by | Mar 30, 2013 | Magazine, Nursing Careers
As a rookie emergency medical technician, Jeffrey Brown went to work his first day on the job both excited and nervous. He was starting work for a private service in Oklahoma. However, it was not a typical first day on the job. It was September 11, 2001, and fire departments, ambulance services and hospitals across the country were being warned by authorities that there had been threats of terrorists loading up ambulances with explosives and blowing them up at hospital doors. In the next days and weeks that followed, Brown and his fellow EMTs and paramedics received frantic calls from paranoid citizens who saw anthrax in every letter and small pox in every child coming down with a common case of chicken pox.
Most EMTs have easier starts to their job. EMTs and paramedics say they’ve had so much textbook and clinical training by the time they begin their careers, that they feel ready to treat patients in any number of unpredictable conditions. Still the first year is a crucial, steep learning curve for those embarking on such a tough job.
“The hardest part is realizing that you can’t help everyone,” says Brown, who now lives in New Orleans. He recalls patients such as an elderly man who refused help despite his children’s worried pleas. Beyond the patients who cannot be helped medically, there are also those whom EMTs cannot help for legal reasons, such as a man who insisted he was fine even though EMS and his own children could see that he was not.
Trial by Fire
Fortunately for students who might not be cut out for dealing with patients in often-difficult circumstances, EMT and paramedic programs require clinical training. The education of EMTs and paramedics (who are also EMTs but have additional classroom and clinical training beyond the EMT-basic or -intermediate level) includes clinical experience, such as following and assisting real EMTs on the job. Usually a percentage of students drop out at this stage, realizing the work isn’t right for them.
Susan Schmele, director of the Oregon Health and Science University (OHSU) Paramedic Program in Portland, Ore., says paramedics-in-training have a lot to learn in that one crucial year of studying and internships. “Students have to learn how to step out onto a scene and take control,” says Schmele. “It’s not like you’re in a controlled environment like a hospital or doctor’s office. You could be anywhere from in the middle of a cow field to a million-dollar home.”
Despite the rigors of unpredictable work in the field, many students are hooked early on and stick with the hours of studying and internships with hospitals, fire departments or ambulance services because they love the work.
Take Peter Lehmann a paramedic and firefighter for Tualatin Valley Fire and Rescue in Portland, Ore., who completed the paramedic program at OHSU. He left an unfulfilling job in corporate sales with an eye toward a career change.
Lehmann, who had a bachelor of arts in business from the University of Vermont, used his new freedom to have some fun and became a rafting guide in Montana. He had to learn first aid for the job, which he found intriguing. Later, he did some ride-alongs in ambulances and knew that he had found his calling.
“It involves teamwork and serving your community,” he says now. “You feel a sense of comfort working with your crews. You have people looking out for you and you’re looking out for them.”
Because Lehmann already had a bachelor’s degree, he was able to skip a lot of the required courses in the associate’s degree program at OHSU and focus almost entirely on emergency medicine. After he received his EMT basic training at another college, he spent four months in classroom instruction at OHSU, another four months doing clinical rotations in the emergency room, operating room and in the obstetrics ward of a local hospital, and the final four months at an internship working on an ambulance with experienced paramedics.
Lehmann, who was one of 1,600 firefighter applicants for 24 openings at Tualatin Valley, is one of the fortunate paramedic grads who found a job that not only pays fairly well, but also offers continuing training. His first days on the job were spent in a three-month fire and paramedic training program in which participants are faced with scenarios-including live fires-to practice what they’ve learned.
Still, even for those with extensive training and the support of fellow paramedics and firefighters, the first year of actually working on an ambulance can be rough.
“Some calls are really hard in your first year,” says Lehmann. “Like bad car wrecks. Those are difficult calls because the patients are so critical. But you’re working with people who are experienced and who can offer another opinion or advice.”
Lehmann adds, “After a call I’ll ask, ‘How could that call have been done better? What could I have done differently?'”
Salaries Out of Step
Not only does Lehmann appreciate the training opportunities and enjoy the camaraderie that comes with being in a fire station, he also enjoys the better pay that is part of his position. In fact, on average firefighters earn higher wages than paramedics.
Training and coursework standards depend on state standards and vary by program, but requirements for paramedics are extensive compared to their EMT-basic counterparts. However their pay is typically lower than that of other allied health professionals with similar levels of medical training. Basic EMTs are versed in first aid techniques, such as CPR, but intermediate EMTs and paramedics can perform more invasive procedures and administer certain drugs.
Low pay has been a frequent topic of discussion and complaint among EMT circles for years. Now a shortage of EMTs is bringing greater attention to the issue.
According to an April 2004 article in the Journal of EMS, most states have seen a decrease in the number of newly certified EMTs and licensed paramedics. Some speculate that declining numbers are due to new curriculum guidelines that are adding hours to many training programs. Pay and attrition are also potential culprits, and many believe that a combination of all three is to blame.
“Paramedics are making a living now, but they often have more than one job,” says Ken Bouvier, president of the National Association of EMTs. “But the ultimate goal is to get salaries up comparable to other jobs in America where you can afford to put food on your family’s table without having to work two or three jobs.”
According to Bouvier and others, pay depends a lot on geography. An EMT in a rural area could make barely more than minimum wage-and that is for non-volunteer EMS. Those who volunteer, however, make as little as $12 a run. That means on a slow day, you might only make $12-if anything. Bouvier says paramedic pay typically ranges anywhere from $10 to $17 an hour, but again, it’s difficult to generalize typical pay because standards and funding vary dramatically from state to state and from county to county. Still, it’s clear that in a profession in which it takes years to become properly trained, and, in the case of paramedics, includes hours of additional classroom and clinical study, salaries are out of step with the level of expertise demanded by the job.
“You pay more money to the lady who would groom your pet than you would a paramedic to save your life,” says Bouvier. “She would spend about an hour grooming your dog and charge you $25; a paramedic might get paid $17 in an hour to save your life.”
The shortage could be good news for those who are considering a career in EMS. In many states, it will mean that jobs will be more plentiful and in some cases may be paying better to attract new talent. Bouvier says many ambulance services and other employers are losing paramedics to competing services that offer sign-on bonuses. As a result, job-hopping is adding to the retention problem. Other trends are less hopeful for future paramedics, like services and government departments replacing two-paramedic teams with one EMT and one paramedic.
Still, for EMTs such as Lehmann and Brown, passion for the work more than makes up for the profession’s drawbacks. Before he decided to go into EMS, Brown was diagnosed with Hodgkins Lymphoma and forced to quit his job as a professional diver, a career he loved. “I’m actually glad I’m not a diver anymore because I never would have found this job,” he says. “I love to do this so much.”
Observing the Experts
Both Brown and Lehmann advise new EMTs to spend their first few years on the job expanding their knowledge outside the classroom, especially by observing experienced colleagues. Lehmann says that working with other paramedics was one of his primary learning tools in his early months on the job. Rookie paramedics often underestimate how much they still have to learn once they are licensed or certified. Both Lehmann and Brown say that new EMTs and paramedics typically encounter cases that are not only difficult to deal with but tough to diagnose, as well.
“When I first got out of school as an EMT-basic, I thought, ‘I’m ready to go. I could be a paramedic now’,” says Brown.
Months later, after a move to New Orleans and a new job at the health department, Brown remembers going on a call to a nursing home with an “old-hand” EMT with several years of experience under his belt. The home had called EMS because one of its patients, an elderly woman, was acting strangely. Brown’s partner took one look at the woman and said to Brown, “Load and go.” Brown, used to the usual protocol of talking to the patient and asking basic questions, didn’t understand but followed his more experienced partner’s lead. As soon as the woman was loaded on to the ambulance, her heart stopped beating regularly, and the two EMTs had to use electric paddles to regain a regular rhythm. Brown’s partner recognized the symptoms, including the familiar pallor that he’d seen on a handful of patients over the many years he had worked in EMS.
Zero to Hero?
While new EMTs are often surprised by life-or-death cases that challenge what they think they already know, they are also equally surprised to find that much of an EMT’s typical day can be slow and quiet. Schmele says sometimes new paramedics are disappointed by the lack of excitement. “Especially younger people,” she says. “They’re a little disappointed that it’s not all car wrecks and gun shot wounds. They’re all geared up for this excitement and then it’s sit around and wait.”
“When I first started,” says Brown, “I thought every call was going to be life and death.” Instead he found his first job working for a private service to involve a lot of transporting patients from nursing homes to hospitals. Bouvier says that typically 90% of EMS work doesn’t involve life or death cases.
Some have used this reality to bolster the notion of “zero to hero” programs that reduce the number of classroom and clinical hours required to earn EMT certification. Looking at the profession more as one of ambulance driving than one of patient care also supports the argument that fewer paramedics are needed on ambulance crews. But EMT advocates think this view is shortsighted.
“Rarely are you going to have the opportunity to save a life,” says Bouvier, conceding that inexperienced, basic EMTs can handle the majority of these non-emergency cases. “Most of the calls are routine. The other seven or eight percent are going to be crisis, life-threatening calls without a well-trained, experienced EMT or paramedic, that patient won’t have a second chance at life.”
Bob Luftus is a retired paramedic in Carbondale, Ill., with decades of experience as a military and civilian paramedic who has worked all over the country and witnessed first hand the struggle of EMTs to be recognized as full-fledged medical professionals and not just patient transporters. “We’re still trying to grow up and be treated like other first responders,” he says of the profession’s growing movement to demand recognition and better pay. “You’re out there helping people, sometimes saving lives, and in the bigger scope of things that’s better than making money.”
by | Mar 30, 2013 | Magazine
Throughout the allied health industry, practitioners are eager to bring about resolution once and for all to the conundrum created by Medicare reform as it was spelled out in the Balanced Budget Act of 1997 (BBA).
The past eight years have been a roller-coaster ride of limitations, periods of momentary relief and ongoing uncertainty. The topsy-turvy environment was enough to send the industry and job market into a tailspin. But physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs)-the three specialties most directly impacted-did what they do best: They assessed the situation and devised a plan to get allied health back on track.
A Brief History
Forty years ago health care was undergoing substantial growing pains, including an expanding elderly population that had barriers to adequate health care. For generations, people had paid for medical care in cash, but health care was now adapting a business persona and insurance was the accepted mode of operation.
However, there was a significant number of older people who didn’t have the means to purchase adequate coverage, and there was a sense that they were being left behind. These circumstances were considered unacceptable in the days of The Great Society, President Lyndon B. Johnson’s encompassing social outreach program. Legislators, therefore, enacted a national insurance program known as Medicare.
Today, the basic coverage parameters remain virtually unchanged: Citizens 65 years old and older or those with certain disabilities, receive assistance paying for their health services. And it worked, until the cost of doing business surpassed federal funding. By the mid 1990s, Medicare was tapped out. The program was on life support and needed some serious resuscitation.
Not only was it operating in the red by 1997, but the projected strain retired baby boomers were going to place on the system-an estimated 80 million eligible beneficiaries by 2030-would ultimately prove to be Medicare’s unraveling. “And there is going to be an increasing elderly population, too,” notes Dave Mason, vice president of government affairs for the American Physical Therapy Association (APTA), based in Alexandria, Va. “We’ll be seeing more people moving into the extremely elderly age bracket and relying on Medicare.”
So when lawmakers saw an opportunity to restructure the program’s spending practices via the Balanced Budget Act, they seized it. Among other provisions, the legislation restricted outpatient spending on therapeutic services. It set annual reimbursement for OTs at $1,500 per Medicare patient and a combined cap of $1,500 for both physical and speech therapy.
“The BBA’s purpose was to get Medicare expenditures and rate of growth under control,” says Christine Metzler, director of federal affairs for the American Occupational Therapy Association (AOTA), located in Bethesda, Md.
From a fiscal point of view, the caps seemed logical, but in the clinical environment, it resulted in immediate repercussions. “When the BBA hit, the job market for PTs was expecting a huge need, and almost overnight there was a talent surplus,” says Steven Chesbro, PT, EdD, MHA, GCS, associate professor and chair for the Department of Physical Therapy at Howard University, College of Pharmacy, Nursing & Allied Health Sciences in Washington D.C.
OTs and SLPs found themselves in similar circumstances. “Anytime you have a major shift, it throws the system into shock,” says Carolyn Baum. Ph.D., OTR/L, FAOTA, professor of occupational therapy and neurology, director of the OT program at Washington University in St. Louis, and AOTA president.
Immediate Repercussions
The caps, however, were only one change within the BBA affecting allied health. Medicare has always been divided into two billing segments: Part A covered inpatient hospital stays, skilled nursing facilities, hospice care and some home care; Part B was responsible for reimbursing costs from doctors’ services, medical equipment, and some medical services not covered by Part A. Under the BBA, Part A was switched to a prospective payment system and Part B now included outpatient services, Metzler explains. Additionally, Part B now works off of a physician’s fee schedule, rather than cost-based formulas.
[ads:other]
“There was a shift away from a cost-based system and that required outpatient programs under Part B to switch to a physician’s schedule. That was different from what we’d been doing,” says Baum.
The changes stirred up a lot of uncertainty. Rehabilitation centers, outpatient clinics, and any number of facilities took action to counteract the anticipated revenue loss. “Before the BBA, the incentive was to find new patients and provide them more therapy. After, we saw a tremendous drop in how much Medicare was paying and no one really knew how it would work,” explains Metzler. “So in a pre-emptive response, some therapists were let go or switched to per diem or hourly. Employers weren’t sure how they were going to pay for the therapy and make a profit.”
Of course, the majority of therapists and pathologists have always treated a diverse clientele, but it wasn’t uncommon for Medicare patients to represent a hefty portion of their business-or at least enough of it that the specialists felt the full force of Medicare reform.
Practices had to diversify or reduce their Medicare operations,” states Mason. “They reduced staff and combined practices with other clinics, yet others restructured their operations.”
Unemployment figures reinforced the doubtful perceptions within allied health. According to APTA, unemployment among PTs in 1999 jumped two percent from the year before. The American-Speech-Language-Hearing Association (ASHA), headquartered in Rockville, Md., reported decreased spending on speech therapy.
“Fees were reduced from 12% of the total rehab expenditures to six percent.
That’s huge,” states James Potter, CAE, ASHA director of government relations and public policy. “Part of the decrease is because speech and swallowing services are typically placed behind physical therapy, but together they tend to go over the $1,500 cap.”
Indeed, PTs and SLPs started quipping that patients could walk or they could talk, but they couldn’t afford to do both. “Contributing to the problem is a technical definition for speech therapy that allows Congress to lump it in with PT services. Because of that narrow interpretation of the law, we’ve suffered a double whammy,” says Potter. “We continue to advocate speech therapy be treated like other service deliveries in Medicare, which is as a separate service. At the minimum, we would like SLPs to be able to bill Medicare directly for outpatient services or from private practice settings. OTs and PTs have that ability right now, but the way the outpatient statute is constructed, Medicare limits SLPs to bill from private practice.”
Although the BBA only pertained to Medicare patients, its reach went much further. In fact, it was felt throughout the industry. Even practices that didn’t rely heavily on Medicare donned a cautionary attitude.
“Facilities started reviewing their long-range planning and decided they didn’t necessarily have to fill current vacancies or shelved expansion plans, which would have created new jobs,” notes Mason.
“People weren’t changing jobs like they had been in the years prior to the BBA because the market was unknown,” adds Debra Margolis, MS, OTR/L, professional development manager for occupational therapy at Spaulding Rehabilitation Hospital Network in Boston.
Small Victories
Rather than boosting Medicare’s fiscal well-being, experts-and patients-believed the constraints led to further deterioration of the system. Neither group felt it improved health services; professional organizations including APTA, AOTA and ASHA cried for urgent reforms. Fortunately, Congress listened. Although the BBA Reform Act in 1999 didn’t repeal the caps, it did place a moratorium on them. This action allowed therapists and pathologists to treat their Medicare clients without the overriding budgetary concerns, at least for a while.
Allied health had won some breathing room, but it was temporary, and the job market was hesitant. Notes Chesbro, “The moratorium helped, but employers were slow to respond. The BBA changed how we view the volatility of Medicare reimbursement. We realized the rules could change.”
Indeed, the rules did keep changing. That initial moratorium only lasted two years, after which the caps would be reinstated unless Congress acted again. What happened is that lawmakers imposed another moratorium and then another. The latest was tied to the Medicare Prescription Drug, Improvement and Modernization Act of 2003, which also replaced an anticipated 4.5% cut in Medicare payments to therapists with a 1.5% increase. Meanwhile the caps officially remain on the books.
“Right now it is a difficult environment to really know what will happen with Medicare. You have to plan for the cap even if it’s not in effect,” states Mason.
Complicating matters is the national deficit. “The budget has become a problem. It’s difficult finding money to either continue the moratorium or repeal the cap. The deficit has made a bad situation even worse,” says Potter.
Even when Washington D.C. was operating with a budget surplus, Medicare struggled to find enough funding. But today’s $500 billion deficit really limits legislators’ options. Their hands are virtually tied in what they can and cannot do with new Medicare reforms. Mason explains, “A majority of representatives in both the House and Senate have cosponsored a cap repeal, signifying that we have won the policy debate. But the budget is operating off of a baseline estimate of federal spending as if the caps were in effect. What that means is that in order to repeal the cap altogether, the federal budget would see its spending increase.
“Estimates have stated that a full repeal would cost the government more than $7 billion in 10 years,” he continues. “Therefore, Congress has struggled with the cost implications
of repealing the act. So for now, the moratorium is the only feasible option. However, that moratorium expires in 2006, so the battle continues.”
Making the Grade
As if the BBA didn’t have a big enough influence on allied health, the three specialties (physical therapy, occupational therapy and speech-language pathology) have also experienced a major shift on the academic front. Each has either undergone or is preparing for a redefinition of its entry-level education requirements. For years, the bachelor’s degree was accepted as adequate preparation to enter the work force, but technology, research and general advances have propelled the specialties forward. Now the minimum requirements needed reflect the increased expertise of the practitioners.
Physical therapy raised the entry-level minimum to a master’s degree. Occupational therapy has followed suit, their degree change is scheduled to take full effect in January 2007. And speech-language pathology also pushed for advanced degrees among pathologists. Now, there’s another movement underway to raise the PT level to the doctorate degree. Although the additional training mandates have been generally well-received, they did caused a marked drop in student enrollments.
So when Medicare reform was lopped on top of the new academic prerequisites, the circumstances drove the enrollment figures even lower, and most likely prolonged the situation. “Up to then, programs had waiting lists and new schools were developing bachelor’s degree programs. When the shift went into effect, the next year or two saw enrollments start to drop and they stayed low,” says Peggy Denton, Ph.D., OTR FAOTA, associate professor and director of occupational therapy at University of Wisconsin-La Crosse.
“There weren’t as many people excited about getting into the professions,” adds Chesbro. But now that the initiatives are in place and schools have had time to react, the situation appears to be settling. “There are already 150 entry programs and five are at the doctorate level, and 75% are moving toward the post baccalaureate,” notes Frank E. Gainer, MHS, OTR/L FAOTA, conference and student program manager, education and professional development for AOTA.
“There has been a delay to getting students enrolling at the graduate level,” states Denton. “In the last year or so, however, those numbers have started to bounce back.”
Near a Full Recovery
Between the changing academic standards and the Medicare roller coaster, it’s been a tumultuous period for allied health. But leave it to the therapists and pathologists, those dedicated to getting people back to full function, to rehabilitate their own job market. In fact, the current atmosphere is one of optimism. “There was an overreaction on the part of employers right after the passage of the BBA,” says Baum. “But AOTA is now projecting a 30% increase in demand and more than 40% for OT assistants.”
Adds Gainer, “We took a survey of the educational programs and most said 25% of their students had accepted jobs upon graduation and the rest received offers shortly after graduation.”
Job prospectives for PTs and SLPs are also on the upswing. Ironically, the reason behind the positive momentum is the exact reason why legislators felt compelled to initiate reform: the strain the baby boomers would put on the system. The rehab and therapeutic needs for the population haven’t changed; they will still require the attention and assistance associated with aging patients.
But the BBA did change how practitioners viewed the work place. One of the unforeseen benefits is that the uncertainty forced practitioners to expand their horizons. Allied health specialists can take their expertise and apply it to any number of environments. “I tell my students that occupational therapy is a great profession because there are so many areas to work in,” notes Denton.
OTs are perhaps burgeoning on one of the most exciting periods in the specialty’s history. As employers, communities and aging advocacy groups are readying to meet the needs of baby boomers, new positions are being created. “Occupational therapists with the entrepreneurial spirit are working with older individuals to put the necessary items in place in order to help clients remain in their homes. And there is a whole new market for training older drivers,” states Gainer.
“More and more therapists are working with community programs for aging and developing initiatives,” adds Baum. “There are assessment centers and assistive technology centers that support people’s independence. We see new graduates working for contractors and builders to help them facilitate universal designs, making more places accessible to people with disabilities.”
“Schools have been very proactive in getting students to look beyond traditional OT roles. The real challenge, however, is to retain people because there are so many options,” explains Margolis.
PTs are also taking on a more proactive role. “Before physical therapists were tertiary providers for maintenance or rehab services. Now, they’re considered more of a primary provider and working on secondary prevention, so the wellness environment is hot right now,” states Chesbro.
Of course, schools continue to be the predominant employer of SLPs, which probably will be the case for the foreseeable future. However, there are whispers of job diversity. “For a while, there have been projections of growth in the school-based setting, but as baby boomers head into retirement, the health care setting is showing more promise. There are opportunities for SLPs to grow, ” says Potter.
The specifics of how the employment picture will play out aren’t crystal clear. There are a lot of mitigating factors that haven’t been ironed out. The future of Medicare payment structure is still dependent on Congressional action. Whatever it decides will definitely impact the industry’s next move.
“Allied health specialists should be mindful of participating in the legislative process and knowing where the funding is coming from,” cautions Chesbro. “The job market and practice environments change based on those conditions.”
by | Mar 30, 2013 | Magazine
There are nuclear weapons, nuclear energy and even the nuclear family, but today, one of the most exciting and timely “nuclears” is nuclear medicine. This allied health specialty is on the verge of an unprecedented chapter in its long and prestigious history. The field is set to take on amazing changes in technology and awesome career opportunities, all at a record pace.
In the Beginning
In the 100-plus years since Henri Becquerel discovered the mysterious “aura” generated by uranium, the science of nuclear medicine has traveled a long road filled with revolutionary accomplishments. First, Madam Marie Curie labeled that aura as “radioactivity” in 1897. Within four years, Alexander Graham Bell had come to believe that placing sources of radium on or near tumors could be a significant health breakthrough. Although that practice may not have been the safest or most effective means of caring for patients, experts of the day were convinced the science had a viable medical purpose. Additional research led to the first published study in 1913, explaining the use of intravenous radium injections as a therapy for various diseases. From then on, the field only gained momentum.
Throughout the 20th century, numerous advances furthered the number and scope of applications. The 21st century sees nuclear medicine as one of the most technical and innovative health care specialties. Today, nearly every discipline benefits from its diverse capabilities. Oncologists use it to view tumors and surrounding tissues. There are also radioactive therapies that target cancerous cells. Cardiologists rely on nuclear medicine to provide accurate scans of damaged areas within the heart. Pediatrics, orthopedics and even pain management all use scans in order to determine treatment plans.
Perhaps the most influential development in recent times, however, is the positron emission tomography (PET), which provides 3-D computer-reconstructed images that measure metabolism and the degree of function in an organ or tumor. This enables doctors to assess neurological disorders, cardiovascular disease and a variety of cancers, including lung, breast, thyroid, esophageal, cervical, pancreatic and lymphoma.
Nuclear medicine is so diverse, in fact, that the Society of Nuclear Medicine (SNM), the specialty’s professional association based in Reston, Va., reports nearly 100 different imaging and therapeutic procedures are available. That variety makes nuclear medicine a very reliable diagnostic tool—no wonder it’s a routine component in countless treatment plans. SNM estimates nuclear medicine technologists (NMTs) perform between 10 to 12 million procedures per year. That statistic is primed to soar as the specialty undergoes yet another transformation as companies continue to push technical boundaries.
Keeping Up With the Times
As one might expect, the computer has greatly changed the practice of nuclear medicine. Gone are the days when a single camera occupied an entire room. Thanks to microchip technology, physicians and technologists now operate compact, digital cameras that provide clearer, more succinct and targeted scans.
“The more sophisticated computers become, the faster techs are able to do things. Some of the things we did 10 or 12 years ago we don’t even do now because we can do other procedures better with newer technology,” says Erasmo Carrasco, CNMT, ARRT (N), a technologist who travels for Teamstaff Rx.
“Nuclear medicine definitely has become more technical,” adds Neeta Pandhit-Taskar, MD, a clinical assistant physician at Memorial Sloan-Kettering Cancer Center in New York, as well as an assistant professor of nuclear medicine services and radiology at Cornell University. “Over the last few years there have been a lot of developments, especially in PET. It’s a growing area.”
[ads:career]
Additionally, the equipment used in nuclear medicine continues to advance the expertise of its operators. Technologists in this area experience a wide breadth of procedures and equipment, and as a result, they are often perfect candidates for numerous career choices. As a traveler, Carrasco is constantly supplied with invaluable opportunities. “Assignments allow you to learn new equipment and procedures; it’s a meaningful experience,” he explains. “Also, there are a lot of good techs out there to learn from, and they know what they’re doing.”
Population Growth
Increased reliance on nuclear medicine in conjunction with ongoing technical evolution has resulted in one of the healthiest employment environments in the health care industry. The U.S. Bureau of Labor Statistics (BLS) reported approximately 18,000 nuclear medicine jobs were held in 2000. The BLS also labeled the specialty as one that’s “expected to grow faster than average…through the year 2010.” That’s good news for the current 14,000 certified technologists nationwide, but even better news for those just entering the profession. Simply put, the demand for qualified NMTs will continue to grow unabated for the foreseeable future.
“I have seen it go from a glut of technologists [with not enough jobs], to now when there is more need and fewer techs,” comments Brenda King, a clinical specialist for Bristol-Myers Squibb (BMS) in its medical imaging division in Los Angeles.
Like so many health care disciplines, nuclear medicine has endured cyclical employment periods in the past. What makes this upswing different? Some of the same factors contributing to the current nursing shortage, which is one of the worst in history, are affecting nuclear medicine: Namely, an aging public and work force.
As the population ages, the demand on health care increases, which very likely could result in busier nuclear medicine departments. Even now, large acute care hospitals have expanded their nuclear medicine facilities to fulfill current requests. “There is the potential to have many cameras in one department, as well as to have cameras in different departments under the same license,” notes Lynn Fulk, CNMT, ARRT (R), program director of the nuclear medicine technology program at Ball State University in Muncie, Ind.
But as the number of orders swells, the staff will need to grow proportionately. Unfortunately, the current work force, from techs to doctors and even radiologic pharmacists, is aging. As these individuals retire, their positions must be filled in order to continue meeting hospitals’ needs. Industry experts, however, say nuclear medicine education programs certificate as well as associate and bachelor’s degrees aren’t producing enough graduates. In the long-term, this scenario will result in serious staffing shortages.
Tough Competition
Unlike the nursing crisis, however, this allied health specialty’s situation differs because the number of environments employing NMTs has grown dramatically in recent years. The new competition for techs comes from private imaging centers. These businesses have a firm hold in the marketplace, appealing to consumers’ increasing desire for full-body scans that promise to help with early disease detection or to put worried minds at ease.
Another contender is private medical practices. Orthopedists, cardiologists and other physician specialties have invested in in-house nuclear medicine equipment in order to provide further assistance to their patients, as well as another means to generate income.
“There are radiology groups that have acquired PET and computerized tomography (CT) equipment,” notes Pandhit-Taskar.
“Doctors’ offices, imaging centers and hospitals are all competing for technologists. There are a lot of techs quitting hospitals to work in offices or centers where there aren’t on-call requirements,” explains Carrasco. “[As traveling technologists], we’re usually filling in for someone who left to work somewhere else.”
In his six years of traveling, Carrasco says he has rarely been without a job. “The places [travelers] go to work are hurting for techs, and the current staff is usually already overworked.”
Manufacturers are also vying for NMTs to aid in their research and development efforts, as well as to work in sales. After all, who knows the equipment better and can earnestly convey its benefits to potential customers? King, for example, wanted a new challenge after nearly 20 years in the hospital environment. It was her clinical skills that trained her for a sales position at BMS. “I saw it as an area for growth and a chance to show what a NMT could do,” she says. “I could have stayed and scanned patients or dealt with radiologic pharmacists for the rest of my career, but I felt there was something more out there and a sales job could be a stepping stone.
“There are [corporate] opportunities for [an NMT] who is prepared for them,” she continues. Now King applies her clinical experience with her customer service skills to research and development efforts, including clinical trials. “I have different customers now and they rely more on my technical expertise.”
Preparation Is Key
Although techs may be leaving the clinical environment, they remain within the specialty. For many people, it’s the variety that keeps them there. From traditional scans to antibody therapy research or even equipment sales, nuclear medicine continues to evolve, prompting constant progression of skills. Indeed, the critical exactness required for most procedures insists techs maintain a high level of expertise. “You always have to think, especially when dealing with radiation,” says Carrasco. “There is always new equipment and procedures to learn, which keeps the job from becoming routine.”
“It’s not just anatomical scans,” adds Pandhit-Taskar. “There is basic science involved as well as sophisticated technology used to assess different physiological processes. That’s one of the strong appeals of nuclear medicine, there is so much to do in the field.”
Unlike so many other disciplines, not all states require NMTs to be licensed. Still, most mandate some proof of competence, usually certification by either the Nuclear Medicine Technology Certification Board (NMTCB) or the American Registry of Radiologic Technologists (ARRT). Both organizations require candidates to complete an education program and a minimum of clinical practice hours. Continuing education hours are also mandated in order to renew licensure or maintain certification.
The buzz in the industry, however, is a call to eventually raise the minimum qualifications to a bachelor’s degree, as well as to establish an advanced level of practice. “Advanced practice technologists, like nurse practitioners (NP) or physician assistants (PA), will become more [commonplace]. The general NMT will need to have more specific advanced skills and knowledge,” suggests King.
“If they do not have a bachelor’s degree, I recommend students stay in school in order to get it,” adds Fulk. “Employers want students to be qualified to do more than just the basic entry-level medicine. They want students to be exposed to CT and radiology physics.”
Always Something Different
Another pro to a career in nuclear medicine, say seasoned professionals, is the diversity inherent to the specialty. Because it applies to many areas within health care, techs routinely interact with a broad spectrum of hospital personnel from nurses to PAs, physicians, pharmacists and, of course, other NMTs. Often, the tech sits in on treatment plan meetings and offers his or her expertise.
“Plus we have subgroups of disease management teams that meet and discuss interesting cases. It really is a multimodality interaction,” states Pandhit-Taskar.
Additionally, techs interact with the facility’s client community. Not only do they perform the scans and therapies, but NMTs also spend time with patients. From obtaining medical histories to explaining procedures, techs play a role in coaching people through their treatments. “It’s what makes nuclear medicine very interesting; we’re not just reading films,” asserts Pandhit-Taskar.
Because of this connection with staff and patients, experts agree diversity within the discipline is critical. “To have someone who understands your culture and language goes a long way in being able to deliver health care,” asserts King, who is African American.
There have been notable changes in the specialty’s demographics during the past 20 years. Still, Caucasian females hold the majority of positions. Geography, however, can make a difference. In his experience, Carrasco, a Mexican American, says certain urban and regional areas boast more ethnic diversity. “It really depends on where you are,” he states. “In the Southwest, you see more people of my nationality working in nuclear medicine, but in Maine, there aren’t a lot of Hispanics.”
“It’s a slow process to get more diversity in the health care field…but we’re trying to raise NMT as a career opportunity for upcoming students,” says King.
The Society of Nuclear Medicine is not only striving to stir up the ethnic mix in nuclear medicine, but it’s also campaigning to spread the word about the specialty. The predicted shortage could have a huge impact on the health care industry unless more people are informed about the infinite possibilities available with a nuclear medicine career. “There are new opportunities opening up all the time,” Fulk emphasizes.
Indeed, depending on what unfolds within the next few years, this exciting field could be penning its most impressive chapter yet.
by | Mar 30, 2013 | Magazine, Nursing Careers, Veterans in Nursing
The Department of] Veterans Affair’s most important asset is a highly motivated and diverse workforce of more than 200,000 people committed to our mission of service to veterans. Our employees are the foundation of the department and the key to our success. We offer a wide array of career opportunities to prospective applicants in many clinical, technical and administrative career fields at locations throughout the country. Our Web site can tell you more about these job opportunities. We hope that you will consider a career with Veterans Affairs and become a part of our proud tradition of providing the highest quality of service to those men and women who have served our great Nation. -Anthony J. Principi Secretary of Veterans Affairs
Just the Facts
The Department of Veterans Affairs (VA) was established on March 15, 1989, succeeding the Veterans Administration, which was established in 1930. In 1989, President Reagan signed legislation to elevate Veterans Affairs to the 14th Department in the President’s Cabinet.
The department has 224,724 employees 202,709 of which are employed by the Veterans Health Administration. It is the second largest of the 15 cabinets and is responsible for providing federal benefits to veterans and their dependents. This is a staggering responsibility when you consider the numbers: about a quarter of the nation’s population-approximately 70 million people-are eligible for VA benefits and services, and there are 26 million living veterans at this time.
The VA estimates it will spend $59.6 billion in 2003 to provide services and $25.9 billion of that will be spent in the area of health care. The VA’s health care system includes 163 hospitals, 850 ambulatory care and community-based outpatient clinics, 137 nursing homes, 43 domiciliaries and 73 comprehensive home-care programs. More than 4.5 million people received care in VA health care facilities in 2002. This was an unprecedented increase of 9.5% over the number of patients treated in 2001.
The VA will also invest nearly an additional $1.4 billion in research this year. These funds are made possible by the VA’s Medical Account, National Institutes of Health, pharmaceutical companies and other foundations.
The VA is at the forefront of medical advancements and research. It has become a world leader in research on aging, women’s health, AIDS and post-traumatic stress disorder. VA researchers have had key roles in developing the cardiac pacemaker, the CT scan and have made improvements in artificial limbs. The researchers have received many prestigious awards including the Nobel Prize for their work.
The biggest reward for researchers in the VA, however, is the ability to see the immediate benefits of their research. Many of the researchers are also practicing physicians, and this dual role allows them to put their research to immediate use.
Considering the work the VA does every year, it is no surprise that they require a large network of “highly motivated” individuals. Employment opportunities abound at the VHA and VA, and they value their employees, a fact that is reflected in employee’s generous benefit packages.
The Benefits
Salaries
Starting salaries at the VA are dependent on education, training, years of experience, the duties of the position and, in some cases, guidelines from professional boards. The VA’s General Schedule Salary Table is available at www.va.gov.
Health Insurance
As you can imagine, employees of the VA choose from a wide selection of health care plans based on their individual needs. Fee-for-service plans, health maintenance organizations and point of service plans are just a few of the options. The VA pays approximately 75% of the health benefit premium. Many plans offer dental coverage as well, and coverage may continue into retirement. Pre-tax options can also result in more take-home pay.
Training and Continuing Education
The VA manages the largest education and health professions training program in the U.S. They are affiliated with 107 medical schools, 55 dental schools and more than 1,200 other schools across the country.
VA employees can also benefit from VA Learning Online a program offering a number of general education and college-level courses on the Internet. The VA offers tuition reimbursement to individuals who are studying in fields deemed to have shortages.
The Employee Incentive Scholarship Program is available to employees continuing their education in areas where recruitment and retention is difficult.
Quality of Life Benefits
A childcare subsidy is available to full- and part-time VA employees. This subsidy is paid on a sliding scale based on income. Alternate work schedules are also available in some circumstances, and commuting assistance is offered to VA employees based on mass transit commuting costs.
Other Benefits
Additional benefits, similar to those found in the private sector, include retirement programs, life insurance and paid days off. Some of these benefits are more generous than those found in the private sector, however, and are detailed on the VA’s Web site at www.va.gov under employment opportunities.
Extra benefits not commonly found in the private sector include liability protection and job portability. Descriptions of these benefits are also available on the VA’s Web site.
Many Routes to the VA
If you would like to pursue a career with the VA, there are many avenues to get you there. On the Internet, go to www.va.gov/jobs/search/healthcare.htm to find links to the VHA Placement Service, VA Jobs at USAJOBS and VHA Executive Recruitment. You can also go to www.vacareers.com to do a job search by state, facility or occupation.
If you have additional questions, call the Health Care Development and Retention Office (HCSDRO) at 504-589-5267.
by | Mar 30, 2013 | Magazine, Nursing Careers, Nursing Students
The genesis of the United States Peace Corps stems back to 1960 and then-presidential candidate John F. Kennedy’s impromptu speech at the University of Michigan. Kennedy challenged students to support the cause of peace by living and working in developing countries. By 1961, then-President Kennedy signed Executive Order 10924 and officially established the Peace Corps.
Since then, more than 170,000 volunteers have worked in 136 host countries. According to the Corps’ Web site (www.peacecorps.gov), volunteers work and live in rural and urban communities in Asia, Central America, Europe and Africa. Volunteers work on everything from education, health and HIV/ AIDS, business, information technology, agriculture and the environment.
The men and women who join the Peace Corps are as diverse as the work that they do and the countries where they work. Volunteers come from a multitude of races, ethnic backgrounds, ages and religions. They have varying physical abilities and come from different geographical regions and diverse personal backgrounds.
Today, the Peace Corps is more important than ever: In May 2003, the Peace Corps committed 1,000 new volunteers to work on HIV/AIDS related activities, as part of President Bush’s Global AIDS Relief Package.
Volunteer Opportunities in Health
Health care opportunities abound in the Peace Corps for individuals looking for an exciting opportunity to truly make a profound impact in the lives of people all over the world. Peace Corps health volunteers make up 21% of the overall volunteers, and they help improve basic health care at the grass-roots level by focusing on prevention, human capacity building and education. Volunteers work on basic health care issues, such as combating malnutrition and providing safe drinking water.
Volunteering in health and HIV/AIDS allows volunteers to educate and promote the awareness of HIV/AIDS—one of the most serious worldwide threats to public health and development. According to the Peace Corps’ Web site, health care volunteers train youth as peer educators, collaborate with religious leaders to develop appropriate education strategies, provide support to children orphaned by HIV/AIDS, and develop programs that provide support to families and communities affected by the disease.
Health Extension
Volunteers in Health Extension raise awareness in communities about the need for health education. Activities include identifying local leaders to teach families about maternal and child health, basic nutrition, or sanitation; setting up training on nutrition, sanitation, or oral rehydration therapy; organizing groups to raise money for needed health care materials; and training of trainers for peer education about AIDS and other STDs.
Applicants must have a bachelor’s degree and an interest in community health demonstrated through volunteer or work experience, or be a registered nurse with a demonstrated interest in community health. Counseling or teaching can also qualify as experience for this program.
Public Health Education
Volunteers in Public Health Education teach public health in classrooms and model methodologies and subjects for primary and secondary school teachers. Projects include undertaking “knowledge, attitude and practice” surveys in communities; assisting clinics or government planning offices in identifying health education needs; devising educational programs to address local health conditions; assisting in marketing of messages aimed at improving local health practices; carrying out epidemiological studies; and acting as backup professionals for other health volunteers.
Public Health Education applicants must have a bachelor’s degree in health education, nutrition, dietetics, or another health-related discipline. Applicants can also have a master’s degree in public health or be a registered nurse certified in public health, midwifery, or be a certified physician’s assistants. Most applicants have also been active in health-related activities on a volunteer basis. Other relevant experience includes expertise in disease surveillance, creative training and adult education techniques, and community entry and survey methods.
Master’s International and Fellows/USA
The Peace Corps offers two advanced education programs to Peace Corps volunteers: Master’s International and Fellows/USA. The Master’s International program allows volunteers to incorporate Peace Corps service into their master’s degree programs at more than 40 colleges and universities. The Fellows/USA program offers former volunteers scholarships or reduced tuition in advanced degree programs at more than 30 participating colleges and universities.
In return for these educational benefits, Fellows commit to working in an underserved community as they pursue their graduate degree. Additionally, Peace Corps volunteers may apply for partial deferment of many loans and up to 15 % cancellation of Perkins loans.
Volunteer Benefits
Serving in the Peace Corps gives volunteers the chance to learn a new language, live in another culture, and develop career and leadership skills. Among financial benefits, the Peace Corps offers a monthly living allowance, comprehensive medical and dental coverage, $6,075 after the completion of three months of training and two years of volunteer service, a reasonably priced health insurance plan available after the completion of volunteer service for up to 18 months, and 24 vacation days per year.
The Peace Corps’ Office of Returned Volunteer Services (RVS) provides career, educational and re-entry related assistance through its 11 regional recruiting offices and its Career Center in Washington, D.C.
Former volunteers also have non-competitive eligibility status for appointments to U.S. government executive branch agencies for one year after their completion of service. This means that former volunteers can be appointed to some federal government positions without competing with the general public.
For more in-depth information on the Peace Corps’ volunteer opportunities, log onto www.peacecorps.gov, where you can request a brochure and an application, fill out an online application, find a recruiting agent or a regional recruiting office, and much more.
Peace Corps Stats
Peace Corps officially established: March 1, 1961
Total number of volunteers and trainees to date: 170,000
Total number of countries served: 136
Current number of volunteers and trainees: 6,678
Volunteer breakdown:
32% in education
21% in health
18% in environment
14% in business
9% in agriculture
7% other
Gender: 61% female, 39% male
Marital status: 91% single, 9% married
People of color: 15% of Peace Corps volunteers
Age: 28 years old (average), 25 years old (median)
Volunteers over age 50: 6% (oldest volunteer is 84)
Education: 86% have undergraduate degrees, 12% have graduate studies/degrees
Current number of countries served: 69
Fiscal year 2003 budget: $295 million
