customers seated at the bar. Bartenders also check identification of customers seated at the bar, to ensure they meet the minimum age requirement for the purchase of alcohol and tobacco products. Bartenders usually are responsible for ordering and maintaining an inventory of liquor, mixes, and other bar supplies. They often form attractive displays out of bottles and glassware and wash the glassware and utensils after each use.

The majority of bartenders who work in eating and drinking establishments directly serve and interact with patrons. Because customers typically frequent drinking establishments for the friendly atmosphere, most bartenders must be friendly and helpful with customers. Bartenders at service bars, on the other hand, have little contact with customers because they work in small bars in restaurants, hotels, and clubs where only waiters and waitresses serve drinks. Some establishments, especially larger ones, use automatic equipment to mix drinks of varying complexity at the push of a button. Even in these establishments, however, bartenders still must be efficient and knowledgeable in case the device malfunctions or a customer requests a drink not handled by the equipment.

Hosts and hostesses try to create a good impression of a restaurant by warmly welcoming guests. Because hosts and hostesses are restaurants' personal representatives, they try to insure that service is prompt and courteous and that the meal meets expectations. They may courteously direct patrons to where coats and other personal items may be left and indicate where patrons can wait until their table is ready. Hosts and hostesses assign guests to tables suitable for the size of their group, escort patrons to their seats, and provide menus. They also schedule dining reservations, arrange parties, and organize any special services that are required. In some restaurants, they also act as cashiers.

Dining room attendants and bartender helpers assist waiters, waitresses, and bartenders by cleaning tables, removing dirty dishes, and keeping serving areas stocked with supplies. They replenish the supply of clean linens, dishes, silverware, and glasses in the dining room and keep the bar stocked with glasses, liquor, ice, and drink garnishes. Bartender helpers also keep bar equipment clean and wash glasses. Dining room attendants set tables with clean tablecloths, napkins, silverware, glasses, and dishes and serve ice water, rolls, and butter. At the conclusion of meals, they remove dirty dishes and soiled linens from tables. Cafeteria attendants stock serving tables with food, trays, dishes, and silverware and may carry trays to dining tables for patrons.

Counter attendants take orders and serve food at counters. In cafeterias, they serve food displayed on counters and steam tables, carve meat, dish out vegetables, ladle sauces and soups, and fill beverage glasses. In lunchrooms and coffee shops, counter attendants take orders from customers seated at the counter, transmit orders to the kitchen, and pick up and serve food. They also fill cups with coffee, soda, and other beverages and prepare fountain specialties, such as milkshakes and ice cream sundaes. Counter attendants prepare some short-order items, such as sandwiches and salads, and wrap or place orders in containers for carry out. They also clean counters, write itemized checks, and sometimes accept payment.

Fast-food workers take orders from customers at counters or drivethrough windows at fast-food restaurants. They pick up the ordered beverage and food items, serve them to a customer, and accept payment. Many fast-food workers also cook and package food, make coffee, and fill beverage cups using drink-dispensing machines.

Working Conditions

Food and beverage service workers are on their feet most of the time and often carry heavy trays of food, dishes, and glassware. During busy dining periods, they are under pressure to serve customers quickly and efficiently. The work is relatively safe, but care must be taken to avoid slips, falls, and burns.

Part-time work is more common among food and beverage service workers than among workers in almost any other occupation. Those on part-time schedules include half of all waiters and waitresses, and 6 out of 10 food counter and fountain workers, compared to 1 out of 6 workers throughout the economy. Slightly more than half of all bartenders work

Part-time work is more common among food and beverage service workers than among workers in almost any other occupation.

full-time with 35 percent working part-time and the remainder working a variable schedule.

The wide range in dining hours creates work opportunities attractive to homemakers, students, and other individuals seeking supplemental income. In fact, nearly 2 out of 3 food counter and fountain workers are between 16 and 19 years old. Many food and beverage service workers work evenings, weekends, and holidays. Some work split shifts that is, they work for several hours during the middle of the day, take a few hours off in the afternoon, and then return to their jobs for evening hours.

Employment

Food and beverage service workers held over 5.4 million jobs in 1998. Waiters and waitresses held about 2,019,000 of these jobs; counter attendants and fast-food workers, 2,025,000; dining room and cafeteria attendants and bartender helpers, 405,000; bartenders, 404,000; hosts and hostesses, 297,000; and all other food preparation and service workers, 280,000.

Restaurants, coffee shops, bars, and other retail eating and drinking places employed the overwhelming majority of food and beverage service workers. Others worked in hotels and other lodging places, bowling alleys, casinos, country clubs, and other membership organizations.

Jobs are located throughout the country but are typically plentiful in large cities and tourist areas. Vacation resorts offer seasonal employment, and some workers alternate between summer and winter resorts, instead of remaining in one area the entire year.

Training, Other Qualifications, and Advancement There are no specific educational requirements for food and beverage service jobs. Although many employers prefer to hire high school graduates for waiter and waitress, bartender, and host and hostess positions, completion of high school is usually not required for fast-food workers, counter attendants, and dining room attendants and bartender helpers. For many people, a job as a food and beverage service worker serves as a source of immediate income, rather than a career. Many entrants to these jobs are in their late teens or early twenties and have a high school education or less. Usually, they have little or no work experience. Many are full-time students or homemakers. Food and beverage service jobs are a major source of part-time employment for high school and college students.

Because maintaining a restaurant's image is important to its success, employers emphasize personal qualities. Food and beverage service workers are in close contact with the public, so these workers should be well-spoken and have a neat, clean appearance. They should enjoy dealing with all kinds of people and possess a pleasant disposition.

Waiters and waitresses need a good memory to avoid confusing customers' orders and to recall faces, names, and preferences of

frequent patrons. These workers should also be good at arithmetic so they can total bills without the assistance of a calculator or cash register if necessary. In restaurants specializing in foreign foods, knowledge of a foreign language is helpful. Prior experience waiting on tables is preferred by restaurants and hotels that have rigid table service standards. Jobs at these establishments often have higher earnings, but they may also have higher educational requirements than less demanding establishments.

Usually, bartenders must be at least 21 years of age, but employers prefer to hire people who are 25 or older. Bartenders should be familiar with State and local laws concerning the sale of alcoholic beverages.

Most food and beverage service workers pick up their skills on the job by observing and working with more experienced workers. Some employers, particularly those in fast-food restaurants, use selfinstruction programs with audiovisual presentations and instructional booklets to teach new employees food preparation and service skills. Some public and private vocational schools, restaurant associations, and large restaurant chains provide classroom training in a generalized food service curriculum.

Some bartenders acquire their skills by attending a bartending or vocational and technical school. These programs often include instruction on State and local laws and regulations, cocktail recipes, attire and conduct, and stocking a bar. Some of these schools help their graduates find jobs.

Due to the relatively small size of most food-serving establishments, opportunities for promotion are limited. After gaining some experience, some dining room and cafeteria attendants and bartender helpers are able to advance to waiter, waitress, or bartender jobs. For waiters, waitresses, and bartenders, advancement usually is limited to finding a job in a more expensive restaurant or bar where prospects for tip earnings are better. A few bartenders open their own businesses. Some hosts and hostesses and waiters and waitresses advance to supervisory jobs, such as maitre d'hotel, dining room supervisor, or restaurant manager. In larger restaurant chains, food and beverage service workers who excel at their work are often invited to enter the company's formal management training program. (For more information, see the Handbook statement on restaurant and food service managers.)

Job Outlook

Job openings are expected to be abundant for food and beverage service workers. Employment of food and beverage service occupations is expected to grow about as fast as the average for all occupations through 2008, stemming from increases in population, personal incomes, and leisure time. While employment growth will produce many new jobs, the overwhelming majority of openings will arise from the need to replace the high proportion of workers who leave this occupation each year. There is substantial movement into and out of the occupation because education and training requirements are minimal, and the predominance of part-time jobs is attractive to people seeking a short-term source of income rather than a career. However, keen competition is expected for bartender, waiter and waitress, and other food and beverage service jobs in popular restaurants and fine dining establishments, where potential earnings from tips are greatest.

Projected employment growth will vary by type of food and beverage service job. Growth in the number of families and the more affluent, 55-and-older population will result in more restaurants that offer table service and more varied menus-requiring waiters and waitresses and hosts and hostesses. Employment of fast-food workers also is expected to increase in response to the continuing fastpaced lifestyle of many Americans and the addition of healthier foods at many of these restaurants. However, little change is expected in the employment of dining room attendants, as waiters and waitresses increasingly assume their duties. Employment of bartenders is expected to decline as drinking of alcoholic beverages outside the home— particularly cocktails-continues to drop.

Earnings

Food and beverage service workers derive their earnings from a combination of hourly wages and customer tips. Earnings vary greatly, depending on the type of job and establishment. For example, fastfood workers and hosts and hostesses usually do not receive tips, so their wage rates may be higher than those of waiters and waitresses and bartenders, who may earn more from tips than from wages. In some restaurants, these workers contribute a portion of their tips to a tip pool, which is distributed among the establishment's other food and beverage service workers and kitchen staff. Tip pools allow workers who normally do not receive tips, such as dining room attendants, to share in the rewards of a well-served meal.

In 1998, median hourly earnings (not including tips) of full-time waiters and waitresses were $5.85. The middle 50 percent earned between $5.58 and $6.32; the top 10 percent earned at least $7.83. For most waiters and waitresses, higher earnings are primarily the result of receiving more in tips rather than higher hourly wages. Tips usually average between 10 and 20 percent of guests' checks, so waiters and waitresses working in busy, expensive restaurants earn the most.

Full-time bartenders had median hourly earnings (not including tips) of $6.25 in 1998. The middle 50 percent earned from $5.72 and $7.71; the top 10 percent earned at least $9.19 an hour. Like waiters and waitresses, bartenders employed in public bars may receive more than half of their earnings as tips. Service bartenders are often paid higher hourly wages to offset their lower tip earnings.

Median weekly hourly earnings (not including tips) of full-time dining room attendants and bartender helpers were $6.03 in 1998. The middle 50 percent earned between $5.67 and $7.11; the top 10 percent earned over $8.49 an hour. Most received over half of their earnings as wages; the rest of their income was a share of the proceeds from tip pools.

Full-time counter attendants and fast-food workers, except cooks, had median hourly earnings (not including tips) of $6.06 in 1998. The middle 50 percent earned between $5.67 and $7.14, while the highest 10 percent earned over $8.45 a hour. Although some counter attendants receive part of their earnings as tips, fast-food workers usually do not.

In establishments covered by Federal law, most workers beginning at the minimum wage earned $5.15 an hour in 1998. However, various minimum wage exceptions apply under specific circumstances to disabled workers, full-time students, youth under age 20 in their first 90 days of employment, tipped employees, and student-learners. Employers are also permitted to deduct from wages the cost, or fair value, of any meals or lodging provided. However, many employers provide free meals and furnish uniforms. Food and beverage service workers who work full time often receive typical benefits, while part-time workers usually do not.

In some large restaurants and hotels, food and beverage service workers belong to unions-principally the Hotel Employees and Restaurant Employees International Union and the Service Employees International Union.

Related Occupations

Other workers whose jobs involve serving customers and helping them enjoy themselves include flight attendants, butlers, and tour bus drivers.

Sources of Additional Information

Information about job opportunities may be obtained from local employers and local offices of the State employment service.

A guide to careers in restaurants, a list of 2- and 4-year colleges that have food service programs, and information on scholarships to those programs is available from:

National Restaurant Association, 1200 17th St. NW., Washington, DC 20036-3097.

For general information on hospitality careers, write to: Council on Hotel, Restaurant, and Institutional Education, 1200 17th St. NW., Washington, DC 20036-3097.

Nature of the Work

Dental assistants perform a variety of patient care, office, and laboratory duties. They work at chair-side as dentists examine and treat patients. They make patients as comfortable as possible in the dental chair, prepare them for treatment, and obtain dental records. Assistants hand instruments and materials to dentists, and keep patients' mouths dry and clear by using suction or other devices. Assistants also sterilize and disinfect instruments and equipment, prepare tray setups for dental procedures, and instruct patients on postoperative and general oral health care.

Some dental assistants prepare materials for making impressions and restorations, expose radiographs, and process dental x-ray film as directed by a dentist. They may also remove sutures, apply anesthetics and cavity preventive agents to teeth and gums, remove excess cement used in the filling process, and place rubber dams on the teeth to isolate them for individual treatment.

Those with laboratory duties make casts of the teeth and mouth from impressions taken by dentists, clean and polish removable appliances, and make temporary crowns. Dental assistants with office duties schedule and confirm appointments, receive patients, keep treatment records, send bills, receive payments, and order dental supplies and materials. Dental assistants should not be confused with dental hygienists, who are licensed to perform different clinical tasks. (See the statement on dental hygienists elsewhere in the Handbook.)

Dental assistants hand instruments and materials to dentists and keep patients' mouths dry and clear.

Working Conditions

Dental assistants work in a well-lighted, clean environment. Their work area is usually near the dental chair, so they can arrange instruments, materials, and medication, and hand them to the dentist when needed. Dental assistants wear gloves and masks to protect themselves from infectious diseases. Following safety procedures minimizes the risks of handling radiographic equipment.

Most dental assistants have a 32- to 40-hour workweek, which may include work on Saturdays or evenings.

Employment

Dental assistants held about 229,000 jobs in 1998. More than 3 out of 10 worked part time, sometimes in more than one dental office.

Virtually all dental assistants work in a private dental office. A small number work in dental schools, private and government hospitals, State and local public health departments, or in clinics.

Training, Other Qualifications, and Advancement Most assistants learn their skills on the job, though some are trained in dental assisting programs offered by community and junior colleges, trade schools, technical institutes, or the Armed Forces. Assistants must be a dentist's "third hand"; therefore, dentists look for people who are reliable, can work well with others, and have good manual dexterity. High school students interested in a career as a dental assistant should take courses in biology, chemistry, health, and office practices.

The American Dental Association's Commission on Dental Accreditation approved 251 dental assisting training programs in 1999. Programs include classroom, laboratory, and preclinical instruction in dental assisting skills and related theory. In addition, students gain practical experience in dental schools, clinics, or dental offices. Most programs take 1 year or less to complete and lead to a certificate or diploma. Two-year programs offered in community and junior colleges lead to an associate degree. All programs require a high school diploma or its equivalent, and some require a typing or science course for admission. Some private vocational schools offer 4- to 6-month courses in dental assisting, but the Commission on Dental Accreditation does not accredit these.

Certification is available through the Dental Assisting National Board. Certification is an acknowledgment of an assistant's qualifications and professional competence, and may be an asset when seeking employment. In several States that have adopted standards for dental assistants who perform radiological procedures, completion of the certification examination meets those standards. Candidates may qualify to take the certification examination by graduating from an accredited training program, or by having 2 years of full-time experience as a dental assistant. In addition, applicants must have current certification in cardiopulmonary resuscitation.

Without further education, advancement opportunities are limited. Some dental assistants working the front office become office managers. Others, working chair-side, go back to school to become dental hygienists.

Job Outlook

Job prospects for dental assistants should be good. Employment is expected to grow much faster than the average for all occupations through the year 2008. Also, the proportion of workers leaving the occupation and who must be replaced is above average. Many opportunities are for entry-level positions offering on-the-job training.

Population growth and greater retention of natural teeth by middleaged and older people will fuel demand for dental services. Older dentists, who are less likely to employ assistants, will leave and be

replaced by recent graduates, who are more likely to use one, or even two. In addition, as dentists' workloads increase, they are expected to hire more assistants to perform routine tasks, so they may devote their own time to more profitable procedures.

Numerous job openings for dental assistants will arise from the need to replace assistants who leave the occupation. For many, this entry-level occupation provides basic training and experience and serves as a stepping-stone to more highly skilled and higher paying jobs. Other assistants leave the job to take on family responsibilities, return to school, retire, or for other reasons.

Earnings

Median hourly earnings of dental assistants were $10.88 in 1998. The middle 50 percent earned between $8.94 and $13.11 an hour. The lowest 10 percent earned less than $7.06 and the highest 10 percent earned more than $15.71 an hour.

Related Occupations

Workers in other occupations supporting health practitioners include medical assistants, physical therapist assistants, occupational therapy assistants, pharmacy technicians and assistants, and veterinary assistants.

Sources of Additional Information Information about career opportunities, scholarships, accredited dental assistant programs, and requirements for certification is available from: Commission on Dental Accreditation, American Dental Association, 211 E. Chicago Ave., Suite 1814, Chicago, IL 60611. Internet: http://www.ada.org

Dental Assisting National Board, Inc., 676 North Saint Clair, Suite 1880, Chicago, IL 60611. Internet: http://www.dentalassisting.com For general information about a career as a dental assistant, including training and continuing education, contact:

American Dental Assistants Association, 203 North LaSalle St., Suite 1320, Chicago, IL 60601.

For information about a career as a dental assistant and schools offering training, contact:

National Association of Health Career Schools, 2301 Academy Dr., Harrisburg, PA 17112.

Information about certification as a dental assistant is available from: American Medical Technologists, 710 Higgins Rd., Park Ridge, IL 60068-5765. Internet: http://www.amt1.com

Medical Assistants

(O*NET 66005 and 66099A)

Significant Points

Medical assistants is expected to be one of the 10 fastest growing occupations through the year 2008.

Job prospects should be best for medical assistants with formal training or experience.

Nature of the Work

Medical assistants perform routine administrative and clinical tasks to keep the offices and clinics of physicians, podiatrists, chiropractors, and optometrists running smoothly. They should not be confused with physician assistants who examine, diagnose, and treat patients under the direct supervision of a physician. (Physician assistants are discussed elsewhere in the Handbook.)

The duties of medical assistants vary from office to office, depending on office location, size, and specialty. In small practices, medical assistants are usually "generalists," handling both administrative and clinical duties and reporting directly to an office manager, physician, or other health practitioner. Those in large practices tend to specialize in a particular area under the supervision of department administrators.

Medical assistants perform many administrative duties.

Medical assistants perform many administrative duties. They answer telephones, greet patients, update and file patient medical records, fill out insurance forms, handle correspondence, schedule appointments, arrange for hospital admission and laboratory services, and handle billing and bookkeeping.

Clinical duties vary according to State law and include taking medical histories and recording vital signs, explaining treatment procedures to patients, preparing patients for examination, and assisting the physician during the examination. Medical assistants collect and prepare laboratory specimens or perform basic laboratory tests on the premises, dispose of contaminated supplies, and sterilize medical instruments. They instruct patients about medication and special diets, prepare and administer medications as directed by a physician, authorize drug refills as directed, telephone prescriptions to a pharmacy, draw blood, prepare patients for x rays, take electrocardiograms, remove sutures, and change dressings.

Medical assistants may also arrange examining room instruments and equipment, purchase and maintain supplies and equipment, and keep waiting and examining rooms neat and clean.

Assistants who specialize have additional duties. Podiatric medical assistants make castings of feet, expose and develop x rays, and assist podiatrists in surgery. Ophthalmic medical assistants help ophthalmologists provide medical eye care. They administer diagnostic tests, measure and record vision, and test the functioning of eyes and eye muscles. They also show patients how to use eye dressings, protective shields, and safety glasses, and how to insert, remove, and care for contact lenses. Under the direction of the physician, they may administer medications, including eye drops. They also maintain optical and surgical instruments and assist the ophthalmologist in surgery.

Working Conditions

Medical assistants work in well-lighted, clean environments. They constantly interact with other people, and may have to handle several responsibilities at once.

Most full-time medical assistants work a regular 40-hour week. Some work part-time, evenings, or weekends.

Employment

Medical assistants held about 252,000 jobs in 1998. Sixty-five percent were in physicians' offices, and 14 percent were in offices of other health practitioners such as chiropractors, optometrists, and podiatrists. The rest were in hospitals, nursing homes, and other health care facilities.

Training, Other Qualifications, and Advancement Most employers prefer to hire graduates of formal programs in medical assisting. Such programs are offered in vocational-technical high

schools, postsecondary vocational schools, community and junior colleges, and in colleges and universities. Postsecondary programs usually last either 1 year, resulting in a certificate or diploma, or 2 years, resulting in an associate degree. Courses cover anatomy, physiology, and medical terminology as well as typing, transcription, recordkeeping, accounting, and insurance processing. Students learn laboratory techniques, clinical and diagnostic procedures, pharmaceutical principles, medication administration, and first aid. They study office practices, patient relations, medical law, and ethics. Accredited programs include an internship that provides practical experience in physicians' offices, hospitals, or other health care facilities.

Although formal training in medical assisting is available, such training-while generally preferred—is not always required. Some medical assistants are trained on the job, although this is less common than in the past. Applicants usually need a high school diploma or the equivalent. Recommended high school courses include mathematics, health, biology, typing, bookkeeping, computers, and office skills. Volunteer experience in the health care field is also helpful.

Two agencies recognized by the U.S. Department of Education accredit programs in medical assisting: the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Accrediting Bureau of Health Education Schools (ABHES). In 1999, there were about 450 medical assisting programs accredited by CAAHEP and over 140 accredited by ABHES. The Committee on Accreditation for Ophthalmic Medical Personnel accredited 14 programs in ophthalmic medical assisting.

Although there is no licensing for medical assistants, some States require them to take a test or a short course before they can take x rays or perform other specific clinical tasks. Employers prefer to hire experienced workers or certified applicants who have passed a national examination, indicating that the medical assistant meets certain standards of competence. The American Association of Medical Assistants awards the Certified Medical Assistant credential; the American Medical Technologists awards the Registered Medical Assistant credential; the American Society of Podiatric Medical Assistants awards the Podiatric Medical Assistant Certified credential; and the Joint Commission on Allied Health Personnel in Ophthalmology awards the Ophthalmic Medical Assistant credential at three levels: Certified Ophthalmic Assistant, Certified Ophthalmic Technician, and Certified Ophthalmic Medical Technologist.

Because medical assistants deal with the public, they must be neat and well-groomed and have a courteous, pleasant manner. Medical assistants must be able to put patients at ease and explain physicians' instructions. They must respect the confidential nature of medical information. Clinical duties require a reasonable level of manual dexterity and visual acuity.

Medical assistants may be able to advance to office manager. They may qualify for a variety of administrative support occupations, or may teach medical assisting. Some, with additional education, enter other health occupations such as nursing and medical technology.

Job Outlook

Employment of medical assistants is expected to grow much faster than the average for all occupations through the year 2008 as the health services industry expands due to technological advances in medicine, and a growing and aging population. It is one of the fastest growing occupations.

Employment growth will be driven by the increase in the number of group practices, clinics, and other health care facilities that need a high proportion of support personnel, particularly the flexible medical assistant who can handle both administrative and clinical duties. Medical assistants primarily work in outpatient settings, where much faster than average growth is expected.

In view of the preference of many health care employers for trained personnel, job prospects should be best for medical assistants with formal training or experience, particularly those with certification.

Sources of Additional Information

Information about career opportunities, CAAHEP-accredited educational programs in medical assisting, and the Certified Medical Assistant exam is available from:

The American Association of Medical Assistants, 20 North Wacker Dr., Suite 1575, Chicago, IL 60606-2903. Internet: http://www.aama-ntl.org

Information about career opportunities and the Registered Medical Assistant certification exam is available from:

☛ Registered Medical Assistants of American Medical Technologists, 710 Higgins Rd., Park Ridge, IL 60068-5765. Internet: http://www.amt1.com

For a list of ABHES-accredited educational programs in medical assisting, write:

Accrediting Bureau of Health Education Schools, 803 West Broad St., Suite 730, Falls Church, VA 22046. Internet: http://www.abhes.org For information about a career as a medical assistant and schools offering training, contact:

National Association of Health Career Schools, 2301 Academy Dr., Harrisburg, PA 17112.

Information about career opportunities, training programs, and the Certified Ophthalmic Assistant exam is available from:

Joint Commission on Allied Health Personnel in Ophthalmology, 2025 Woodlane Dr., St. Paul, MN 55125-2995. Internet: http://www.jcahpo.org

Information about careers for podiatric assistants is available from: ☛ American Society of Podiatric Medical Assistants, 2124 S. Austin Blvd., Cicero, IL 60650.

Nursing and Psychiatric Aides

(O*NET 66008 and 66014)

Significant Points

Job prospects for nursing aides will be good because of fast growth and high turnover in this large occupation.

Minimum education or training is generally required for entry level jobs, but earnings are low.

Nature of the Work

Nursing and psychiatric aides help care for physically or mentally ill, injured, disabled, or infirm individuals confined to hospitals, nursing or residential care facilities, and mental health settings. (Home health and personal care aides, whose duties are similar but who work in clients' homes, are discussed elsewhere in the Handbook.)