mixing of ingredients to form powders, tablets, capsules, ointments, and solutions-is only a small part of a pharmacist's practice, because most medicines are produced by pharmaceutical companies in a standard dosage and drug delivery form.

Pharmacists in community or retail pharmacies counsel patients, as well as answer questions about prescription drugs, such as possible adverse reactions or interactions. They provide information about over-the-counter drugs and make recommendations after asking a series of health questions, such as whether the customer is taking any other medications. They also give advice about durable medical equipment and home health care supplies. Those who own or manage community pharmacies may sell nonhealthrelated merchandise, hire and supervise personnel, and oversee the general operation of the pharmacy. Some community pharmacists provide specialized services to help patients manage conditions such as diabetes, asthma, smoking cessation, or high blood pressure.

Pharmacists in hospitals and clinics dispense medications and advise the medical staff on the selection and effects of drugs. They may make sterile solutions and buy medical supplies. They also assess, plan, and monitor drug regimens. They counsel patients on the use of drugs while in the hospital, and on their use at home when they are discharged. Pharmacists may also evaluate drug use patterns and outcomes for patients in hospitals or managed care organizations.

Pharmacists who work in home health care monitor drug therapy and prepare infusions-solutions that are injected into patients-and other medications for use in the home.

Pharmacists must ensure that prescriptions are accurately filled.

Most pharmacists keep confidential computerized records of patients' drug therapies to ensure that harmful drug interactions do not occur. They frequently teach pharmacy students serving as interns in preparation for graduation and licensure.

Some pharmacists specialize in specific drug therapy areas, such as psychiatric disorders, intravenous nutrition support, oncology, nuclear pharmacy, and pharmacotherapy.

Working Conditions

Pharmacists usually work in clean, well-lighted, and well-ventilated areas. Many pharmacists spend most of their workday on their feet. When working with sterile or potentially dangerous pharmaceutical products, pharmacists wear gloves and masks and work with other special protective equipment. Many community and hospital pharmacies are open for extended hours or around the clock, so pharmacists may work evenings, nights, weekends, and holidays. Consultant pharmacists may travel to nursing homes or other facilities to monitor people's drug therapy.

About 1 out of 7 pharmacists worked part time in 1998. Most full-time salaried pharmacists worked about 40 hours a week. Some, including most self-employed pharmacists, worked more than 50 hours a week.

Employment

Pharmacists held about 185,000 jobs in 1998. About 3 out of 5 worked in community pharmacies, either independently owned or part of a drug store chain, grocery store, department store, or mass merchandiser. Most community pharmacists were salaried employees, but some were self-employed owners. About one-quarter of salaried pharmacists worked in hospitals, and others worked in clinics, mail-order pharmacies, pharmaceutical wholesalers, home health care agencies, or the Federal Government.

Some pharmacists hold more than one job. They may work a standard week in their primary work setting, and also work part time elsewhere.

Training, Other Qualifications, and Advancement

A license to practice pharmacy is required in all States, the District of Columbia, and U.S. territories. To obtain a license, one must serve an internship under a licensed pharmacist, graduate from an accredited college of pharmacy, and pass a State examination. Most States grant a license without extensive reexamination to qualified pharmacists already licensed by another State-check with State boards of pharmacy for details. Many pharmacists are licensed to practice in more than one State. States may require continuing education for license renewal.

In 1998, 81 colleges of pharmacy were accredited to confer degrees by the American Council on Pharmaceutical Education. Nearly all pharmacy programs grant the degree of Doctor of Pharmacy (Pharm.D.) which requires at least 6 years of postsecondary study. A small number of pharmacy schools continue to award the 5-year Bachelor of Science (B.S.) in pharmacy degree. However, all accredited pharmacy schools are expected to graduate their last B.S. class by the year 2005. Either a Pharm.D. or B.S. degree currently fulfills the requirements to take the licensure examination of a state board of pharmacy.

Requirements for admission to colleges of pharmacy vary. A few colleges admit students directly from high school. Most colleges of pharmacy, however, require 1 or 2 years of college-level prepharmacy education. Entry requirements usually include mathematics and basic sciences, such as chemistry, biology, and physics, as well as courses in the humanities and social sciences. Some colleges require the applicant to take the Pharmacy College Admissions Test.

All colleges of pharmacy offer courses in pharmacy practice, designed to teach students to dispense prescriptions, communicate

with patients and other health professionals, and to strengthen their understanding of professional ethics and practice management responsibilities. Pharmacists' training increasingly emphasizes direct patient care, as well as consultative services to other health professionals.

In the 1997-1998 academic year, 60 colleges of pharmacy awarded the Master of Science degree or the Ph.D. degree. Although a number of pharmacy graduates interested in further training pursue an advanced degree in pharmacy, there are other options. Some complete 1- or 2-year residency programs or fellowships. Pharmacy residencies are postgraduate training programs in pharmacy practice. Pharmacy fellowships are highly individualized programs designed to prepare participants to work in research laboratories.

Areas of graduate study include pharmaceutics and pharmaceutical chemistry (physical and chemical properties of drugs and dosage forms), pharmacology (effects of drugs on the body), and pharmacy administration, including pharmacoeconomics and social-behavioral aspects of patient care.

Prospective pharmacists should have scientific aptitude, good communication skills, and a desire to help others. They must also be conscientious and pay close attention to detail, because the decisions they make affect human lives.

In community pharmacies, pharmacists usually begin at the staff level. After they gain experience and secure the necessary capital, some become owners or part owners of pharmacies. Pharmacists in chain drug stores may be promoted to pharmacy supervisor or manager at the store level, then to the district or regional level, and later to an executive position within the chain's headquarters.

Hospital pharmacists may advance to supervisory or administrative positions. Pharmacists in the pharmaceutical industry may advance in marketing, sales, research, quality control, production, packaging, and other areas.

Job Outlook

Employment of pharmacists is expected to grow slower than the average for all occupations through the year 2008, despite the increased pharmaceutical needs of a larger and older population, and greater use of medication.

Retail pharmacies are taking steps to increase their prescription volume to make up for declining dispensing fees. Automation of drug dispensing and greater use of pharmacy technicians will help them to dispense more prescriptions. The number of community pharmacists needed in the future will depend on the expansion rate of chain drug stores and the willingness of insurers to reimburse pharmacists for providing clinical services to patients taking prescription medications. With its emphasis on cost control, managed care encourages growth of lower-cost prescription drug distributors such as mail-order firms for certain medications. Slower employment growth is expected in traditional chain and independent pharmacies.

Employment in hospitals is also expected to grow slowly, as hospitals reduce inpatient stays, downsize, and consolidate departments. Pharmacy services are shifting to long-term, ambulatory, and home care settings, where opportunities for pharmacists will be best. New opportunities for pharmacists are emerging in managed care organizations, where pharmacists analyze trends and patterns in medication use for their populations of patients. Fast growth is also expected for pharmacists trained in research, disease management, and pharmacoeconomics-determining the costs and benefits of different drug therapies.

Cost-conscious insurers and health systems may continue to emphasize the role of pharmacists in primary and preventive health services. They realize that the expense of using medication to treat diseases and conditions is often considerably less than the potential costs for patients whose conditions go untreated. Pharmacists can also reduce the expenses resulting from unexpected complications due to allergic reactions or medication interactions.

According to a survey by Drug Topics magazine, published by Medical Economics Co., average base salaries of full-time, salaried pharmacists were about $59,700 a year in 1998. Pharmacists working in chain drug stores had an average base salary of about $62,300 a year, while pharmacists working in independent drug stores averaged about $56,300, and hospital pharmacists averaged about $59,500 a year. Overall, salaries for pharmacists were highest on the West coast. Many pharmacists also receive compensation in the form of bonuses, overtime, and profit-sharing.

Related Occupations

Persons in other professions who may work with pharmaceutical compounds are biological technicians, medical scientists, pharmaceutical chemists, and pharmacologists.

Sources of Additional Information

For information on pharmacy as a career, preprofessional and professional requirements, programs offered by all the colleges of pharmacy, and student financial aid, contact:

American Association of Colleges of Pharmacy, 1426 Prince St., Alexandria, VA 22314. Internet: http://www.aacp.org

General information on careers in pharmacy is available from: American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Internet: http://www.ashp.org

☛ American Pharmaceutical Association, 2215 Constitution Ave. NW., Washington, DC 20037-2985. Internet: http://www.aphanet.org

National Association of Chain Drug Stores, 413 N. Lee St., P.O. Box 1417-D49, Alexandria, VA 22313-1480. Internet: www.nacds.org State licensure requirements are available from each State's Board of Pharmacy.

Information on specific college entrance requirements, curriculums, and financial aid is available from any college of pharmacy.

Physical Therapists

(O*NET 32308)

Significant Points

Although the effects of Federal limits on reimbursement for therapy services will cause keen competition for jobs during the first half of the projection period, employment is expected to increase over the 1998-2008 period.

Physical therapists provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease. They restore, maintain, and promote overall fitness and health. Their patients include accident victims and individuals with disabling conditions such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy.

Therapists examine patients' medical histories, then test and measure their strength, range of motion, balance and coordination, posture, muscle performance, respiration, and motor function. They also determine patients' ability to be independent and reintegrate into the community or workplace after injury or illness. Next, they develop treatment plans describing a treatment strategy, the purpose, and anticipated outcome. Physical therapist assistants, under the direction and supervision of a physical therapist, may be involved in the implementation of the treatment plan. Physical therapist aides perform routine support tasks, as directed by the therapist. (Physical therapist assistants and aides are discussed elsewhere in the Handbook.)

Treatment often includes exercise for patients who have been immobilized and lack flexibility, strength, or endurance. They

A physical therapist helps a patient increase range of motion after an injury.

encourage patients to use their own muscles to further increase flexibility and range of motion before finally advancing to other exercises improving strength, balance, coordination, and endurance. Their goal is to improve how an individual functions at work and home.

Physical therapists also use electrical stimulation, hot packs or cold compresses, and ultrasound to relieve pain and reduce swelling. They may use traction or deep-tissue massage to relieve pain. Therapists also teach patients to use assistive and adaptive devices such as crutches, prostheses, and wheelchairs. They may also show patients exercises to do at home to expedite their recovery.

As treatment continues, physical therapists document progress, conduct periodic examinations, and modify treatments when necessary. Such documentation is used to track the patient's progress, and identify areas requiring more or less attention.

Physical therapists often consult and practice with a variety of other professionals, such as physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language pathologists, and audiologists.

Some physical therapists treat a wide range of ailments; others specialize in areas such as pediatrics, geriatrics, orthopedics, sports medicine, neurology, and cardiopulmonary physical therapy.

Working Conditions

Physical therapists practice in hospitals, clinics, and private offices that have specially equipped facilities or they treat patients in hospital rooms, homes, or schools.

Most physical therapists work a 40-hour week, which may include some evenings and weekends. The job can be physically demanding because therapists often have to stoop, kneel, crouch, lift, and stand for long periods of time. In addition, physical therapists move heavy equipment and lift patients or help them turn, stand, or walk.

Employment

Physical therapists held about 120,000 jobs in 1998; about 1 in 4 worked part time. The number of jobs is greater than the number of practicing physical therapists because some physical therapists hold two or more jobs. For example, some may have a private practice, but also work part time in another health facility. About 1 in 10 physical therapists held more than one job in 1998.

Over two-thirds of physical therapists were employed in either hospitals or offices of physical therapists. Other jobs were in home health agencies, outpatient rehabilitation centers, offices and clinics of physicians, and nursing homes. Some physical therapists are self-employed in private practices. They may provide services to individual patients or contract to provide services in hospitals, rehabilitation centers, nursing homes, home health agencies, adult daycare programs, and schools. They may be in solo practice or be part of a consulting group. Physical therapists also teach in academic institutions and conduct research.

Training, Other Qualifications, and Advancement

All States require physical therapists to pass a licensure exam after graduating from an accredited physical therapist educational program before they can practice.

According to the American Physical Therapy Association, there were 189 accredited physical therapist programs in 1999. Of the accredited programs, 24 offered bachelor's degrees, 157 offered master's degrees, and 8 offered doctoral degrees. By 2002, all physical therapist programs seeking accreditation will be required to offer degrees at the master's degree level and above, in accordance with the Commission on Accreditation in Physical Therapy Education.

Physical therapist programs start with basic science courses such as biology, chemistry, and physics, and then introduce specialized

courses such as biomechanics, neuroanatomy, human growth and development, manifestations of disease, examination techniques, and therapeutic procedures. Besides classroom and laboratory instruction, students receive supervised clinical experience. Individuals who have a 4-year degree in another field and want to be a physical therapist, should enroll in a master's or a doctoral level physical therapist educational program.

Competition for entrance into physical therapist educational programs is very intense, so interested students should attain superior grades in high school and college, especially in science courses. Courses useful when applying to physical therapist educational programs include anatomy, biology, chemistry, social science, mathematics, and physics. Before granting admission, many professional education programs require experience as a volunteer in a physical therapy department of a hospital or clinic.

Physical therapists should have strong interpersonal skills to successfully educate patients about their physical therapy treatments. They should also be compassionate and posses a desire to help patients. Similar traits are also needed to interact with the patient's family.

Physical therapists are expected to continue professional development by participating in continuing education courses and workshops. A number of States require continuing education to maintain licensure.

Job Outlook

Employment of physical therapists is expected to grow faster than the average for all occupations through 2008. However, Federal legislation imposing limits on reimbursement for therapy services may continue to adversely affect the job market for physical therapists in the near term. Because of the effects of these provisions, the majority of expected employment growth for physical therapists will occur in the second half of the projection period.

Over the long run, the demand for physical therapists should continue to rise as a result of growth in the number of individuals with disabilities or limited function requiring therapy services. The rapidly growing elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. Also, the baby-boom generation is entering the prime age for heart attacks and strokes, increasing the demand for cardiac and physical rehabilitation. More young people will need physical therapy as technological advances save the lives of a larger proportion of newborns with severe birth defects.

Future medical developments should also permit a higher percentage of trauma victims to survive, creating additional demand for rehabilitative care. Growth may also result from advances in medical technology which permit treatment of more disabling conditions.

Widespread interest in health promotion should also increase demand for physical therapy services. A growing number of employers are using physical therapists to evaluate worksites, develop exercise programs, and teach safe work habits to employees in the hope of reducing injuries.

Earnings

Median annual earnings of physical therapists were $56,600 in 1998. The middle 50 percent earned between $44,460 and $77,810 a year. The lowest 10 percent earned less than $35,700 and the highest 10 percent earned more than $90,870 a year. Median annual earnings in the industries employing the largest number of physical therapists in 1997 were as follows:

Home health care services

Nursing and personal care facilities

Offices of other health care practitioners

Offices and clinics of medical doctors. Hospitals..............

Related Occupations Physical therapists rehabilitate persons with physical disabilities. Others who work in the rehabilitation field include occupational therapists, speech pathologists, audiologists, orthotists, prosthetists, and respiratory therapists.

Sources of Additional Information

Additional information on a career as a physical therapist and a list of accredited educational programs in physical therapy are available from:

☛ American Physical Therapy Association, 1111 North Fairfax St., Alexandria, VA 22314-1488. Internet: http://www.apta.org

Physician Assistants

(O*NET 32511)

Significant Points

The typical physician assistant program lasts about 2 years and usually requires at least 2 years of college and some health care experience for admission.

Earnings are high and job opportunities should be good.

Nature of the Work

Physician assistants (PAs) provide health care services with supervision by physicians. They should not be confused with medical assistants, who perform routine clinical and clerical tasks. (Medical assistants are discussed elsewhere in the Handbook.) PAS are formally trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. Working as members of the health care team, they take medical histories, examine patients, order and interpret laboratory tests and x rays, and make diagnoses. They also treat minor injuries by suturing, splinting, and casting. PAs record progress notes, instruct and counsel patients, and order or carry out therapy. In 46 States and the District of Columbia, physician assistants may prescribe medications. PAs may also have managerial duties. Some order medical and laboratory supplies and equipment and may supervise technicians and assistants.

Physician assistants always work with the supervision of a physician. However, PAs may provide care in rural or inner city clinics

$65,600 60,400

56,600

55,100 50,100

Physician assistants are projected to be among the fastest growing occupations.

where a physician is present for only 1 or 2 days each week, conferring with the supervising physician and other medical professionals as needed or required by law. PAs may also make house calls or go to hospitals and nursing homes to check on patients and report back to the physician.

The duties of physician assistants are determined by the supervising physician and by State law. Aspiring PAs should investigate the laws and regulations in the States where they wish to practice.

Many PAS work in primary care areas such as general internal medicine, pediatrics, and family medicine. Others work in specialty areas, such as general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide preand post-operative care and may work as first or second assistants during major surgery.

Working Conditions

Although PAs usually work in a comfortable, well-lighted environment, those in surgery often stand for long periods, and others do considerable walking. Schedules vary according to practice setting and often depend on the hours of the supervising physician. The workweek of PAs in physicians' offices may include weekends, night hours, or early morning hospital rounds to visit patients. They may also be on-call. PAs in clinics usually work a 40-hour week.

Employment

Physician assistants held about 66,000 jobs in 1998. The number of jobs is greater than the number of practicing PAs because some hold two or more jobs. For example, some PAs work with a supervising physician, but also work in another practice, clinic, or hospital. According to the American Academy of Physician Assistants, there were about 34,200 certified PA's in clinical practice, as of January 1999.

Sixty-seven percent of jobs for PA's were in the offices and clinics of physicians, dentists, or other health practitioners. About 21 percent were in hospitals. The rest were mostly in public health clinics, nursing homes, prisons, home health care agencies, and the Department of Veterans Affairs.

According to the American Academy of Physician Assistants, about one-third of all PAS provide health care to communities having fewer than 50,000 residents where physicians may be in limited supply.

Training, Other Qualifications, and Advancement

All States require that new PAs complete an accredited, formal education program. As of July 1999, there were 116 accredited or provisionally accredited educational programs for physician assistants; 64 of these programs offered a bachelor's degree or a degree option. The rest offered either a certificate, an associate degree, or a master's degree. Most PA graduates have at least a bachelor's degree.

Admission requirements vary, but many programs require 2 years of college and some work experience in the health care field. Students should take courses in biology, English, chemistry, math, psychology, and social sciences. More than half of all applicants hold a bachelor's or master's degree. Many applicants are former emergency medical technicians, other allied health professionals,

or nurses.

PA programs usually last 2 years. Most programs are in schools of allied health, academic health centers, medical schools, or 4-year colleges; a few are in community colleges, the military, or hospitals. Many accredited PA programs have clinical teaching affiliations with medical schools.

PA education includes classroom instruction in biochemistry, nutrition, human anatomy, physiology, microbiology, clinical pharmacology, clinical medicine, geriatric and home health care, disease prevention, and medical ethics. Students obtain supervised

clinical training in several areas, including primary care medicine, inpatient medicine, surgery, obstetrics and gynecology, geriatrics, emergency medicine, psychiatry, and pediatrics. Sometimes, PA students serve one or more of these "rotations" under the supervision of a physician who is seeking to hire a PA. These rotations often lead to permanent employment.

As of 1999, 49 States and the District of Columbia had legislation governing the qualifications or practice of physician assistants; Mississippi did not. All jurisdictions required physician assistants to pass the Physician Assistants National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA)—open openly to graduates of accredited PA educational programs. Only those successfully completing the examination may use the credential "Physician Assistant-Certified (PA-C)." In order to remain certified, PAS must complete 100 hours of continuing medical education every 2 years. Every 6 years, they must pass a recertification examination or complete an alternate program combining learning experiences and a take-home examination.

Some PA's pursue additional education in order to practice in a specialty area such as surgery, neonatology, or emergency medicine. PA postgraduate residency training programs are available in areas such as internal medicine, rural primary care, emergency medicine, surgery, pediatrics, neonatology, and occupational medicine. Candidates must be graduates of an accredited program and be certified by the NCCPA.

Physician assistants need leadership skills, self-confidence, and emotional stability. They must be willing to continue studying throughout their career to keep up with medical advances.

As they attain greater clinical knowledge and experience, PAs can advance to added responsibilities and higher earnings. However, by the very nature of the profession, individual PAs are always supervised by physicians.

Job Outlook

Employment opportunities are expected to be good for physician assistants, particularly in areas or settings that have difficulty attracting physicians, such as rural and inner city clinics. Employment of PAs is expected to grow much faster than the average for all occupations through the year 2008 due to anticipated expansion of the health services industry and an emphasis on cost containment.

Physicians and institutions are expected to employ more PAS to provide primary care and assist with medical and surgical procedures because PAs are cost-effective and productive members of the health care team. Physician assistants can relieve physicians of routine duties and procedures. Telemedicine-using technology to facilitate interactive consultations between physicians and physician assistants-will also expand the use of physician assistants.

Besides the traditional office-based setting, PAs should find a growing number of jobs in institutional settings such as hospitals, academic medical centers, public clinics, and prisons. Additional PAs may be needed to augment medical staffing in inpatient teaching hospital settings if the number of physician residents is reduced. In addition, State-imposed legal limitations on the numbers of hours worked by physician residents are increasingly common and encourage hospitals to use PAs to supply some physician resident services. Opportunities will be best in States that allow PAs a wider scope of practice, such as the ability to prescribe medication.

Earnings

Median annual earnings of physician assistants were $47,090 in 1998. The middle 50 percent earned between $25,110 and $71,450 a year. The lowest 10 percent earned less than $18,600 and the highest 10 percent earned more than $86,760 a year.