all hours of the day and night, weekends, and holidays. In addition, officers may be required to work paid overtime.  Training, Other Qualifications, and Advancement  Correctional officers inspect mail and visitors for prohibited items. officers often work in a cellblock alone, or with another officer, among the 50 to 100 inmates who reside there. The officers enforce regulations primarily through their interpersonal com­ munication skills and through the use of progressive sanctions, such as the removal of some privileges. In the highest security facilities, where the most dangerous inmates are housed, correctional officers often monitor the activities of prisoners from a centralized control center with closed-circuit television cameras and a computer tracking sys­ tem. In such an environment, the inmates may not see anyone but officers for days or weeks at a time and may leave their cells only for showers, solitary exercise time, or visitors. Depending on the offenders’ security classification, correctional officers may have to restrain inmates in handcuffs and leg irons to safely escort them to and from cells and other areas and to see autho­ rized visitors. Officers also escort prisoners between the institu­ tion and courtrooms, medical facilities, and other destinations. Bailiffs, also known as marshals or court officers, are law enforcement officers who maintain safety and order in court­ rooms. Their duties, which vary by location, include enforcing courtroom rules, assisting judges, guarding juries from outside contact, delivering court documents, and providing general se­ curity for courthouses. Work environment. Working in a correctional institution can be stressful and hazardous. Every year, correctional officers are injured in confrontations with inmates. Correctional officers and jailers have one of the highest rates of nonfatal on-the-job injuries. First-line supervisors/managers of correctional officers also face the risk of work-related injury. Correctional officers may work indoors or outdoors. Some correctional institutions are well lighted, temperature controlled, and ventilated, but others are old, overcrowded, hot, and noisy. Although both jails and prisons can be dangerous places to work, prison popula­ tions are more stable than jail populations, and correctional of­ ficers in prisons know the security and custodial requirements of the prisoners with whom they are dealing. Consequently, they tend to be safer places to work. Correctional officers usually work an 8-hour day, 5 days a week, on rotating shifts. Some correctional facilities have lon­ Digitizedger for shifts FRASER and more days off between scheduled work weeks. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Correctional officers go through a training academy and then are assigned to a facility where they learn most of what they need to know for their work through on-the-job training. Quali­ fications vary by agency, but all agencies require a high school diploma or equivalent, and some also require some college edu­ cation or full-time work experience. Military experience is of­ ten seen as a plus for corrections employment. Education and training. A high school diploma or gradua­ tion equivalency degree is required by all employers. The Fed­ eral Bureau of Prisons requires entry-level correctional officers to have at least a bachelor’s degree; 3 years of full-time experi­ ence in a field providing counseling, assistance, or supervision to individuals; or a combination of the two. Some State and local corrections agencies require some college credits, but law enforcement or military experience may be substituted to fulfill this requirement. Federal, State, and some local departments of corrections provide training for correctional officers based on guidelines established by the American Correctional Association and the American Jail Association. Some States have regional training academies that are available to local agencies. At the conclusion of formal instruction, all State and local correctional agencies provide on-the-job training, including training on legal restric­ tions and interpersonal relations. Many systems require firearms proficiency and self-defense skills. Officer trainees typically re­ ceive several weeks or months of training in an actual job set­ ting under the supervision of an experienced officer. However, on-the-job training varies widely from agency to agency. Academy trainees generally receive instruction in a number of subjects, including institutional policies, regulations, and operations, as well as custody and security procedures. New Federal correctional officers must undergo 200 hours of formal training within the first year of employment. They also must complete 120 hours of specialized training at the U.S. Federal Bureau of Prisons residential training center at Glynco, Geor­ gia, within 60 days of their appointment. Experienced officers receive annual in-service training to keep abreast of new devel­ opments and procedures. Correctional officers that are members of prison tactical response teams are trained to respond to disturbances, riots, hostage situations, forced cell moves, and other potentially dangerous confrontations. Team members practice disarming prisoners wielding weapons, protecting themselves and inmates against the effects of chemical agents, and other tactics. Other qualifications. All institutions require correctional officers to be at least 18 to 21 years of age, be a U.S. citizen or permanent resident, and have no felony convictions. New applicants for Federal corrections positions must be appointed before they are 37 years old. Some institutions require previous experience in law enforcement or the military, but college cred­ its can be substituted to fulfill this requirement. Others require a record of previous job stability, usually accomplished through  Service Occupations 469  2 years of work experience, which need not be related to correc­ tions or law enforcement. Correctional officers must be in good health. Candidates for employment are generally required to meet formal stan­ dards of physical fitness, eyesight, and hearing. In addition, many jurisdictions use standard tests to determine applicant suitability to work in a correctional environment. Good judg­ ment and the ability to think and act quickly are indispens­ able. Applicants are typically screened for drug abuse, sub­ ject to background checks, and required to pass a written examination. Advancement. Qualified officers may advance to the posi­ tion of correctional sergeant. Correctional sergeants supervise correctional officers and usually are responsible for maintaining security and directing the activities of other officers during an assigned shift or in an assigned area. Ambitious and qualified correctional officers can be promoted to supervisory or admin­ istrative positions all the way up to warden. In some jurisdic­ tions, corrections officers are given the opportunity to “bid” for a specialty assignment, such as working in correctional indus­ tries, correctional health or correctional counseling, and receive additional training. Promotion prospects may be enhanced by attending college. Officers sometimes transfer to related jobs, such as probation officer, parole officer, and correctional treat­ ment specialist.  Employment Correctional officers and jailors held about 454,500 jobs in 2008, while first-line supervisors and managers of correctional officers held about 43,500 jobs. An additional 20,200 workers were employed as bailiffs. The vast majority of correctional of­ ficers and jailors and their supervisors were employed by State and local government in correctional institutions such as pris­ ons, prison camps, and youth correctional facilities.  Job Outlook Employment growth is expected to be as fast as the average for all occupations, and job opportunities are expected to be favorable. Employment change. Employment of correctional officers is expected to grow 9 percent between 2008 and 2018, about as fast as the average for all occupations. Increasing demand for correctional officers will stem from population growth and rising rates of incarceration. Mandatory sentencing guidelines calling for longer sentences and reduced parole for inmates are a primary reason for increasing incarceration rates. Some States are reconsidering mandatory sentencing guidelines because of budgetary constraints, court decisions, and doubts about their  effectiveness. Some employment opportunities also will arise in the private sector, as public authorities contract with private companies to provide and staff corrections facilities. Both State and Federal corrections agencies are increasingly using private prisons. Job prospects. Job opportunities for correctional officers are expected to be favorable. The need to replace correctional officers who transfer to other occupations, retire, or leave the labor force, coupled with rising employment demand, will gen­ erate job openings. In the past, some local and State corrections agencies have experienced difficulty in attracting and keeping qualified applicants, largely because of low salaries, shift work, and the concentration of jobs in rural locations. This situation is expected to continue.  Earnings Median annual wages of correctional officers and jailers were $38,380 in May 2008. The middle 50 percent earned between $29,660 and $51,000. The lowest 10 percent earned less than $25,300, and the highest 10 percent earned more than $64,110. Median annual wages in the public sector were $50,830 in the Federal Government, $38,850 in State government, and $37,510 in local government. In the facilities support services industry, where the relatively small number of officers employed by pri­ vately operated prisons is classified, median annual wages were $28,790. Median annual wages of first-line supervisors/managers of correctional officers were $57,380 in May 2008. The middle 50 percent earned between $41,740 and $73,630. The low­ est 10 percent earned less than $32,300, and the highest 10 percent earned more than $86,970. Median annual wages were $57,050 in State government and $57,300 in local government. Median annual wages of bailiffs were $37,820 in May 2008. The middle 50 percent earned between $26,730 and $51,470. The lowest 10 percent earned less than $18,750, and the highest 10 percent earned more than $61,500. Median annual wages were $32,690 in local government. In March 2009, the average salary for Federal correctional officers was $53,459. Federal salaries were slightly higher in areas where prevailing local pay levels were higher. In addition to typical benefits, correctional officers employed in the public sector are usually provided with uniforms or a clothing allowance to purchase their own uniforms. Civil service systems or merit boards cover officers employed by the Federal Govem-  Projections data from the National Employment Matrix Occupational Title Correctional officers.................................................................. .... First-line supervisors/managers of correctional officers......... ... Bailiffs, correctional officers, and jailers............................... .... Bailiffs............................................................................... .... Correctional officers and jailers......................................... ...  SOC Code -  33-1011 33-3010 33-3011 33-3012  Employment, 2008 518,200 43,500 474,800 20,200 454,500  Projected Employment, 2018 566,500 47,200 519,400 21,900 497,500  Change, 2008-2018 Number Percent 48,300 9 3,700 9 44,600 9 1,700 8 42,900 9  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa tion Included in the Handbook.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  470 Occupational Outlook Handbook  ment and most State governments. Their retirement coverage entitles correctional officers to retire at age 50 after 20 years of service or at any age with 25 years of service. Unionized cor­ rectional officers often have slightly higher wages and benefits.  Related Occupations Other protective service occupations: Page Police and detectives................................................................ 473 Probation officers and correctional treatment specialists............................................................. 241 Security guards and gaming surveillance officers................... 481  Sources of Additional Information Further information about correctional officers is available from: y American Correctional Association, 206 N. Washington St., Suite 200, Alexandria, VA 22314. Internet:  http://www.aca.org y American Jail Association, 1135 Professional Ct., Hagerstown, MD 21740. Internet:  http://www.corrections.com/aja y Information on entrance requirements, training, and career opportunities for correctional officers at the Federal level may be obtained from the Federal Bureau of Prisons. Internet:  http ://www.bop.gov Information on obtaining a position as a correctional offi­ cer with the Federal Government is available from the Office of Personnel Management through USAJOBS, the Federal Government’s official employment information system. This re­ source for locating and applying for job opportunities can be ac­ cessed through the Internet at http://www.usajohs.opm.gov or through an interactive voice response telephone system at (703) 724-1850 or TDD (978) 461-8404. These numbers are not toll free, so charges may result. The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at  http://www.bls.gov/ooh/ocosl56.htm  Fire Fighters Significant Points • Fire fighting involves hazardous conditions and long, irregular hours. • About 9 out of 10 fire fighters were employed by local governments. • Applicants generally must pass written, physical, and medical examinations, and candidates with some postsecondary education are increasingly preferred. • Keen competition for jobs is expected because this attracts many qualified candidates. Digitized for occupation FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Every year, fires and other emergencies take thousands of lives and destroy property worth billions of dollars. Fire fighters help protect the public against these dangers by responding to hres and a variety of other emergencies. Although they put out fires, fire fighters more frequently respond to other emergencies. They are often the first emergency personnel at the scene of a traffic accident or medical emergency and may be called upon to treat injuries or perform other vital functions. During duty hours, fire fighters must be prepared to respond immediately to a fire or other emergency. Fighting fires is com­ plex and dangerous, and requires organization and teamwork. At every emergency scene, fire fighters perform specific duties assigned by a superior officer. At fires, they connect hose lines to hydrants and operate a pump to send water to high-pressure hoses. Some carry hoses, climb ladders, and enter burning buildings—using systematic and careful procedures—to put out fires. At times, they may need to use tools to make their way through doors, walls, and debris, sometimes with the aid of information about a building’s floor plan. Some find and rescue occupants who are unable to leave the building safely without assistance. They also provide emergency medical at­ tention, ventilate smoke-filled areas and attempt to salvage the contents of buildings. Fire fighters’ duties may change several times while the company is in action. Sometimes they remain at the site of a disaster for days at a time, rescuing trapped survi­ vors, and assisting with medical treatment. Fire fighters work in a variety of settings, including metro­ politan areas, rural areas, airports, chemical plants and other industrial sites. They also have assumed a range of responsi­ bilities, including providing emergency medical services. In fact, most calls to which fire fighters respond involve medical emergencies. In addition, some fire fighters work in hazardous materials units that are specially trained for the control, preven­ tion, and cleanup of hazardous materials, such as oil spills or accidents involving the transport of chemicals. (For more in­ formation, see the Handbook section on hazardous materials removal workers.) Workers specializing in forest fires utilize methods and equipment different from those of other fire fighters. When fires break out, crews of fire fighters are brought in to suppress the blaze with heavy equipment and water hoses. Fighting forest fires, like fighting urban fires, is rigorous work. One of the most effective means of fighting a forest fire is creating fire lines— cutting down trees and digging out grass and all other combus­ tible vegetation in the path of the fire in order to deprive it of fuel. Elite fire fighters called smoke jumpers parachute from air­ planes to reach otherwise inaccessible areas. This tactic, how­ ever, can be extremely hazardous. When they aren’t responding to fires and other emergencies, fire fighters clean and maintain equipment, learn additional skills related to their jobs, conduct practice drills, and partici­ pate in physical fitness activities. They also prepare written re­ ports on fire incidents and review fire science literature to stay informed about technological developments and changing ad­ ministrative practices and policies. Work environment. Fire fighters spend much of their time at fire stations, which are usually similar to dormitories. When an  Service Occupations 471  Firefighters help protect the public by responding to fires and a variety of other emergencies. alarm sounds, fire fighters respond, regardless of the weather or hour. Fire fighting involves a high risk of death or injury. Com­ mon causes include floors caving in, walls toppling, traffic ac­ cidents, and exposure to flame and smoke. Fire fighters also may come into contact with poisonous, flammable, or explosive gases and chemicals and radioactive materials, all of which may have immediate or long-term effects on their health. For these reasons, they must wear protective gear that can be very heavy and hot. Work hours of fire fighters are longer and more varied than the hours of most other workers. Many fire fighters work about 50 hours a week, and sometimes they may work longer. In some agencies, fire fighters are on duty for 24 hours, then off for 48 hours, and receive an extra day off at intervals. In oth­ ers, they work a day shift of 10 hours for 3 or 4 days, work a night shift of 14 hours for 3 or 4 nights, have 3 or 4 days off, and then repeat the cycle. In addition, fire fighters often work extra hours at fires and other emergencies and are regularly assigned to work on holidays. Fire lieutenants and fire cap­ tains frequently work the same hours as the fire fighters they supervise.  Training, Other Qualifications, and Advancement Applicants for fire fighting jobs usually are required to have at least a high school diploma, but candidates with some postsec­ ondary education are increasingly being preferred. Most mu­ nicipal jobs require passing written and physical tests. All fire fighters receive extensive training after being hired. Education and training. Most fire fighters have a high school diploma; however, the completion of community college courses or, in some cases, an associate’s degree, in fire science may improve an applicant’s chances for a job. A number of col­ leges and universities offer courses leading to 2-year or 4-year degrees in fire engineering or fire science. In recent years, an increasing proportion of new fire fighters have had some educa­ tion after high school. As a mle, entry-level workers in large fire departments are trained for several weeks at the department’s training center or academy. Through classroom instruction and practical training, the recruits study fire fighting techniques, fire prevention, hazardous materials control, local building codes, and emergency medical procedures,  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  including first aid and cardiopulmonary resuscitation (CPR). They also learn how to use axes, chain saws, fire extinguishers, ladders, and other fire fighting and rescue equipment. After successfully completing training, the recmits are assigned to a fire company, where they undergo a period of probation. Many fire departments have accredited apprenticeship pro­ grams lasting up to 4 years, including programs in fighting forest fires. These programs combine formal instruction with on-thejob training under the supervision of experienced fire fighters. Almost all departments require fire fighters to be certified as emergency medical technicians. (For more information, see the section of the Handbook on emergency medical technicians and paramedics.) Although most fire departments require the lowest level of certification, Emergency Medical TechnicianBasic (EMT-Basic), larger departments in major metropolitan areas increasingly are requiring paramedic certification. Some departments include this training in the fire academy, whereas others prefer that recruits earn EMT certification on their own, but will give them up to 1 year to do it. In addition to participating in training programs conducted by local fire departments, some fire fighters attend training sessions sponsored by the U.S. National Fire Academy. These training sessions cover topics such as executive development, antiarson techniques, disaster preparedness, hazardous materi­ als control, and public fire safety and education. Some States also have mandatory or voluntary fire fighter training and cer­ tification programs. Many fire departments offer fire fighters incentives, such as tuition reimbursement or higher pay, for completing advanced training. Other qualifications. Applicants for municipal fire fighting jobs usually must pass a written exam; tests of strength, physical stamina, coordination, and agility; and a medical examination that includes a drug screening. Workers may be monitored on a random basis for drug use after accepting employment. Exami­ nations are generally open to people who are at least 18 years of age and have a high school education or its equivalent. Those who receive the highest scores in all phases of testing have the best chances of being hired. Among the personal qualities fire fighters need are mental alert­ ness, self-discipline, courage, mechanical aptitude, endurance, strength, and a sense of public service. Initiative and good judg­ ment also are extremely important, because fire fighters make quick decisions in emergencies. Members of a crew live and work closely together under conditions of stress and danger for ex­ tended periods, so they must be dependable and able to get along well with others. Leadership qualities are necessary for officers, who must establish and maintain discipline and efficiency, as well as direct the activities of the fire fighters in their companies. Advancement. Most experienced fire fighters continue study­ ing to improve their job performance and prepare for promotion examinations. To progress to higher level positions, they acquire expertise in advanced fire fighting equipment and techniques, building construction, emergency medical technology, writing, public speaking, management and budgeting procedures, and public relations. Opportunities for promotion depend upon the results of writ­ ten examinations, as well as job performance, interviews, and  472 Occupational Outlook Handbook  seniority. Hands-on tests that simulate real-world job situations also are used by some fire departments. Usually, fire fighters are first promoted to engineer, then lieu­ tenant, captain, battalion chief, assistant chief, deputy chief, and, finally, chief. For promotion to positions higher than bat­ talion chief, many fire departments now require a bachelor’s degree, preferably in fire science, public administration, or a related field. An associate’s degree is required for executive fire officer certification from the National Fire Academy.  Employment In 2008, total paid employment in fire fighting occupations was about 365,600. Fire fighters held about 310,400 jobs, and first-line supervisors/managers of fire fighting and prevention workers held about 55,200. These employment figures include only paid career fire fighters—they do not cover volunteer fire fighters, who perform the same duties and may constitute the majority of fire fighters in a residential area. According to the U.S. Fire Administration, about 70 percent of fire companies were staffed entirely by volunteer fire fighters in 2007. About 91 percent of fire fighting workers were employed by local governments. Some local and regional fire departments are being consolidated into countywide establishments to re­ duce administrative staffs, cut costs, and establish consistent training standards and work procedures. Some large cities have thousands of career fire fighters, while many small towns have only a few. Most of the fire fighters not employed by local gov­ ernments worked in fire departments on Federal and State in­ stallations, including airports. Private fire fighting companies employ a small number of fire fighters.  Job Outlook Although employment is expected to grow faster than the aver­ age for all jobs, candidates for these positions are expected to face keen competition because these positions are highly attrac­ tive and sought after. Employment change. Employment of fire fighters is ex­ pected to grow by 19 percent over the 2008-18 decade, which is faster than the average for all occupations. Most job growth will stem from volunteer fire fighting positions being converted to paid positions. In recent years, it has become more difficult for volunteer fire departments to recruit and retain volunteers, perhaps because of the considerable amount of training and time commitment required. Furthermore, a trend toward more people living in and around cities has increased the demand for fire fighters. When areas develop and become more densely populated, emergencies and fires affect more buildings and more people and, therefore, require more fire fighters.  Job prospects. Prospective fire fighters are expected to face keen competition for available job openings. Many people are attracted to fire fighting because (1) it is challenging and pro­ vides the opportunity to perform an essential public service, (2) a high school education is usually sufficient for entry, and (3) a pension is usually guaranteed after 25 years of service. Consequently, the number of qualified applicants in most areas far exceeds the number of job openings, even though the written examination and physical requirements eliminate many applicants. This situation is expected to persist in com­ ing years. Applicants with the best chances are those who are physically fit and score the highest on physical-conditioning and mechanical aptitude exams. Those who have completed some fire fighter education at a community college and have EMT or paramedic certification will have an additional advantage.  Earnings Median annual wages of fire fighters were $44,260 in May 2008. The middle 50 percent earned between $31,180 and $58,440. The lowest 10 percent earned less than $22,440, and the highest 10 percent earned more than $72,210. Median an­ nual wages were $44,800 in local government, $45,610 in the Federal Government, $25,300 in other support services, and $37,870 in State governments. Median annual wages of first-line supervisors/managers of fire fighting and prevention workers were $67,440 in May 2008. The middle 50 percent earned between $53,820 and $86,330. The lowest 10 percent earned less than $40,850, and the highest 10 percent earned more than $108,930. First-line supervisors/ managers of fire fighting and prevention workers employed in local government earned a median of about $69,000 a year. According to the International City-County Management As­ sociation, average salaries in 2008 for sworn full-time positions were as follows: Rank Fire chief............................... ............ Deputy chief.......................... ............ Battalion chief....................... ............ ............ ............ Fire lieutenant ....................... ............ Engineer................................ ............  Minimum annual base salary $78,672 69,166 66,851 65,691 60,605 50,464 48,307  Maximum annual base salary $104,780 88,571 81,710 83,748 72,716 60,772 62,265  Fire fighters who average more than a certain number of work hours per week are required to be paid overtime. The threshold is determined by the department. Fire fighters often work extra  Projections data from the National Employment Matrix Occupational Title Fire fighting occupations.......................................... First-line supervisors/managers of fire fighting and prevention workers.................................... Fire fighters...........................................................  SOC Code  Employment, 2008 365,600  33-1021 33-2011  55,200 310,400  Projected Employment, 2018 427,600 59,700 367,900  Change, 2008-2018 Number Percent 62,100 17 4,500 57,500  8 19  (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ tion Included in the Handbook.__  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Service Occupations 473  shifts to maintain minimum staffing levels and during special emergencies. In 2008, 66 percent of all fire fighters were union members or covered by a union contract. Fire fighters receive benefits that usually include medical and liability insurance, vacation and sick leave, and some paid holidays. Almost all fire depart­ ments provide protective clothing (helmets, boots, and coats) and breathing apparatus, and many also provide dress uniforms. Fire fighters generally are covered by pension plans, often of­ fering retirement at half pay after 25 years of service or if the individual is disabled in the line of duty.  Related Occupations Other occupations that involve protecting the public and prop­ erty are: Page Emergency medical technicians and paramedics.......................419 Fire inspectors and investigators................................................... 525 Police and detectives........................................................................473  Sources of Additional Information Information about a career as a fire fighter may be obtained from local fire departments and from either of the following organizations: V International Association of Fire Fighters, 1750 New York Ave. NW., Washington, DC 20006. Internet: http://www.iaff.org y U.S. Fire Administration, 16825 South Seton Ave., Emmitsburg, MD 21727. Internet: http://www.usfa.dhs.gov Information about professional qualifications and a list of colleges and universities offering 2-year or 4-year degree pro­ grams in fire science or fire prevention may be obtained from: y National Fire Academy, 16825 South Seton Ave., Emmitsburg, MD 21727. Internet: http://www.usfa.dhs.gov/nfa The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocos329.htm  Police and Detectives Significant Points • Police work can be dangerous and stressful. • Education requirements range from a high school di­ ploma to a college degree or higher. • Job opportunities in most local police departments will be favorable for qualified individuals, while competi­ tion is expected for jobs in State and Federal agencies. • Bilingual applicants with college training in police science or with military police experience will have the best opportunities.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Nature of the Work Police officers and detectives protect lives and property. Law enforcement officer’s duties depend on the size and type of their organizations. Police and detectives pursue and apprehend individuals who break the law and then issue citations or give warnings. A large proportion of their time is spent writing reports and maintaining records of incidents they encounter. Most police officers patrol their jurisdictions and investigate any suspicious activity they notice. They also respond to calls from individuals. Detectives, who often are called agents or special agents, perform investi­ gative duties such as gathering facts and collecting evidence. The daily activities of police and detectives vary with their occupational specialty—such as police officer, game warden, or detective—and whether they are working for a local, State, or Federal agency. Duties also differ substantially among vari­ ous Federal agencies, which enforce different aspects of the law. Regardless of job duties or location, police officers and de­ tectives at all levels must write reports and maintain meticulous records that will be needed if they testify in court. State and Local Law Enforcement. Uniformed police officers have general law enforcement duties. They maintain regular pa­ trols and respond to calls for service. Much of their time is spent responding to calls and doing paperwork. They may direct traf­ fic at the scene of an accident, investigate a burglary, or give first aid to an accident victim. In large police departments, officers usually are assigned to a specific type of duty. Many urban police agencies are involved in community po­ licing—a practice in which an officer builds relationships with the citizens of local neighborhoods and mobilizes the public to help fight crime. Police agencies are usually organized into geographic dis­ tricts, with uniformed officers assigned to patrol a specific area. Officers in large agencies often patrol with a partner. They attempt to become familiar with their patrol area and remain alert for anything unusual. Suspicious circumstances and haz­ ards to public safety are investigated or noted, and officers are dispatched to individual calls for assistance within their district. During their shift, they may identify, pursue, and arrest sus­ pected criminals; resolve problems within the community; and enforce traffic laws. Some agencies have special geographic jurisdictions and enforcement responsibilities. Public college and university po­ lice forces, public school district police, and agencies serving transportation systems and facilities are examples. Most law en­ forcement workers in special agencies are uniformed officers. Some police officers specialize in a particular field, such as chem­ ical and microscopic analysis, training and firearms instruction, or handwriting and fingerprint identification. Others work with spe­ cial units, such as horseback, bicycle, motorcycle, or harbor patrol; canine corps; special weapons and tactics (SWAT); or emergency response teams. A few local and special law enforcement officers primarily perform jail-related duties or work in courts. (For infor­ mation on other officers who work in jails and prisons, see correc­ tional officers, listed elsewhere in the Handbook.) Sheriffs and deputy sheriffs enforce the law on the county level. Sheriffs usually are elected to their posts and perform du­ ties similar to those of a local or county police chief. Sheriffs’  474 Occupational Outlook Handbook  departments tend to be relatively small, most having fewer than 50 sworn officers. Deputy sheriffs have law enforcement duties similar to those of officers in urban police departments. Police and sheriffs’ deputies who provide security in city and county courts are sometimes called bailiffs. State police officers, sometimes called State troopers or highway patrol officers, arrest criminals Statewide and patrol highways to enforce motor vehicle laws and regulations. State police officers often issue traffic citations to motorists. At the scene of accidents, they may direct traffic, give first aid, and call for emergency equipment. They also write reports used to deter­ mine the cause of the accident. State police officers frequently are called upon to render assistance to other law enforcement agencies, especially those in rural areas or small towns. State highway patrols operate in every State except Hawaii. Most full-time sworn personnel are uniformed officers who regularly patrol and respond to calls for service. Others work as investigators, perform court-related duties, or carry out admin­ istrative or other assignments. Detectives are plainclothes investigators who gather facts and collect evidence for criminal cases. Some are assigned to in­ teragency task forces to combat specific types of crime. They conduct interviews, examine records, observe the activities of suspects, and participate in raids or arrests. Detectives usually specialize in investigating one type of violation, such as homi­ cide or fraud. They are assigned cases on a rotating basis and work on them until an arrest and conviction is made or until the case is dropped. Fish and game wardens enforce fishing, hunting, and boating laws. They patrol hunting and fishing areas, conduct search and rescue operations, investigate complaints and accidents, and aid in prosecuting court cases. Federal Law Enforcement. Federal Bureau of Investiga­ tion (FBI) agents are the Government’s principal investigators, responsible for investigating violations of more than 200 cat­ egories of Federal law and conducting sensitive national secu­ rity investigations. Agents may conduct surveillance, monitor court-authorized wiretaps, examine business records, investi­ gate white-collar crime, or participate in sensitive undercover assignments. The FBI investigates a wide range of criminal ac­ tivity, including organized crime, public corruption, financial crime, bank robbery, kidnapping, terrorism, espionage, drug trafficking, and cybercrime. There are many other Federal agencies that enforce particu­ lar types of laws. U.S. Drug Enforcement Administration (DEA) agents enforce laws and regulations relating to illegal drugs. U.S. marshals and deputy marshals provide security for the Federal courts and ensure the effective operation of the judicial system. Bureau of Alcohol, Tobacco, Firearms, and Explosives agents enforce and investigate violations of Federal firearms and explo­ sives laws, as well as Federal alcohol and tobacco tax regulations. The U.S. Department of State Bureau of Diplomatic Security special agents are engaged in the battle against terrorism. The Department of Homeland Security also employs numer­ ous law enforcement officers within several different agencies, including Customs and Border Protection, Immigration and Customs Enforcement, and the U.S. Secret Service. U.S. Bor­ der agents protect more than 8,000 miles of international Digitized forPatrol FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  GANGS /ARCOT  '3  The daily activities of police and detectives vary with their oc­ cupational specialty. land and water boundaries. Immigration inspectors interview and examine people seeking entry into the United States and its ter­ ritories. Customs inspectors enforce laws governing imports and exports by inspecting cargo, baggage, and articles worn or carried by people, vessels, vehicles, trains, and aircraft entering or leav­ ing the United States. Federal Air Marshals provide air security by guarding against attacks targeting U.S. aircraft, passengers, and crews. U.S. Secret Service special agents and U.S. Secret Service uniformed officers protect the President, the Vice Presi­ dent, their immediate families, and other public officials. Secret Service special agents also investigate counterfeiting, forgery of Government checks or bonds, and fraudulent use of credit cards. Other Federal agencies employ police and special agents with sworn arrest powers and the authority to carry firearms. These agencies include the Postal Service, the Bureau of Indian Affairs Office of Law Enforcement, the Forest Service, and the National Park Service. Work environment. Police and detective work can be very dangerous and stressful. Police officers and detectives have one of the highest rates of on-the-job injury and illness. In addition to the obvious dangers of confrontations with criminals, police officers and detectives need to be constantly alert and ready to deal appropriately with a number of other threatening situa­ tions. Many law enforcement officers witness death and suffer­ ing resulting from accidents and criminal behavior. A career in law enforcement may take a toll on their private lives. Uniformed officers, detectives, agents, and inspectors usu­ ally are scheduled to work 40-hour weeks, but paid overtime is common. Shift work is necessary because protection must be provided around the clock. Junior officers frequently work weekends, holidays, and nights. Police officers and detectives are required to work whenever they are needed and may work long hours during investigations. Officers in most jurisdictions, whether on or off duty, are expected to be armed and to exercise their authority when necessary. The jobs of some Federal agents, such as U.S. Secret Service and DEA special agents, require extensive travel, often on very short notice. These agents may relocate a number of times over the course of their careers. Some special agents, such as those in the U.S. Border Patrol, may work outdoors in rugged terrain and in all kinds of weather.  Service Occupations 475  Training, Other Qualifications, and Advancement Education requirements range from a high school diploma to a college degree or higher. Most police and detectives learn much of what they need to know on the job, often in their agency’s training academy. Civil service regulations govern the appointment of police and detectives in most States, large municipalities, and special police agencies, as well as in many smaller jurisdictions. Candidates must be U.S. citizens, usually at least 21 years old, and meet rigorous physical and personal qualifications. Education and training. Applicants usually must have at least a high school education, and some departments require 1 or 2 years of college coursework or, in some cases, a college degree. Physical education classes and participation in sports are also helpful in developing the competitiveness, stamina, and agility needed for many law enforcement positions. Knowledge of a foreign language is an asset in many Federal agencies and urban departments. State and local agencies encourage applicants to take courses or training related to law enforcement subjects after high school. Many entry-level applicants for police jobs have com­ pleted some formal postsecondary education, and a significant number are college graduates. Many junior colleges, colleges, and universities offer programs in law enforcement or admin­ istration of justice. Many agencies pay all or part of the tuition for officers to work toward degrees in criminal justice, police science, administration of justice, or public administration and pay higher salaries to those who earn one of those degrees. Before their first assignments, officers usually go through a period of training. In State and large local police departments, recruits get training in their agency’s police academy, often for 12 to 14 weeks. In small agencies, recruits often attend a re­ gional or State academy. Training includes classroom instruc­ tion in constitutional law and civil rights, State laws and local ordinances, and accident investigation. Recruits also receive training and supervised experience in patrol, traffic control, use of firearms, self-defense, first aid, and emergency response. Po­ lice departments in some large cities hire high school graduates who are still in their teens as police cadets or trainees. They do clerical work and attend classes, usually for 1 to 2 years, until they reach the minimum age requirement and can be appointed to the regular force. Fish and game wardens also must meet specific requirements. Most States require at least 2 years of college study. Once hired, fish and game wardens attend a training academy lasting from 3 to 12 months, sometimes followed by further training in the field. Federal agencies require a bachelor’s degree, related work experience, or a combination of the two. Federal law enforce­ ment agents undergo extensive training, usually at the U.S. Marine Corps base in Quantico, Virginia, or the Federal Law Enforcement Training Center in Glynco, Georgia. The specific educational requirements, qualifications, and training informa­ tion for a particular Federal agency can be found on its Web site. Many of these agencies are listed as sources of additional information at the end of this statement. To be considered for appointment as an FBI agent, an applicant must be a college graduate and have at least 3 years of profes­   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  sional work experience or must have an advanced degree plus 2 years of professional work experience. An applicant who meets these criteria also must have one of the following: a college major in accounting, electrical engineering, information technology, or computer science; fluency in a foreign language; a degree from an accredited law school; or 3 years of related full-time work experi­ ence. All new FBI agents undergo 18 weeks of training at the FBI Academy on the U.S. Marine Corps base in Quantico, Virginia. Other qualifications. Civil service regulations govern the ap­ pointment of police and detectives in most States, large munici­ palities, and special police agencies, as well as in many smaller jurisdictions. Candidates must be U.S. citizens, usually must be at least 21 years old, and must meet rigorous physical and per­ sonal qualifications. Physical examinations for entry into law enforcement often include tests of vision, hearing, strength, and agility. Eligibility for appointment usually depends on one’s performance in competitive written examinations and previous education and experience. Candidates should enjoy working with people and meeting the public. Because personal characteristics such as honesty, sound judgment, integrity, and a sense of responsibility are especially important in law enforcement, candidates are interviewed by senior officers and their character traits and backgrounds are investigated. A history of domestic violence may disqualify a candidate. In some agencies, candidates are interviewed by a psychiatrist or a psychologist, or given a personality test. Most applicants are subjected to lie detector examinations or dmg testing. Some agencies subject sworn personnel to random dmg testing as a condition of continuing employment. Although similar in nature, the requirements for Federal agents are generally more stringent and the background checks are more thorough. There are polygraph tests as well as inter­ views with references. Jobs that require security clearances have additional requirements. Advancement. Police officers usually become eligible for promotion after a probationary period ranging from 6 months to 3 years. In large departments, promotion may enable an of­ ficer to become a detective or to specialize in one type of police work, such as working with juveniles. Promotions to corporal, sergeant, lieutenant, and captain usually are made according to a candidate’s position on a promotion list, as determined by scores on a written examination and on-the-job performance. Federal agents often are on the General Services (GS) pay scale. Most begin at the GS-5 or GS-7 level. As agents meet time-in-grade and knowledge and skills requirements, they move up the GS scale. Promotions at and above GS-13 are most often managerial positions. Many agencies hire internally for these supervisory positions. A few agents may be able to enter the Senior Executive Series ranks of upper management. Continuing training helps police officers, detectives, and special agents improve their job performance. Through police department academies, regional centers for public safety em­ ployees established by the States, and Federal agency train­ ing centers, instructors provide annual training in self-defense tactics, firearms, use-of-force policies, sensitivity and commu­ nications skills, crowd-control techniques, relevant legal devel­ opments, and advances in law enforcement equipment.  476 Occupational Outlook Handbook  Employment Police and detectives held about 883,600 jobs in 2008. About 79 percent were employed by local governments. State police agencies employed about 11 percent. Various Federal agencies employ police and detectives. According to the U.S. Bureau of Justice Statistics, police and detectives employed by local governments worked primarily in cities with more than 25,000 inhabitants. Some cities have very large police forces, while thousands of small communities em­ ploy fewer than 25 officers each.  Job Outlook Job opportunities in most local police departments will be fa­ vorable for qualified individuals, whereas competition is ex­ pected for jobs in State and Federal agencies. As fast as average employment growth is expected. Employment change. Employment of police and detectives is expected to grow 10 percent over the 2008-18 decade, about as fast as the average for all occupations. Population growth is the main source of demand for police services. Job prospects. Overall opportunities in local police depart­ ments will be favorable for individuals who meet the psycho­ logical, personal, and physical qualifications. In addition to openings from employment growth, many openings will be cre­ ated by the need to replace workers who retire and those who leave local agencies for Federal jobs and private-sector security jobs. Jobs in local police departments that offer relatively low salaries, or those in urban communities in which the crime rate is relatively high, may be the easiest to get. Some smaller de­ partments may have fewer opportunities as budgets limit the ability to hire additional officers. Bilingual applicants with mil­ itary experience or college training in police science will have the best opportunities in local and State departments. There will be more competition for jobs in Federal and State law enforcement agencies than for jobs in local agencies. Bi­ lingual applicants with a bachelor’s degree and several years of law enforcement or military experience, especially investigative experience, will have the best opportunities in Federal agencies. The level of government spending determines the level of em­ ployment for police and detectives. The number of job oppor­ tunities, therefore, can vary from year to year and from place to place. Layoffs are rare because retirements enable most staffing cuts to be handled through attrition. Trained law enforcement officers who lose their jobs because of budget cuts usually have little difficulty finding jobs with other agencies.  Earnings Police and sheriff’s patrol officers had median annual wages of $51,410 in May 2008. The middle 50 percent earned between $38,850 and $64,940. The lowest 10 percent earned less than $30,070, and the highest 10 percent earned more than $79,680. Median annual wages were $46,620 in Federal Government, $57,270 in State government, $51,020 in local government and $43,350 in educational services. In May 2008, median annual wages of police and detective su­ pervisors were $75,490. The middle 50 percent earned between $59,320 and $92,700. The lowest 10 percent earned less than $46,000, and the highest 10 percent earned more than $114,300. Median annual wages were $89,930 in Federal Government, $75,370 in State government, and $74,820 in local government. In May 2008, median annual wages of detectives and crimi­ nal investigators were $60,910. The middle 50 percent earned between $45,930 and $81,490. The lowest 10 percent earned less than $36,500, and the highest 10 percent earned more than $97,870. Median annual wages were $73,170 in Federal Gov­ ernment, $53,910 in State government, and $55,930 in local government. In May 2008, median annual wages of fish and game wardens were $48,930. The middle 50 percent earned between $37,500 and $61,290. The lowest 10 percent earned less than $30,400, and the highest 10 percent earned more than $81,710. Median annual wages were $48,960 in Federal Government, $50,440 in State government, and $35,810 in local government. In May 2008, median annual wages of parking enforcement workers were $32,390. The middle 50 percent earned between $25,400 and $42,000. The lowest 10 percent earned less than $20,510, and the highest 10 percent earned more than $50,470. Median annual wages were $33,130 in local government and $27,640 in educational services. In May 2008, median annual wages of transit and railroad police were $46,670. The middle 50 percent earned between $37,640 and $57,830. The lowest 10 percent earned less than $31,300, and the highest 10 percent earned more than $72,700. Median annual wages were $49,370 in State government, $43,720 in local government, and $56,300 in rail transportation. Federal law provides special salary rates to Federal em­ ployees who serve in law enforcement. Additionally, Federal special agents and inspectors receive law enforcement avail­ ability pay (LEAP)—equal to 25 percent of the agent’s grade and step—awarded because of the large amount of overtime that these agents are expected to work. Salaries were slightly  Projections data from the National Employment Matrix Change, Projected 2008-2018 Employment, Occupational Title Number Percent 2018 10 84,700 968,400 883,600 Police and detectives......................................................................... .... 8 7,800 105,200 97,300 33-1012 First-line supervisors/managers of police and detectives......... .... 17 18,700 112,200 130,900 .... 33-3021 Detectives and criminal investigators.......................................... 8 700 9,000 8,300 33-3031 Fish and game wardens................................................................. .... 9 57,500 723,300 665,700 33-3050 Police officers................................................................................. .... 9 57,300 718,800 661,500 33-3051 Police and sheriff’s patrol officers.......................................... .... 200 5 4,500 4,300 33-3052 Transit and railroad police....................................................... .... (NOTE) Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Informa­ soc Code  tion Included in the Handbook.   https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  Employment, 2008  Service Occupations 477  higher in selected areas where the prevailing local pay level was higher. Because Federal agents may be eligible for a special law enforcement benefits package, applicants should ask their recruiter for more information. Total earnings for local, State, and special police and detec­ tives frequently exceed the stated salary because of payments for overtime, which can be significant. According to the International City-County Management Association’s annual Police and Fire Personnel, Salaries, and Expenditures Survey, average salaries for sworn full-time posi­ tions in 2008 were as follows: Rank Police chief............................ ............... Deputy chief........................... .............. Police captain....................................... Police lieutenant.................... .............. Police sergeant...................... .............. Police corporal...................... ..............  Minimum salary $90,570 74,834 72,761 65,688 58,739 49,421  Maximum salary w/o longevity $113,930 96,209 91,178 79,268 70,349 61,173  In addition to the common benefits—paid vacation, sick leave, and medical and life insurance—most police and sher­ iffs’ departments provide officers with special allowances for uniforms. Many police officers retire at half-pay after 20 years of service; others often are eligible to retire with 30 or fewer years of service.  Related Occupations Other occupations that help protect and serve people are: Page Correctional officers................................................................. 467 Emergency medical technicians and paramedics.................... 419 Fire fighters.............................................................................. 470 Private detectives and investigators..........................................477 Probation officers and correctional treatment specialists............................................................. 241 Security guards and gaming surveillance officers................... 481  from the nearest State FBI office. The address and phone number are listed in the local telephone directory. Internet: http://www.fbi.gov Information on career opportunities, qualifications, and train­ ing for U.S. Secret Service Special Agents and Uniformed Of­ ficers is available from the Secret Service Personnel Division at (202) 406-5830, (888) 813-8777, (888) 813-USSS, or U.S. Secret Services, Recruitment and Hiring Coordination Center, 245 Murray Dr., Building 410, Washington, DC 20223. Inter­ net: http://www.secretservice.gov/join Information about qualifications for employment as a Drug Enforcement Administration (DEA) Special Agent is available from the nearest DEA office, DEA Office of Personnel, 8701 Morrissette Dr., Springfield, VA 22152, or call (800) DEA4288. Internet: http://www.usdoj.gov/dea Information about jobs in other Federal law enforcement agencies is available from: y U.S. Marshals Service, Human Resources Division—Law Enforcement Recruiting, Washington, DC 20530-1000. Internet: http://www.usmarshals.gov y U.S. Bureau of Alcohol, Tobacco, Firearms, and Explosives, Office of Governmental and Public Affairs, 99 New York Ave. NE. Mail Stop 5S144, Washington, DC 20226. Internet: http://www.atf.gov y U.S. Customs and Border Protection, 1300 Pennsylvania Ave. NW., Washington, DC 20229. Internet: http://www.cbp.gov y U.S. Department of Homeland Security, Washington, DC 20528. Internet: http://www.dhs.gov The Occupational Information Network (0*NET) pro­ vides information on a wide range of occupational char­ acteristics. Links to 0*NET appear at the end of the In­ ternet version of this occupational statement, accessible at http://www.bls.gov/ooh/ocosl60.htm  Private Detectives and Investigators Significant Points  Sources of Additional Information Information about entry requirements may be obtained from Federal, State, and local law enforcement agencies. To find Federal, State, and local law enforcement job fairs and other recruiting events across the country, contact: V National Law Enforcement Recruiters Association, PO Box 17132, Arlington, VA 22216. Internet: http://www.nlera.org For general information about sheriffs and to learn more about the National Sheriffs’ Association scholarship, contact: y National Sheriffs’ Association, 1450 Duke St., Alexandria, VA 22314. Internet: http://www.sheriffs.org For information about chiefs of police, contact: y International Association of Chiefs of Police, 515 N. Washington St., Alexandria, VA 22314. Internet: http://www.theiacp.org Information related to Federal law enforcement: Information about qualifications for employment as a Fed­ Bureau of Investigation (FBI) Special Agent is available Digitized eral for FRASER https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  • Work hours are often irregular, and the work can be dangerous. • About 21 percent are self-employed. • Keen competition is expected for most jobs. • Most private detectives and investigators have some college education and previous experience in inves­ tigative work.  Nature of the Work Private detectives and investigators assist individuals, busi­ nesses, and attorneys by finding and analyzing information. They connect clues to uncover facts about legal, financial, or personal matters. Private detectives and investigators offer many services, including executive, corporate, and celebrity protection; preemployment verification; and individual back­ ground profiles. Some investigate computer crimes, such as  478 Occupational Outlook Handbook  identity theft, harassing e-mails, and illegal downloading of copyrighted material. They also provide assistance in criminal and civil liability cases, insurance claims and fraud cases, child custody and protection cases, missing-persons cases, and pre­ marital screening. They are sometimes hired to investigate indi­ viduals to prove or disprove infidelity. Private detectives and investigators may use many methods to determine the facts in a case. Much of their work is done with a computer. For example, they often recover deleted e-mails and documents. They also may perform computer database searches or work with someone who does. Computers allow investiga­ tors to quickly obtain huge amounts of information, such as records of a subject’s prior arrests, convictions, and civil legal judgments; telephone numbers; information about motor vehi­ cle registrations; records of association and club memberships; social networking site details; and even photographs. Detectives and investigators also perform various other types of surveillance or searches. To verify facts, such as an individu­ al’s income or place of employment, they may make phone calls or visit a subject’s workplace. In other cases, especially those involving missing persons and background checks, investiga­ tors interview people to gather as much information as possible about an individual. Sometimes investigators go undercover, pretending to be someone else in order to get information or to observe a subject inconspicuously. They even arrange to be hired in businesses to observe workers for wrongdoing. Most detectives and investigators are trained to perform physical surveillance, which may be high tech or low tech. They may observe a site, such as the home of a subject, from an inconspicuous location or a vehicle. Using photographic and video cameras, binoculars, cell phones, and GPS systems, de­ tectives gather information on an individual. Surveillance can be time consuming. The duties of private detectives and investigators depend on the needs of their clients. In cases that involve fraudulent workers’ compensation claims, for example, investigators may carry out long-term covert observation of a person suspected of fraud. If an investigator observes the person performing an ac­ tivity that contradicts injuries stated in a worker’s compensation  w ■  V-  Private detectives and investigators may use many methods to determine the facts in a case.  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  claim, the investigator would take video or still photographs to document the activity and report it to the client. Detectives and investigators must be mindful of the law in conducting investigations. They keep up with Federal, State, and local legislation, such as privacy laws and other legal issues affecting their work. The legality of certain methods may be unclear, and investigators and detectives must make judgment calls in deciding how to pursue a case. They must also know how to collect evidence properly so that they do not compro­ mise its admissibility in court. Private detectives and investigators often specialize. Those who focus on intellectual property theft, for example, investi­ gate and document acts of piracy, help clients stop illegal activ­ ity, and provide intelligence for prosecution and civil action. Other investigators specialize in developing financial profiles and carrying out asset searches. Their reports reflect informa­ tion gathered through interviews, investigation and surveil­ lance, and research, including reviews of public documents. Computer forensic investigators specialize in recovering, an­ alyzing, and presenting data from computers for use in investi­ gations or as evidence. They determine the details of intrusions into computer systems, recover data from encrypted or erased files, and recover e-mails and deleted passwords. Legal investigators assist in preparing criminal defenses, locat­ ing witnesses, serving legal documents, interviewing police and prospective witnesses, and gathering and reviewing evidence. Le­ gal investigators also may collect information on the parties to a lit­ igation, take photographs, testify in court, and assemble evidence and reports for trials. They often work for law firms or lawyers. Corporate investigators conduct internal and external inves­ tigations for corporations. In internal investigations, they may investigate drug use in the workplace, ensure that expense ac­ counts are not abused, or determine whether employees are stealing assets, merchandise, or information. External inves­ tigations attempt to thwart criminal schemes from outside the corporation, such as fraudulent billing by a supplier. Investiga­ tors may spend months posing as employees of the company in order to find misconduct. Financial investigators may be hired to develop confidential financial profiles of individuals or companies that are prospec­ tive parties to large financial transactions. These investigators often are certified public accountants (CPAs) who work closely with investment bankers and other accountants. They also might search for assets in order to recover damages awarded by a court in fraud or theft cases. Detectives who work for retail stores or hotels are responsi­ ble for controlling losses and protecting assets. Store detectives, also known as loss prevention agents, safeguard the assets of re­ tail stores by apprehending anyone attempting to steal merchan­ dise or destroy store property. They prevent theft by shoplifters, vendor representatives, delivery personnel, and store employ­ ees. Store detectives also conduct periodic inspections of stock areas, dressing rooms, and rest rooms, and sometimes assist in opening and closing the store. They may prepare loss preven­ tion and security reports for management and testify in court against people they apprehend. Hotel detectives protect guests of the establishment from theft of their belongings and preserve  Service Occupations 479  order in hotel restaurants and bars. They also may keep undesir­ able individuals, such as known thieves, off the premises. Work environment. Many detectives and investigators spend time away from their offices conducting interviews or doing surveillance, but some work in the office most of the day con­ ducting computer searches and making phone calls. When an investigator is working on a case, the environment might range from plush boardrooms to seedy bars. Store and hotel detectives work in the businesses that they protect. Investigators generally work alone, but they sometimes work with others, especially during surveillance or when they follow a subject. Some of the work involves confrontation, so the job can be stressful and dangerous. Some situations, such as certain body­ guard assignments for corporate or celebrity clients, call for the investigator to be armed. In most cases, however, a weapon is not necessary, because the purpose of the work is gathering informa­ tion and not law enforcement or criminal apprehension. Owners of investigative agencies have the added stress of having to deal with demanding and sometimes distraught clients. Although consid­ ered a dangerous occupation, private detectives and investigators have a relatively low incidence of nonfatal work-related injuries. Private detectives and investigators often work irregular hours because of the need to conduct surveillance and contact peo­ ple who are not available during normal working hours. Early morning, evening, weekend, and holiday work is common.  Training, Other Qualifications, and Advancement Most private detectives and investigators have some college education and previous experience in investigative work. In the majority of States, they are required to be licensed. Education and training. There are no formal education re­ quirements for most private detective and investigator jobs, al­ though many have postsecondary degrees. Courses in criminal justice and police science are helpful to aspiring private detec­ tives and investigators. Although related experience is usually required, some people enter the occupation directly after gradu­ ation from college, generally with an associate’s or bachelor’s degree in criminal justice or police science. Experience in po­ lice investigation is viewed favorably. Most corporate investigators must have a bachelor’s degree, preferably in a business-related field. Some corporate investiga­ tors have a master’s degree in business administration or a law degree; others are CPAs. For computer forensics work, a computer science or account­ ing degree is more helpful than a criminal justice degree. An accounting degree provides good background knowledge for investigating computer fraud. Either of these two degrees pro­ vides a good starting point, after which investigative techniques can be learned on the job. Alternatively, many colleges and universities now offer certificate programs, requiring from 15 to 21 credits, in computer forensics. These programs are most beneficial to law enforcement officers, paralegals, or others who already are involved in investigative work. A few colleges and universities now offer bachelor’s or master’s degrees in com­ puter forensics, and others are planning to begin offering such degrees. Most computer forensic investigators learn their trade while working for a law enforcement agency, either as a sworn officer or a civilian computer forensic analyst. They are trained  https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis  at their agency’s computer forensics training program. Many people enter law enforcement specifically to get this training and establish a reputation before moving to the private sector. Most of the work of private detectives and investigators is learned on the job. New investigators will usually