In 1998, about 58 percent of special education teachers belonged to unions-mainly the American Federation of Teachers and the National Education Association--that bargain with school systems over wages, hours, and the terms and conditions of employment.

In some schools, teachers receive extra pay for coaching sports and working with students in extracurricular activities. Some teachers earn extra income during the summer, working in the school system or in other jobs.

Related Occupations

Special education teachers work with students who have disabilities and special needs. Other occupations involved with the identification, evaluation, and development of students with disabilities include school psychologists, social workers, speech pathologists, rehabilitation counselors, adapted physical education teachers, special

Chiropractors

(O*NET 32113)

Significant Points

education technology specialists, and occupational, physical, creative arts, and recreational therapists.

Sources of Additional Information

For information on professions related to early intervention and education for children with disabilities, a list of accredited schools, teacher certification, financial aid information, and general information on related personnel issues-including recruitment, retention, and supply of and demand for special education professionals--contact:

National Clearinghouse for Professions in Special Education, Council for Exceptional Children, 1920 Association Dr., Reston, VA 20191-1589. Internet: http://www.special-ed-careers.org

To learn more about the special education teacher certification and licensing requirements in your State, contact your State's department of education.

Employment of chiropractors is expected to increase rapidly and job prospects should be good. Chiropractic care of back, neck, extremities, and other joint damage has become more accepted as a result of recent research and changing attitudes.

In chiropractic, as in other types of independent practice, earnings are relatively low in the beginning, but increase as the practice grows.

Nature of the Work

Chiropractors, also known as doctors of chiropractic or chiropractic physicians, diagnose and treat patients whose health problems are associated with the body's muscular, nervous, and skeletal systems, especially the spine. Chiropractors believe interference with these systems impairs normal functions and lowers resistance to disease. They also hold that spinal or vertebral dysfunction alters many important body functions by affecting the nervous system, and that skeletal imbalance through joint or articular dysfunction, especially in the spine, can cause pain.

The chiropractic approach to health care is holistic, stressing the patient's overall health and wellness. It recognizes that many factors affect health, including exercise, diet, rest, environment, and heredity. Chiropractors use natural, drugless, nonsurgical health treatments, and rely on the body's inherent recuperative abilities. They also recommend lifestyle changes-in eating, exercise, and sleeping habits, for example-to their patients. When appropriate, chiropractors consult with and refer patients to other health practitioners.

Like other health practitioners, chiropractors follow a standard routine to secure the information needed for diagnosis and treatment. They take the patient's medical history, conduct physical, neurological, and orthopedic examinations, and may order laboratory tests. X rays and other diagnostic images are important tools because of the emphasis on the spine and its proper function. Chiropractors also employ a postural and spinal analysis common to chiropractic diagnosis.

In cases in which difficulties can be traced to involvement of musculoskeletal structures, chiropractors manually adjust the spinal column. Many chiropractors use water, light, massage, ultra

sound, electric, and heat therapy. They may also apply supports such as straps, tapes, and braces. Chiropractors counsel patients about wellness concepts such as nutrition, exercise, lifestyle changes, and stress management, but do not prescribe drugs or perform surgery.

Some chiropractors specialize in sports injuries, neurology, orthopedics, nutrition, internal disorders, or diagnostic imaging.

Many chiropractors are solo or group practitioners who also have the administrative responsibilities of running a practice. In larger offices, chiropractors delegate these tasks to office managers and chiropractic assistants. Chiropractors in private practice are responsible for developing a patient base, hiring employees, and keeping records.

Chiropractors, like other health practitioners, are sometimes on their feet for long periods of time. Chiropractors who take x rays employ appropriate precautions against the dangers of repeated exposure to radiation.

Employment

Chiropractors held about 46,000 jobs in 1998. Most chiropractors are in solo practice, although some are in group practice or work for other chiropractors. A small number teach, conduct research at chiropractic institutions, or work in hospitals and clinics.

Many chiropractors are located in small communities. There are geographic imbalances in the distribution of chiropractors, in part because many establish practices close to chiropractic institutions.

Training, Other Qualifications, and Advancement

All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet educational and examination requirements established by the State. Chiropractors can only practice in States where they are licensed. Some States have agreements permitting chiropractors licensed in one State to obtain a license in another without further examination, provided that educational, examination, and practice credentials meet State specifications.

Most State boards require at least 2 years of undergraduate education, and an increasing number require a 4-year bachelor's degree. All boards require completion of a 4-year chiropractic college course at an accredited program leading to the Doctor of Chiropractic degree.

For licensure, most State boards recognize either all or part of the four-part test administered by the National Board of Chiropractic Examiners. State examinations may supplement the National Board tests, depending on State requirements.

To maintain licensure, almost all States require completion of a specified number of hours of continuing education each year, Continuing education programs are offered by accredited chiropractic programs and institutions, and chiropractic associations. Special councils within some chiropractic associations also offer programs leading to clinical specialty certification, called "diplomate" certification, in areas such as orthopedics, neurology, sports injuries, occupational and industrial health, nutrition, diagnostic imaging, thermography, and internal disorders.

In 1998, there were 16 chiropractic programs and institutions in the United States accredited by the Council on Chiropractic Education. All required applicants to have at least 60 semester hours of undergraduate study leading toward a bachelor's degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor's degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelor's degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the State boards.

During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in basic science subjects such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years stress courses in manipulation and spinal adjustments, and provide clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic (D.C.).

Chiropractic requires keen observation to detect physical abnormalities. It also takes considerable hand dexterity to perform adjustments, but not unusual strength or endurance. Chiropractors should be able to work independently and handle responsibility. As in other health-related occupations, empathy, understanding, and the desire to help others are good qualities for dealing effectively with patients. Newly licensed chiropractors can set up a new practice, purchase an established one, or enter into partnership with an established prac

titioner. They may also take a salaried position with an established chiropractor, a group practice, or a health care facility.

Job Outlook

Job prospects are expected to be good for persons who enter the practice of chiropractic. Employment of chiropractors is expected to grow faster than the average for all occupations through the year 2008 as consumer demand for alternative medicine grows. Chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery. As a result, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of back, neck, extremities, and other joint damage has become more accepted as a result of recent research and changing attitudes about alternative health care practices. The rapidly expanding older population, with their increased likelihood of mechanical and structural problems, will also increase demand.

Demand for chiropractic treatment is also related to the ability of patients to pay, either directly or through health insurance. Although more insurance plans now cover chiropractic services, the extent of such coverage varies among plans. Increasingly, chiropractors must educate communities about the benefits of chiropractic care in order to establish a successful practice.

In this occupation, replacement needs arise almost entirely from retirements. Chiropractors usually remain in the occupation until they retire; few transfer to other occupations. Establishing a new practice will be easiest in areas with a low concentration of chiropractors.

Earnings

Median annual earnings of salaried chiropractors were $63,930 in 1998. The middle 50 percent earned between $36,820 and $110,820 a year.

Self-employed chiropractors usually earn more than salaried chiropractors. According to the American Chiropractic Association, average income for all chiropractors, including the self-employed, was about $86,500, after expenses, in 1997. In chiropractic, as in other types of independent practice, earnings are relatively low in the beginning, and increase as the practice grows. Earnings are also influenced by the characteristics and qualifications of the practitioner, and geographic location. Self-employed chiropractors must provide for their own health insurance and retirement.

Related Occupations

Chiropractors treat and work to prevent bodily disorders and injuries. So do physicians, dentists, optometrists, podiatrists, veterinarians, occupational therapists, and physical therapists.

Sources of Additional Information

General information on chiropractic as a career is available from: American Chiropractic Association, 1701 Clarendon Blvd., Arlington, VA 22209. Internet: http://www.amerchiro.org

☛ International Chiropractors Association, 1110 North Glebe Rd., Suite 1000, Arlington, VA 22201. Internet: http://www.chiropractic.org ☛ World Chiropractic Alliance, 2950 N. Dobson Rd., Suite 1, Chandler, AZ 85224-1802.

☛ Dynamic Chiropractic, P.O. Box 6100, Huntington, CA 92615. Internet: http://www.chiroweb.com

For a list of chiropractic programs and institutions, as well as general information on chiropractic education, contact:

☛ Council on Chiropractic Education, 7975 North Hayden Rd., Suite A210, Scottsdale, AZ 85258.

For information on State education and licensure requirements,

contact:

Federation of Chiropractic Licensing Boards, 901 54th Ave., Suite 101, Greeley, CO 80634. Internet: http://www.fclb.org/fclb

For information on requirements for admission to a specific chiropractic college, as well as scholarship and loan information, contact the admissions office of the individual college.

Dentists

(O*NET 32105A, 32105B, 32105D, 32105F, and 32105G)

Significant Points

Most dentists have at least 8 years of education beyond high school.

Employment of dentists is expected to grow slower than the average as young people are troubled less by tooth decay.

Dental care will focus more on prevention, including teaching people how to care better for their teeth.

Nature of the Work

Dentists diagnose, prevent, and treat teeth and tissue problems. They remove decay, fill cavities, examine x rays, place protective plastic sealants on children's teeth, straighten teeth, and repair fractured teeth. They also perform corrective surgery on gums and supporting bones to treat gum diseases. Dentists extract teeth and make models and measurements for dentures to replace missing teeth. They provide instruction on diet, brushing, flossing, the use of fluorides, and other aspects of dental care, as well. They also administer anesthetics and write prescriptions for antibiotics and other medications.

Dentists use a variety of equipment, including x-ray machines, drills, and instruments such as mouth mirrors, probes, forceps, brushes, and scalpels. They also wear masks, gloves, and safety glasses to protect themselves and their patients from infectious diseases.

Dentists in private practice oversee a variety of administrative tasks, including bookkeeping, and buying equipment and supplies. They may employ and supervise dental hygienists, dental assistants, dental laboratory technicians, and receptionists. (These occupations are described elsewhere in the Handbook.)

Most dentists are general practitioners, handling a variety of dental needs. Other dentists practice in one of eight specialty areas. Orthodontists, the largest group of specialists, straighten teeth. The next largest group, oral and maxillofacial surgeons, operate on the mouth and jaws. The remainder may specialize as pediatric dentists (dentistry for children); periodontists (treating gums and bone supporting the teeth); prosthodontists (making artificial teeth or dentures); endodontists (root canal therapy); public health dentists; and oral pathologists (studying oral diseases).

Dentists will focus on preventive care, teaching people how to

better care for their teeth.

Working Conditions

Most dentists work 4 or 5 days a week. Some work evenings and weekends to meet their patients' needs. Most full-time dentists work about 40 hours a week, but others work more. Initially, dentists may work more hours as they establish their practice. Experienced dentists often work fewer hours. A considerable number continue in part-time practice well beyond the usual retirement age.

Most dentists are "solo practitioners," meaning they own their own businesses and work alone or with a small staff. Some dentists have partners, and a few work for other dentists as associate dentists.

Employment

Dentists held about 160,000 jobs in 1998. About 9 out of 10 dentists are in private practice. Others work in private and public hospitals and clinics, the Federal Government, and in dental research.

Training, Other Qualifications, and Advancement

All 50 States and the District of Columbia require dentists to be licensed. In most States, a candidate must graduate from a dental school accredited by the American Dental Association's Commission on Dental Accreditation, and pass written and practical examinations to qualify for a license. Candidates may fulfill the written part of the State licensing by passing the National Board Dental Examinations. Individual States or regional testing agencies give the written or practical examinations.

Currently, about 17 States require dentists to obtain a specialty license before practicing as a specialist. Requirements include 2 to 4 years of postgraduate education and, in some cases, completion of a special State examination. Most State licenses permit dentists to engage in both general and specialized practice. Dentists who want to teach or do research usually spend an additional 2 to 5 years in advanced dental training, in programs operated by dental schools or hospitals.

Dental schools require a minimum of 2 years of college-level predental education. However, most dental students have at least a bachelor's degree. Predental education emphasizes course work in the sciences.

All dental schools require applicants to take the Dental Admissions Test (DAT). When selecting students, schools consider scores earned on the DAT, the applicants' grade point average, and information gathered through recommendations and interviews.

Dental school usually lasts 4 academic years. Studies begin with classroom instruction and laboratory work in basic sciences including anatomy, microbiology, biochemistry, and physiology. Beginning courses in clinical sciences, including laboratory techniques, are also provided at this time. During the last 2 years, students treat patients, usually in dental clinics, under the supervision of licensed dentists.

Most dental schools award the degree of Doctor of Dental Surgery (D.D.S.). The rest award an equivalent degree, Doctor of Dental Medicine (D.M.D.).

Dentistry requires diagnostic ability and manual skills. Dentists should have good visual memory, excellent judgment of space and shape, a high degree of manual dexterity, and scientific ability. Good business sense, self-discipline, and communication skills are helpful for success in private practice. High school and college students who want to become dentists should take courses in biology, chemistry, physics, health, and mathematics.

Some dental school graduates work for established dentists as associates for a year or two in order to gain experience and save money to equip an office of their own. Most dental school graduates, however, purchase an established practice or open a new practice immediately after graduation. Each year about one-fourth to one-third of new graduates enroll in postgraduate training programs to prepare for a dental specialty.

Job Outlook

Employment of dentists is expected to grow slower than the average for all occupations through 2008. Although employment growth will provide some job opportunities, most jobs will result from the need to replace the large number of dentists projected to retire. Job prospects should be good if the number of dental school graduates does not grow significantly, thus keeping the supply of newly qualified dentists near current levels.

Demand for dental care should grow substantially through 2008. As members of the baby-boom generation advance into middle age, a large number will need maintenance on complicated dental work, such as bridges. In addition, elderly people are more likely to retain their teeth than were their predecessors, so they will require much more care than in the past. The younger generation will continue to need preventive check-ups despite treatments such as fluoridation of the water supply, which decreases the incidence of tooth decay. Dental care will focus more on prevention, including teaching people how to care better for their teeth. Dentists will increasingly provide care that is aimed at preventing tooth loss-rather than just providing treatments, such as fillings. Improvements in dental technology will also allow dentists to provide more effective and less painful treatment to their patients.

However, the employment of dentists is not expected to grow as rapidly as the demand for dental services. As their practices expand, dentists are likely to hire more dental hygienists and dental assistants to handle routine services.

Earnings

Median annual earnings of salaried dentists were $110,160 in 1998. Earnings vary according to number of years in practice, location, hours worked, and specialty.

Self-employed dentists in private practice tend to earn more than salaried dentists. A relatively large proportion of dentists is selfemployed. Like other business owners, these dentists must provide their own health insurance, life insurance, and retirement benefits.

Related Occupations

Dentists examine, diagnose, prevent, and treat diseases and abnormalities. So do clinical psychologists, optometrists, physicians, chiropractors, veterinarians, and podiatrists.

Sources of Additional Information

For information on dentistry as a career and a list of accredited dental schools, contact:

American Dental Association, Commission on Dental Accreditation, 211 E. Chicago Ave., Chicago, IL 60611. Internet: http://www.ada.org American Association of Dental Schools, 1625 Massachusetts Ave. NW., Washington, DC 20036. Internet: http://www.aads.jhu.edu

The American Dental Association will also furnish a list of State boards of dental examiners. Persons interested in practicing dentistry should obtain the requirements for licensure from the board of dental examiners of the State in which they plan to work.

Prospective dental students should contact the office of student financial aid at the schools to which they apply, for information on scholarships, grants, and loans, including Federal financial aid.

Optometrists

(O*NET 32108)

Employment growth will be fastest in retail optical stores and outpatient clinics.

Optometrists usually remain in practice until they retire, so job openings arising from replacement needs are low.

Nature of the Work

Over half of the people in the United States wear glasses or contact lenses. Optometrists (doctors of optometry, also known as O.D.'s) provide most primary vision care.

Optometrists examine people's eyes to diagnose vision problems and eye diseases. They use instruments and observation to examine eye health and to test patients' visual acuity, depth and color perception, and their ability to focus and coordinate the eyes. They analyze test results and develop a treatment plan. Optometrists prescribe eyeglasses and contact lenses, and provide vision therapy and low vision rehabilitation. They administer drugs to patients to aid in the diagnosis of eye vision problems and prescribe drugs to treat some eye diseases. Optometrists often provide pre- and post-operative care to cataract, laser vision correction, and other eye surgery patients. They also diagnose conditions due to systemic diseases such as diabetes and high blood pressure, and refer patients to other health practitioners as needed.

Optometrists should not be confused with ophthalmologists or dispensing opticians. Ophthalmologists are physicians who perform eye surgery, and diagnose and treat eye diseases and injuries. Like optometrists, they also examine eyes and prescribe eyeglasses and contact lenses. Dispensing opticians fit and adjust eyeglasses and in some States may fit contact lenses according to prescriptions written by ophthalmologists or optometrists. (See statements on physicians and dispensing opticians elsewhere in the Handbook.)

Most optometrists are in general practice. Some specialize in work with the elderly, children, or partially sighted persons who need specialized visual devices. Others develop and implement ways to protect workers' eyes from on-the-job strain or injury. Some specialize in contact lenses, sports vision, or vision therapy. A few teach optometry, perform research, or consult.

Most optometrists are private practitioners who also handle the business aspects of running an office, such as developing a patient base, hiring employees, keeping records, and ordering equipment and supplies. Optometrists who operate franchise optical stores may also have some of these duties.

Significant Points

All States and the District of Columbia require that optometrists be licensed, which requires a Doctor of Optometry degree from an accredited optometry school and passing both a written and a clinical State board examination.

Optometrists diagnose vision problems and eye diseases.

to suit the needs of patients. Emergency calls, once uncommon, have increased with the passage of therapeutic drug laws expanding optometrists' ability to prescribe medications.

Employment

Optometrists held about 38,000 jobs in 1998. The number of jobs is greater than the number of practicing optometrists because some optometrists hold two or more jobs. For example, an optometrist may have a private practice, but also work in another practice, clinic, or vision care center. According to the American Optometric Association, about two-thirds of practicing optometrists are in private practice.

Although many optometrists practice alone, a growing number are in a partnership or group practice. Some optometrists work as salaried employees of other optometrists or of ophthalmologists, hospitals, health maintenance organizations (HMO's), or retail optical stores. A small number of optometrists are consultants for industrial safety programs, insurance companies, manufacturers of ophthalmic products, HMO's, and others.

Training, Other Qualifications, and Advancement

All States and the District of Columbia require that optometrists be licensed. Applicants for a license must have a Doctor of Optometry degree from an accredited optometry school and pass both a written and a clinical State board examination. In many States, applicants can substitute the examinations of the National Board of Examiners in Optometry, usually taken during the student's academic career, for part or all of the written examination. Licenses are renewed every 1 to 3 years and in all States, continuing education credits are needed for renewal.

The Doctor of Optometry degree requires completion of a 4year program at an accredited optometry school preceded by at least 3 years of preoptometric study at an accredited college or university (most optometry students hold a bachelor's degree or higher). In 1999, 17 U.S. schools and colleges of optometry held an accredited status with the Council on Optometric Education of the American Optometric Association.

Requirements for admission to schools of optometry include courses in English, mathematics, physics, chemistry, and biology. A few schools require or recommend courses in psychology, history, sociology, speech, or business. Applicants must take the Optometry Admissions Test, which measures academic ability and scientific comprehension. Most applicants take the test after their sophomore or junior year. Competition for admission is keen.

Optometry programs include classroom and laboratory study of health and visual sciences, as well as clinical training in the diagnosis and treatment of eye disorders. Included are courses in pharmacology, optics, vision science, biochemistry, and systemic disease.

Business ability, self-discipline, and the ability to deal tactfully with patients are important for success. The work of optometrists requires attention to detail and good manual dexterity.

Optometrists wishing to teach or do research may study for a master's or Ph.D. degree in visual science, physiological optics, neurophysiology, public health, health administration, health information and communication, or health education. One-year postgraduate clinical residency programs are available for optometrists who wish to specialize in any of the following: family practice optometry, pediatric optometry, geriatric optometry, vision therapy, contact lenses, hospital based optometry, primary care optometry, or ocular disease. Job Outlook

Employment of optometrists is expected to grow about as fast as the average for all occupations through 2008 in response to the vision care needs of a growing and aging population. As baby boomers age, they will be more likely to visit optometrists and ophthalmologists because of the onset of vision problems in middle age, including computer-related vision problems. The demand for optometric services will also increase because of growth in the oldest age group, with their increased likelihood of cataracts, glaucoma, diabetes, and

hypertension. Employment of optometrists will also grow due to greater recognition of the importance of vision care, rising personal incomes, and growth in employee vision care plans. Employment growth will be fastest in retail optical stores and outpatient clinics.

Employment of optometrists would grow more rapidly were it not for anticipated productivity gains that will allow each optometrist to see more patients. These gains will result from greater use of optometric assistants and other support personnel, and the introduction of new equipment and procedures. New surgical procedures using lasers are available that can correct some vision problems, but they remain expensive.

In addition to growth, the need to replace optometrists who leave the occupation will create employment opportunities. Relatively few opportunities from this source are expected, however, because most optometrists continue to practice until they retire; few transfer to other occupations.

Earnings

Median annual earnings of salaried optometrists were $68,500 in 1998. The middle 50 percent earned between $43,750 and $93,700 a year. The lowest 10 percent earned less than $24,820 and the highest 10 percent earned more than $123,770 a year. Salaried optometrists tend to earn more initially than do optometrists who set up their own independent practice. In the long run, those in private practice usually earn more.

According to the American Optometric Association, new optometry graduates in their first year of practice earned median net incomes of $55,000 in 1998. Overall, optometrists earned median net incomes of $92,000.

Related Occupations

Workers in other occupations who apply scientific knowledge to prevent, diagnose, and treat disorders and injuries are chiropractors, dentists, physicians, podiatrists, veterinarians, speech-language pathologists, and audiologists.

Sources of Additional Information

For information on optometry as a career and a listing of accredited optometric educational institutions, as well as required preoptometry

courses, contact:

☛ American Optometric Association, Educational Services, 243 North Lindbergh Blvd., St. Louis, MO 63141-7881. Internet: http://www.aoanet.org

☛ Association of Schools and Colleges of Optometry, 6110 Executive Blvd., Suite 510, Rockville, MD 20852. Internet: http://www.opted.org

The Board of Optometry in each State can supply information on licensing requirements.

For information on specific admission requirements and sources of financial aid, contact the admissions officer of individual optometry schools.

Physicians

(O*NET 32102A, 32102B, 32102E, 32102F, 32102J, and 32102U)

Significant Points

Physicians are much more likely to work as salaried employees of group medical practices, clinics, or health care networks than in the past.

Formal education and training requirements are among the longest of any occupation, but earnings are among the highest.

Nature of the Work

Physicians serve a fundamental role in our society and have an effect upon all our lives. They diagnose illnesses and prescribe and