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APPENDIX
D
- Estimates of the Current
Supply of Personnel in :10 Allied
Health Fielcis
Making an accurate assessment of the supply of allied health practitioners
in each of the various fields is not easy. For many occupations, there is no
reliable data source for either the total number of qualified people, the
number working, or the number not working but available if the right
market conditions were to occur. BLS uses the Occupational Employment
Survey (OES) to collect data on the number of filled jobs. In fields with a
high incidence of persons holding multiple jobs, however, BLS data are
an inaccurate reflection of the labor force. Another major source of data
is the decennial census of the United States, which was last conducted in
1980. These data are now dated, and their definitions of allied health fields
often do not match the professions' definitions. A third source of data,
memberships of the allied health professional associations, may provide
information from only a small fraction of the supply of practitioners. Be-
cause not all practitioners in a field are listed as certificate, license, or
registration holders and not all listed practitioners are in the active labor
force, using these categories as a data source does not always offer accurate
representations of the labor force.
Despite these data limitations, some estimates of the supply of practi-
tioners can be made. For example, in fields in which holding multiple jobs
is not common, the BLS data closely approximate the number of people
working in the field. In addition, professional associations collect data on
both the number of qualified practitioners and the number of practitioners
active in the field. This appendix presents supply estimates that have been
derived from various sources of data. Although it is difficult to pinpoint
a "best figure," the estimates can be used to map a reasonable range of the
296
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APPENDIX D
297
number of people working in each of the 10 fields highlighted in this
report.
Dietitians
BLS estimated total dietitian employment in 1986 to be 40,201 positions
(38,201 people held wage and salary jobs, and 2,000 people were self-
employed dietitians). BLS defines dietitians as people who "organize, plan,
and conduct food service or nutritional programs to assist in Ethel pro-
motion of health and control of disease." Dietitians "may administer activ-
ities of a department providing quantity food service" and "may plan,
organize, and conduct programs in nutritional research."
The American Hospital Association's 1985 annual survey indicated that
there were 14,993 full- and part-time dietitians employed in U.S. registered
hospitals that year. BLS estimates that 37 percent of all dietitians were
employed in hospitals in 1986. Assuming that the number of dietitians
working in hospitals did not change significantly between 1985 and 1986,
and that the number in 1986 was roughly equal to the association's 1985
survey figure, we can then extrapolate from the American Hospital As-
sociation data (14,933 dietitians employed/37 percent of dietitians) and
estimate that there were about 40,100 dietitians employed in 1986 a figure
that confirms the BLS estimate.
The American Dietetic Association reported 44,570 registered active
dietitians on its rolls at the end of 1987.
Dental Hygienists
The Occupational Employment Survey defines dental hygienists as peo-
ple who "perform dental prophylactic treatments and instruct groups and
individuals in the care of the teeth and mouth." BLS estimated that dental
hygienists filled 86,676 jobs in 1987 none was self-employed. As men-
tioned earlier, the BLS data pertain to jobs. People who hold more than
one job are counted at each job site. Because the practice of holding multiple
jobs is common among dental hygienists, the number of dental hygienist
jobs that are filled greatly exceeds the number of working dental hygienists.
The Bureau of Health Professions of the Health Resources and Services
Administration estimate that there were 45,800 dental hygienists in 1984
filling an estimated 76,000 jobs. Thus, each working hygienist filled an
average of 1.66 jobs. Assuming the job-to-hygienist ratio was about the
same in 1986 as in 1984, the committee estimates that there were about
52,200 working hygienists in 1986.
Dental hygienists are licensed in every state and the District of Columbia.
To obtain a license, a candidate must graduate from a dental hygiene school
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APPENDIX D
accredited by the Commission on Dental Accreditation and pass both writ-
ten and clinical examinations. According to the commission's 1986/1987
annual report, a total of 51,713 students graduated from accredited schools
between 1976 and 1986.
Emergency Medical Technicians
BLS estimates that there were 65,229 paid emergency medical techni-
cians (EMTs) in 1986. According to the OES instrument, EMTs "administer
first aid treatment and transport sick or injured persons to medical facilities,
working as a member of an emergency medical team." EMTs are not
ambulance attendants and drivers.
Because there are many volunteer EMTs, the number of paid EMTs
understates the true supply of practitioners. The 1985 National Emergency
Medical Services Clearinghouse survey indicated that approximately 95,000
EMTs are certified annually in 42 states. However, New York, Texas, and
California, three of the most populous states, were not among those re-
porting. Certification is generally valid for 2 years; the committee therefore
estimates that there are at least 200,000 certified EMTs in the United States
. .
in any given year.
Medical Laboratory Technologists and Technicians
According to BLS estimates, there were 239,350 jobs for medical labo-
ratory technologists and technicians in 1986 (this figure includes 1,000 self-
employed persons). The OES defines medical and clinical laboratory tech-
nologists as people who "perform a wide range of complex procedures in
the general areas of the clinical laboratory or Ewho] perform specialized
procedures in such areas as cytology, histology, and microbiology." Their
"duties may include supervising and coordinating activities of workers en-
gaged in laboratory testing and include workers who teach medical tech-
nology when teaching is not their primary activity." Medical and clinical
laboratory technicians are defined as persons who "perform routine tests
in medical laboratories for use in treatment and diagnosis of disease." They
"prepare vaccines, biologicals, and serums for prevention of disease" and
"prepare tissue samples for pathologists, take blood samples, and execute
such laboratory tests as urinalysis and blood counts." Laboratory technicians
"may work under the general supervision of a medical laboratory tech-
nologist." Although BLS collects separate data for the two categories of
laboratory personnel, the data are combined for reporting purposes.
It is difficult to estimate the ratio of technologists to technicians. Of the
209,000 registrants of the American Society of Clinical Pathologists in 1987,
82 percent were medical technologists. In September 1987 the registry of
the National Certification Agency for Medical Laboratory Personnel was
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APPENDIX D
299
composed of 83 percent technologists and 17 percent technicians. If the
above ratios are applied to the BLS estimate of total employment of medical
laboratory technologists and technicians, the numbers of technologists and
technicians in the work force in 1986 would have been about 196,267 and
43,083, respectively. A word of caution is in order, however. Technicians
may be less likely than technologists to be certified; thus, our estimate may
underrepresent technicians and overrepresent technologists. Unfortu-
nately, there is no easy way to verify the ratio of technicians to technologists.
Medical Record Administrators and Technicians
BLS does not estimate total employment for medical record administra-
tors.
The American Hospital Association's 1985 annual survey shows 7,639
full- and part-time medical record administrators employed in U.S. reg-
istered hospitals in that year. If, as indicated by the American Medical
Record Association 1986 membership survey, approximately 73 percent
of all medical record administrators work in acute care facilities, we can
extrapolate from the American Hospital Association data to determine the
total number of persons employed as medical record administrators: 10,464.
If this is the case, more than 20 percent of people filling medical record
administrator jobs must be unregistered because the American Medical
Record Association reported only 8,240 registered medical record admin-
istators in 1987.
Medical record technician employment was estimated by BLS to be 39,888
in 1986. The OES defines medical record technicians as persons who "com-
pile and maintain medical records of hospital and clinic patients." The
American Medical Record Association reported 14,690 accredited record
technicians in 1987.
The American Hospital Association's 1985 annual survey shows 43,383
full- and part-time medical record technicians employed in U.S. registered
hospitals. This figure is not only substantially higher than the BLS estimate
of 24,500 jobs in hospitals, but it is also higher than the BLS estimate of
total technicians' jobs in all settings. The reasons for this difference are not
known, but they may be sought in an examination of the ways in which
job definitions are developed and then interpreted by survey respondents.
Occupational Therapists
BLS estimates that there were 29,355 jobs for occupational therapists in
1985. The OES defines occupational therapists as persons who "plan, or-
ganize, and participate in medically oriented occupational programs in
hospitals or similar institutions to rehabilitate patients who are physically
or mentally ill."
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300
APPENDIX D
The American Hospital Association 1985 annual survey shows 10,595
full- and part-time occupational therapists employed in U.S. registered
hospitals. The American Occupational Therapy Association reports that
about 28 percent of its members worked in general and pediatric hospitals
in 1986. BLS estimates that 32.5 percent of total occupational therapy
employment is in hospitals.
The total active membership of registered occupational therapists in the
American Occupational Therapy Association at the end of 1987 was about
27,300. Until mid-1987, registered occupational therapists automatically
became members of the association, and the tally of active members rep-
resented about 99 percent of the professional work force. Membership in
the association is now voluntary.
Physical Therapists
Total 1986 employment of physical therapists was estimated by BLS to
be about 61,168 positions, including 5,000 self-employed persons. The OES
defines physical therapists as persons who "apply techniques and treatments
that help relieve pain, increase the patient's strength, and decrease or
prevent deformity and crippling."
The American Physical Therapy Association estimated the number of
licensed physical therapists to be 65,890 as of June 1986. All states require
practicing professional physical therapists to be licensed.
Radiologic Technologists and Technicians
According to BLS estimates, there were 115,429 jobs for radiologic tech-
nologists and technicians in 1986. The OES defines radiologic technologists
as persons who "take x-rays, CAT scans, or administer non-radioactive
materials into Lal patient's blood stream for diagnostic and therapeutic
purposes." Hospitals were asked to include in the category of radiologic
technologist all workers whose primary duties were to demonstrate portions
of the human body on x-ray film or fluoroscopic screens. Radiologic tech-
nicians were defined as persons who "maintain and safely use equipment
and supplies necessary to demonstrate portions of the human body on x-
ray film or a fluoroscopic screen for diagnostic purposes." Included in the
BLS "radiologic technologists and technicians" category are radiation ther-
apists and sonographers. Nuclear medicine technicians are not included.
The Bureau of Health Professions estimates that there were 143,000
radiologic health service workers of all types in 1986, including nuclear
medicine technologist
Nuclear Medicine Technologists
Nuclear medicine technologists "prepare, administer, and measure ra-
dioactive isotopes in therapeutic, diagnostic, and tracer studies utilizing a
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APPENDIX D
301
variety of radioisotope equipment." They "prepare stock solutions of ra-
dioactive materials and calculate doses to be administered by radiologists."
They "subject patients to radiation Land] execute blood volume, red cell
survival and fat absorption studies following standard laboratory tech-
niques."
BLS estimates that there were 9,677 nuclear medicine technologist jobs
in 1986, of which 89 percent were in hospitals. Over 88 percent of the
respondents to a 1987 survey conducted by the Nuclear Medicine Tech-
nology Certification Board indicated that they worked in hospitals.
The 1985 American Hospital Association survey of U.S. hospitals indi-
cated that there were 7,972 full- and part-time nuclear medicine technol-
ogists employed in U.S. registered hospitals in that year. If approximately
89 percent of all nuclear medicine technologists work in hospitals, the
American Hospital Association data suggest that the total number of nu-
clear medicine technologists employed in 1985 was about 9,000, which is
in close agreement with the BLS estimate. The Nuclear Medicine Tech-
nology Certification Board reported 10,298 certified technologists in Au-
gust 1987.
Respiratory Therapists
BLS estimated that there were 56,333 jobs for respiratory therapists in
1986 there were no self-employed respiratory therapists. The OES de-
f~nes respiratory therapists as persons who "set up and operate various
types of equipment, such as iron lungs, oxygen tents, resuscitators, and
incubators, to administer oxygen and other gases to patients."
The 1985 American Hospital Association survey indicated that there
were 32,623 respiratory therapists employed in U.S. registered hospitals
in that year. The American Association for Respiratory Care states that
the majority of respiratory care practitioners work in hospitals. BLS esti-
mates that 88 percent of such jobs are to be found in hospitals.
Speech Pathologists and Audiologists
BLS estimates that jobs for speech pathologists and audiologists num-
bered 45,129 positions in 1986, including 3,000 self-employed practitioners.
The OES defines speech pathologists and audiologists as health care prac-
titioners who "examine and provide remedial services for persons with
speech and hearing disorders and perform research related to speech and
language problems."
The 1985 American Hospital Association survey identified 5,354 speech
pathologists and audiologists who were employed in U.S. registered hos-
1 ~ ~
pitals in that year. Il. as BLS states, hospitals provide only about 10 percent
of total employment for speech pathologists and audiologists, the total
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APPENDIX D
number of speech pathologists and audiologists employed in 1985 would
have been about 53,540 substantially higher than the BLS estimate.
There are 56,287 speech pathologists and audiologists who are certified
by the American Speech-Language-Hearing Association. Ninety-two per-
cent of certified practitioners are members of the association. Although
basic occupational preparation is at the master's level, persons holding only
a bachelor's degree in speech pathology and audiology are employed in
some settings and may be considered a part of the labor supply. There is
no estimate of the number of bachelor's-level practitioners.
Representative terms from entire chapter:
american hospital
