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Health jobs you might not know about.

Heath services have offered some of the brightest career opportunities of the last decade. Employment in this booming field grew by more than two and a half million in the 1980's. Future prospects appear equally as favorable. In its latest series of employment projections, the Bureau of Labor Statistics forecasts growth exceeding 40 percent in several health occupations between 1990 and 2005.

BLS provides projections and detailed career information for more than 25 health-related occupations. You can read about these jobs in the 1992-1993 Occupational Outlook Handbook, which will be published in the spring. But promising opportunities also exist in health careers that, for a variety of reasons, are not covered in the Handbook. This article offers a look at four of them.

What Are These Occupations?

Workers in the occupations described here have a wide range of duties. Biomedical equipment technicians maintain the advanced machinery crucial to the practice of modern medicine. Perfusionists operate the heart-lung machines that pump life-giving blood during surgery. Orthotists design and make braces and other devices to help the disabled lead more active lives. Biomedical communications specialists--artists, editors, illustrators, instructional designers, librarians, photographers, writers--document the miracles of modern medicine and science for other health professionals, students, and the rest of us.

Different as these occupations may be, they have much in common. Each joins different skills, talents, and training with a shared interest in science and medicine. Each offers a valuable service in a growing industry. And each provides the practitioner with the chance to earn not only good living but a satisfying one, too.

Biomedical Equipment Technicians

Electronics technology lies at the heart of modern health care. The family doctor's black bag has given way to a black box loaded with microchips and circuit boards. Today, doctors, nurses, and other health professionals use an array of sophisticated instruments to perform everything from routine checkups to the diagnosis and treatment of life-threatening diseases.

A cardiac monitor measures a heart's beat. If the beat is out of synch, a defibrillator can shock it back into rhythm. Infusion pumps administer intravenous liquids with the precision of a digital clock. New imaging technologies allow doctors to watch vital organs at work and detect warning signs of diseases not yet present. These devices, however, aren't infallible. Equipment requires regular inspections, maintenance, repair, and replacement. These tasks fall to biomedical equipment technicians, or biomeds. They are also called biomedical engineering technicians. Typically, biomeds conduct safety and performance tests on medical equipment; repair electronic monitoring devices; and help train other clinical personnel to operate the equipment.

At Corning Hospital, in Corning, New York, as around the country, there are different grades of biomeds. At the first level, says Gordon Southard, the director of clinical engineering at the hospital, would be a new graduate of a biomed training program. "We view this position as a sort of in-house internship," he says. "This worker generally does routine tests and inspections," according to Southard. At the second level will be a biomed with a few years of job experience who holds an associate's degree in either Biomedical Engineering Technology or Electronics Technology. At the third level are workers with an associate's degree, several years of experience, and a minimum of 26 weeks of additional training. Southard says, "We're currently looking at whether we should have a fourth level for biomeds who maintain and service complex diagnostic and imaging equipment."

Biomeds with experience can move into management. Many prefer to remain at the technical's level, however. "One of the real satisfactions of the job for many biomeds is that they control their work environment," according to Southard. They would give up this self-sufficiency by becoming managers.

As it has in nearly every other aspect of the workplace, computer technology has had a great effect in health care. Here, too, biomeds are involved. Gordon Southard says, "Now, when you troubleshoot, not only must you look at equipment malfunction but also at software problems and operator error."

The changing technology means that biomeds must help other health personnel learn to use equipment properly. Lt. Col. Michael Carver, Chief of Clinical Engineering and Technical Services for the U.S. Air Force, manager a staff including 600 biomeds. He says, "Biomeds are spending a lot of time explaining and teaching one-on-one how equipment works."

Biomeds work in clinics, health centers, and hospitals around the country. Manufacturers of medical equipment also employ biomeds, who may serve as both service and sales representatives. Increasingly, third-prty employers and private companies under contract to hospitals are hiring biomeds, too. Biomeds in hospitals generally work in the department of clinical engineering. The Alliance of Engineering in Medicine and Biology, a professional association, estimates a rough ratio of one biomed per 100 hospital beds. Salaries depend in part on experience. At Corning Hospital, the average starting salary is about $22,000 a year for inexperienced biomeds; those with a few years experience earn about $26,000 a year.

This occupation does not require a 4-year college degree. Biomeds are specialized electronics technicians, many of whom train for 2 years and earn an associate's degree. Students study a variety of electronics courses and also receive training in such areas as anatomy, biology and physiology. (See box for a sample curriculum.) Many of the programs in biomedical engineering technology around the country also recommend or require that their students complete a hospital-based internship.

At some schools, cooperative education is an important part of the curriculum. (See "Cooperative Education: Working Towards You Future," in the Fall 1988 OOQ.) "The majority of employers prefer to hire graduates with experience," says Steve Yelton, chairman of the Biomedical Engineering Technology Program at Cincinnati Technical College. "That preference is probably the best reason for a potential biomed student to consider entering a co-op program," he says. Corning Hospital has been a co-op employer since the mid-1980's. Many of their interns have come from the Biomedical Engineering Technology program at Penn State University. "We try to give them as broad an exposure to the profession as possible," says Southard. Generally, interns work closely with staff biomeds while performing regular inspections of hospital equipment.

Biomeds need continuing education to maintain their skills. "Rapid advances in technology means that biomeds are continually retraining," says Col. Carver. "Servicing equipment has changed," says Carver. "When equipment was simpler, most of the time was spent repairing or replacing broken equipment. Now that it's more complicated, it seems like we spend more time reeducating the technicians," he says.

Much of this retraining occurs at manufacturer's service schools. Col. Carver says that some medical manufacturers are making advances so quickly that the equipment literature frequently can't keep pace with the technology. "You might look at the machine's circuitry and then at the schematic and find that they don't match. Then you rewrite the schematics with colored pencils," says Carver.

The Board of Examiners of Biomedical Equipment Technicians, operating under the direction of the International Certification Commission for Clinical Engineering and Biomedical Equipment Technology, offers a certification program for biomeds. About 3,800 technicians are now certified. Certification is not a requirement for biomeds at present, though some sources believe it will become one. Biomeds who specialize in radiology and clinical laboratory equipment may becoome certified in these areas.

For further information on biomeds contact: Association for Advancement of Medical Instrumentation 3330 Washington Boulevard Suite 400 Arlington, VA 22201-4598

The Bioengineering Education Director, the official education directory of the Alliance for Engineering in Medicine and Biology, is a guide to specialized and interdisciplinary bioengineering programs offered by colleges in the U.S. and Canada. The guide costs $39 and is published by Quest Publishing Company, 1351 Titan Way, Brea, CA. 92621. (714) 738-6400.

Perfusionist

In the 1950's, open heart surgery lay at the frontiers of medicine; now, thousands of such procedures are performed each year. Though these operations may appear routine, the risks involved in each are real, the stakes are high. All the health workers in the operating room have important roles to play. One of them maintains life in a very dramatic way--the perfusionist. The perfusionist controls the heart-lung machine that keeps oxygen-rich blood coursing through the patient's body.

Perfusionist comes from the Latin for "pour through." The diversion of the patient's blodd through the heart-lung machine during surgery is termed "extracorporeal circulation," extracorporeal being Latin for "outside the body." Perfusionists practice extracorporeal technology.

Perfusion has applications not only for heart surgery but for all types of organ transplants, including kidney and liver transplants. Through perfusion, organs can be kept alive outside the body until a transplant operation can be performed. Certain kinds of cancers can also be treated by isolated perfusion. Just as advances in science and medicine occur with frequency, it's likely that new applications of the perfusion tecnology will arise as well.

Juan Navorette, a perfusionist at The George Washington University Hospital in Washington, D.C., says a perfusionist's duties begin long before entering the operating room. "We'll consult with the surgeon-in-charge to determine which equipment and techniques we'll use," he says. At George Washington Hospital, for example, the surgical unit posts a schedule of procedures for the following day. The perfusionist determines the chemical profile of the patient's blood. This sample tells them the physiological needs for oxygen and other blood gases. Before surgery, "we'll run through a pre-bypass check list to assure that all the equipment is working properly," says Navorette.

During heart bypass surgery, perfusionists operate the equipment that acts as the patient's heart and lungs. Perfusionists keep both the surgeon and anesthesiologist informed of the patient's condition. They may also administer certain medicines and drugs through the perfusion equipment, according to the doctor's instructions.

The practice of perfusion is virtually the same at every institution, but different institutions have different case loads. At hospitals where many cardiac operations are regularly performed, "the workload tends to be predictable; in smaller centers, that's not the case," Navorette says. Another difference is that perfusionists who work for hospitals "are subject to all hospital rules," according to Navorotte, "and sometimes perform duties beyond perfusion." Perfusionsts who work for medical practices or contract services would likely find "their duties more specifically oreinted to the perfusion field."

At George Washington Hospital, Navorette is one of three perfusionists on staff. "All of us carry beepers," he says. While one perfusionist is always on duty, another is always on call. "On-call duty is the biggest drawback to the job," he says.

An estimated 2,300 perfusionists practice in the U.S. Approximately 1,800 are certified by the American Board of Cardiovascular Perfusion. Although most perfusionists work for hospitals, other possibilities exist. Some are employed by contract companies that provide client hospitals with perfusion services, supplies, and equipment. Others work for a surgeon or group of surgeons. Manufacturers of perfusion equipment and supplies also employs perfusionists, who work in research and development or marketing and sales.

No matter the setting, perfusionists earn a good living. In its 1990 survey of hospitals and medical school salaries, the University of Texas Medical Branch put the national average annual salary for perfusionists at about $53,000.

From the early 1950's until the mid-1970's, most perfusionists were trained on the job. Today, employers perfer to hire graduates of accredited perfusion programs. Some sources even say that hospitals favor perfusionists with crosstraining in other clinical disciplines who can fill in when shortages exist in other positions.

Navorette trained initially as an emergency medical technician. Later, he studied cardio-pulmonary technology. Then he earned his certificate in perfusion technology at the Newark Beth Israel Medical Center in Newark, N.J.

New perfusionists who wish to sit for the certification exam given by the American Board for Cardiovascular Perfusion must graduate from an accredited school. Currently, there are 26 accredited perfusion programs with about 250 graduates a year. Seven more programs await approval by the Joint Review Committee for Perfusion Education. Most of these programs lead to a certificate; some, to an associate's degree; and a small handful, to a bachelor's degree.

Entrance into these programs is competitive. Typically, the size of each entering class is small, averaging no more than 12 students. Programs receive dozens of applications for each spot. While some schools consider applicants with little or no experience in the health field, most do not. Two programs show how high current admissions standards are. St. Joseph's Medical Center in Wichita, Kansas, requires entering students to have a 3.0 grade point average in college-level anatomy, biology, chemistry, physiology, and pharmacology, plus experience as a registered nurse or respiratory therapist. Walter Reed Medical Center, which trains perfusionists for the Armed Forces, accepts only physician's assistants for its program.

For information on career education and training contact: The American Society of Extra-Corporeal Technology 11480 Sunset Hills Road, Suite 100E Reston, VA 22090 (703) 435-8556

For information on certification contact: American Board of Cardiovascular Perfusion 123 S. 25th Avenue Hattiesburg, MS 39401 (601) 582-3309

Orthotist

As a member of the rehabilitation health team, an orthotist designs, makes, and fits braces and other devices (orthoses) for patients with disabling conditions of the limbs and spine. These devices, made from metals, plastics, and other materials, support and strengthen the weakened areas and enable people to lead more active lives. Orthotists work mostly with braces. Prosthetists, who are frequently mentioned in the same breath as othotists, design and make artificial limbs.

Orthotists work closely with other health professionals, particularly physicians and physical therapists. Luke Stikeleather, a certified orthotist in Fairfax, Virginia, says "My relationship with doctors is similar to that between a pharmacist and a physician. The physician prescribes an orthosis for a patient. The I'll examine the patient to see what his or her particular needs are."

Frequently an orthotist may also be assisted by an orthotics technician, who makes the orthosis according to the orthotist's instructions. Stikeleather employs a technician in his practice, but still does much of the labor himself.

About 90 percent of the orthoses Stikeleather makes are customer specific. After taking measurements and fabricating the device, he will work with the client for a couple of weeks to make adjustments. "Then we may not see the client again until the devide needs changes," says Stikeleather.

In pediatric cases, an orthotist is more likely to have a continuing relationship with the patient. A common pediatric problem is scoliosis, or curvature of the spine. Here, the orthotist is the primary person involved with the treatment, according to Stikeleather. Pediatric orthotics is one specialization in the field. Other orthotic practices are oriented to sports medicine and rehabilitation. But typically, an orthotist sees a variety of cases and wide range of disabilities.

The American Orthotic and Prosthetic Association (AOPA) says there are about 2,700 certified orthotists, prosthetists, and orthotists/prosthetists. About a third of this total are certified orthotists; another third as prosthetists; and the final third hold joint certification.

Orthotists work in hospitals and rehabilitation centers, in laboratories, medical schools and research centers, and government agencies. Stikeleater works for an orthotics manufacturer. He operates a branch office in the Washington suburbs. Several area hospitals also contract his company's services.

Careers in rehabilitation medicine are growing. BLS projects rapid growth for several occupations in the field, such as occupational and physical therapists, between 1990 and 2005. With regard to qualified orthotists, "There is a much greater demand than supply," says Stikeleather, adding, "Opportunities are good across the country."

Typically, an orthotist works a 5-day, 40-hour week, but hours depend on the circumstances. Salaries also depend upon location. In a metropolitan area on the east coast, a board eligible orthotist would probably start with an annual salary in the $25,000 to $30,000 range In the Midwest, it might be a little less. Stikeleather estimates salaries would probably jump $4,000 to $5,000 with certification.

The preferred training for orthotists is completion of a certification program. Four paths to certification exist: (1) a degree in orthotics/prosthetics plus 1-year of experience; (2) a bacherlor's degree in any field plus a post-graduate certificate in orthotics/prosthetics; (3) foreign education/certification; or (4) a unique combination of qualifications. While certification is not required to practice, it does enhance employment prospects and lead to better pay.

Nine programs around the country provide training in orthotics/prosthetics; two programs train orthotics/prosthetics technicians. Stikeleather, for example, who holds a bachelor's degree in social work and had worked for 4 years as a probation officer and juvenile counselor, enrolled in the Orthotics program at Northwestern University Medical school. The coursework there included instruction in subjects such as anatomy and physiology plus work in the lab. Each student is also required to prepare a major research article. Additionally, each student must complete a 1,900-hour residency under the supervision of a certified orthotist.

The profession appealed to Stikeleather for a variety of reasons. As a boy he had suffered from a neurological disease that limited the use of one of his arms. He constructed various homemade devices to help him overcome his disability. He also had an interest in becoming a doctor. And he enjoyed working with tools and equipment. "This is a field that gives you a broad spectrum of opportunities--you deal with individuals, you get to work with your hands, and you work in a medically related field."

For further information contact: American Orthotic and Prosthetic Association 717 Pendleton Street Alexandria, VA 22314 (703) 836-7116

Health Sciences Communication

Many lives have been saved and many more improved by recent advances in health technologies, techniques, and treatment. Health communications professionals can share some of the credit. They marry their interest in science to their skills with pens, cameras, and computers to convey these advances to other health workers and to the rest of us. They help doctors inform their colleagues, professors teach their students, and patients understand their conditions.

Some communications experts work in a variety of media; others specialize. The Health Sciences Communication Association groups them in six major areas:

* Biocommunications manager

* Biophotographer

* Health sciences librarian

* Instructional designer

* Medical writer/editor

* Medical artist and illustrator

These people work in schools of medicine, dentistry, veterinary medicine, nursing, pharmacy, or allied health professions; in large health and research centers; and in health-related businesses, such as pharmaceutical companies and publishing houses. Some freelance. In the following sections we'll take a brief look at the work they do.

For a listing of education and training programs in health sciences communication, consult the Directory of Programs in Biocommunications ($10) published by the Health Sciences Communications Association. For this publication and related information, contact: HeSCA 6105 Lindell Boulevard St. Louis, MO 63122 (314) 725-4722

Biocommunications Manager

Joe Day says he became a biocommunications manager in the same way as many of his colleagues--by accident. Holding a bachelor's degree in English and a masters in communications, he hoped to find a job in broadcasting. A colleague told him of an opening for a TV/film production speacialist at a medical school in upstate New York. Since then, his career has evolved along with the business of biocommunications.

"Over the last 15 to 20 years, media centers in hospitals and medical schools have grown from a couple of photographers and illustrators to full-fledged communications departments," says Day. From New York, Day travelled to the University of Texas in San Antonio, where he became director of medical communications. Along the way, he pursued Ph.D. studies in educational technology. Now the Director of the Education Center at Georgetown University Medical School, he heads a staff that includes audio-visual specialists; graphic artists and designers; instructional designers; medical illustrators; photographers; TV producers and directors; and video engineers. "Regardless of our specialties, however," Day says, "each of us, first and foremost, is a communicator."

Biocommunications is a collaborative process, say Day. As the coordinators of this collaboration, biocommunications managers need a variety of skills. Many spend their early career learning one of the skills that the media center offers the health community. For Day, it was TV production and educational technology. David Gray, director of the medical media department at the Veterans Administration Medical Center in Lexington, Kentucky, is a biological photographer. His colleague at Penn State University's Hershey Medical Center, Maurice Sherrard, is a medical illustrator. Sherrard says, "It's important to have practical knowledge of the fields you manage."

As managers, they also need a strong sense of dollars and cents. They have to know how to budget--both time and money. And they have to know how to deal with people. That includes not only temperamental artists but demanding doctors as well.

Day adds that, as the health business becomes more competitive, many communications departments are adding public relations, institutional marketing, and advertising to their responsibilities.

Biophotographer

Biophotography is vital to education and research in medicine and the health sciences. Biophotographers must possess skills that cross the spectrum of photographic technology. They need to be able to use slides ("the medical field lives on 35mm slides," says one source), prints, motion pictures, videotape, and, now, computer graphics--and be able to use them with precision. At the outset of their careers, they need general photographic skill. With experience, they may specialize in unique branches of the field, such as photomicrography (using a microscope to shoot pictures) or surgical photography.

David Gray, Director of the Medical Media Department at the Veterans Administration Medical Center in Lexington, started as a photographer's apprentice in 1963. He later earned a bachelor's degree in biological communication at the University of Minnesota. Although the work combines both art and science, Gray values technical competence above creativity. "You need a firm grasp of the technology, because the objective is to create a very precise image," he says. You also need a thorough grounding in the sciences, especially biology. "If you want to take a picture of tissue through a microscope, you must known enough about cell structure to find what you're looking for," says Gray. The science background also enables the photographer to ask pertinent questions of the doctor or scientist. "Language in science is very specific," says Gray. "You have to understand it in order to know exactly what kind of image the client wants."

The applications of biophotography extend beyond hospitals, medical schools, and research centers. Biophotographers also work in veterinary schools, agricultural research stations, fisheries and wildlife departments, museums, and other health and science-related organizations. In its 1990 survey of salaries in the health professions, the University of Texas Medical Branch found that the average starting salary for biophotographers was about $21,000 a year.

Biophotographers can learn their skills in 2-year and 4-year programs. Many regularly participate in professional workshops around the country.

A professional association, The Biological Photographic Association, administers a certification program. While not required, the credential is recognized as a sign of professionalism. Certification is a three-part process that includes a written examination, an oral exam, and the evaluation of a portfolio consisting of 30 assignments that cover broad areas of biophotography.

For further information on the occupation or the education and training required, contact: Biological Photographic Association, Inc. 115 Stoneridge Drive Chapel Hill, NC 27514 (919) 967-8247

Health Sciences Librarian

Some sources estimate that more medical and health literature has been published in the last 10 years then in all the years before put together. Tens of thousands of books and monographs have been released; thousands of films, tapes, and audiovisual programs have been produced; and thousands of clinical journals, each publishing several issues with numerous articles a year have been published. In Careers in Health Care, Barbara Swanson writes, "A good teaching hospital has a health science library that contains 250,000 bound volumes, subscribes to 4,000 journals, and maintains more that 1,000 audiovisual programs and 55 indexes." Additionally, more that 150 biomedical data bases are presently available, with more likely to be developed.

Health science libraries, then, are comprehensive learning resource centers, and the librarians who staff them provide a valuable service to library users. Health sciences librarians catalogue, organize, and maintain this information. Additionally, they guide students and other health workers through this maze of information through the preparation of reference guides and bibliographies. The growing importance of nonprint media--such as audio-visual materials, tapes, and slides--means that librarians must develop knowledge and skills in these areas as well.

The University of Texas Medical Branch survey of health professionals salaries says the average annual salary of medical librarians was about $33,000 in 1990.

A master's degree in libray science is the basic educational requirement for health science librarians. The Medical Library Association certifies health science librarians. Though not required, the credential can prove useful. The association provides four levels of certification. For more information contact: Medical Library Association Six North Michigan Avenue Suite 300 Chicago, IL 60602 (312) 419-9094

Instructional Designer

The health sciences have been the proving ground for many new teaching methods in the past. They still are. "Multimedia presentations are becoming much more common in health and medical education," says Maurice Sherrard, director of the Educational Resources Department at the Hershey Medical Center. "Interactive computer graphics, video, and other tools are now used in the classrooms," he says.

At the Hershey Medical Center and at other institutions around the country, instructional designers help medical and health science faculties determine the best way to convey information. "For example," says Sherrard, "the instructor for a course prsents the instructional designer with a course outline. The designer then suggests new instructional methods and resources, such as videos, that will help the course to reach the professor's ultimate goals."

An instructional designer usually holds a college degree in instructional technology or educational communication.

Medical Writer/Editor

As the volume of health, science, and medical information has grown in the last decade, so have the opportunities for skilled writers able to communicate this information. Newspapers and magazines have added new "beats" devoted to these subjects; new publications have emerged to respond to the public's interest in the fields; hospitals, research centers, and other health organizations have added public relations staff to pass the news of medical advances and to give the institution a leg up in an increasingly competitive health care market. In Careers in Health Care, Barbara Swanson writes, "Medical writing is a loosely defined term that encompasses everything from writing an in-plain-English personal health column in the local paper, to writing the package inserts listing contraindications and side effects that accompany pharmaceuticals, to writing the highly technical and precise educational materials from which medical students learn." Jobs in this field, several of which are described below, have many different titles.

Newspapers and magazines and TV and radio stations employ science writers who report and write for a general audience. These writers, usually trained as journalists and having a solid background in the sciences, have seen job opportunities increase recently. However, competition for these positions is stiff.

Hospitals, research centers, and other health care organizations employ health information specialists to inform the public of the organization's achievements and programs in an increasingly competitive market. These writers prepare newsletters, marketing information, annual reports, and other publications to get their message out. Increasingly, they must be skilled in other media, including video and audio-visual productions.

Universities, foundations, and other organizations with research programs frequently employ technical writers. While technical writers often deal with the same subject matter as science writers, they often write for other professionals rather than the general audience.

More than 5,000 medical and clinical journals are published annually. The articles they contain are generally written by physicians, scientists, and other researchers. These journals are likely to have medical writers and editors on staff. These writers contribute medical news to the general press as well.

For more information on medical writers contact: American Medical Writers Association 5272 River Road Suite 370 Bethesda, MD 20016 (301) 493-0003

Medical Artist and Illustrator

Medical artists and illustrators use graphics to teach and communicate procedures, conditions, and concepts in the biological sciences and medicine, including veterinary medicine. Their work appears in books, journals, and magazines, on film and video tape, and as three-dimensional models. A profile of a medical illustrator, David Klemm, appears elsewhere in this issue.

The variety of assignments that medical artists handle means that they must be adept at working with different kinds of media and have a strong foundation in anatomy and medicine. They must be able to relate a complex idea to a simple explanatory diagram or schematic drawing.

A medical artists works as part of a team to provide illustrations and assist with a research problem. Artists also prepare charts, graphs, and tables of statistical data. Some artiss speacialize in preparing artificial body parts, such as noses, eyes, or ears. Still others prepare models for instructional purposes.

Most medical illustrators have pursued graduate training in their specialty at schools certified by the Association of Medical Illustrators. Admission to these programs generally requires a bachelor's degree in either art or science and an extensive art portfolio. However, graphic artists with degrees in graphic arts or design from noncertified schools can find rewarding and creative work in the health sciences.

For information about medical illustrators, contact: Association of Medical Illustrators 1819 Peachtree Stree NE. Suite 560 Atlanta, GA 30309 (404) 350-7900

Michael Stanton is th OOQ's staff writer.
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Author:Stanton, Michael
Publication:Occupational Outlook Quarterly
Article Type:Cover Story
Date:Dec 22, 1991
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