of the remaining 3 States (Connecticut, Maine, and Vermont) and the District of Columbia may apply to any of the 27 veterinary medical colleges as an at-large applicant. The number of positions available to at-large applicants is very limited at most schools, making admission difficult.

While in veterinary medical college, students receive additional academic instruction in the basic sciences for the first 2 years. Later in the program, students are exposed to clinical procedures, such as diagnosing and treating animal diseases and performing surgery. They also do laboratory work in anatomy, biochemistry, medicine, and other scientific subjects. At most veterinary medical colleges, students who plan a career in research can earn both a D.V.M degree and a Doctor of Philosophy (Ph.D.) degree at the same time.

Veterinary graduates who plan to work with specific types of animals or specialize in a clinical area, such as pathology, surgery, radiology, or laboratory animal medicine, usually complete a 1-year internship. Interns receive a small salary but usually find that their internship experience leads to a higher beginning salary, relative to other starting veterinarians. Veterinarians who seek board certification in a specialty must also complete a 2- to 3-year residency program that provides intensive training in specialties, such as internal medicine, oncology, radiology, surgery, dermatology, anesthesiology, neurology, cardiology, ophthalmology, and exotic small animal medicine.

All States and the District of Columbia require that veterinarians be licensed before they can practice. The only exemptions are for veterinarians working for some Federal agencies and some State governments. Licensing is controlled by the States and is not strictly uniform, although all States require successful completion of the D.V.M. degree or equivalent education—and passage of a national board examination. The Educational Commission for Foreign Veterinary Graduates (ECFVG) grants certification to individuals trained outside the U.S. who demonstrate that they meet specified requirements for the English language and clinical proficiency. ECFVG certification fulfills the educational requirement for licensure in all States except Nebraska. Applicants for licensure satisfy the examination requirement by passing the North American Veterinary Licensing Exam (NAVLE), which replaces the National Board Examination (NBE) and the Clinical Competency Test (CCT) as of April 2000. The new NAVLE, administered on computer, takes one day to complete and consists of 360 multiple-choice questions, covering all aspects of veterinary medicine. The NAVLE also includes visual materials designed to test diagnostic skills.

The majority of States also require candidates to pass a State jurisprudence examination covering State laws and regulations. Some States also do additional testing on clinical competency. There are few reciprocal agreements between States, making it difficult for a veterinarian to practice in a different State without first taking another State examination.

Thirty-nine States have continuing education requirements for licensed veterinarians. Requirements differ by State and may involve attending a class or otherwise demonstrating knowledge of recent medical and veterinary advances.

Most veterinarians begin as employees or partners in established practices. Despite the substantial financial investment in equipment, office space, and staff, many veterinarians with experience set up their own practice or purchase an established one.

Newly trained veterinarians can become U.S. Government meat and poultry inspectors, disease-control workers, epidemiologists, research assistants, or commissioned officers in the U.S. Public Health Service, U.S. Army, or U.S. Air Force. A State license may be required.

Prospective veterinarians must have good manual dexterity. They should have an affinity for animals and the ability to get along with animal owners. Additionally, they should be able to quickly make decisions in emergencies.

Job Outlook

Employment of veterinarians is expected to grow faster than the average for all occupations through the year 2008. Job openings stemming from the need to replace veterinarians who retire or otherwise leave the labor force will be almost as numerous as new jobs resulting from employment growth over the 1998-2008 period.

Most veterinarians practice in animal hospitals or clinics and care primarily for companion animals. The number of pets is expected to increase more slowly during the projection period than in the previous decade and may moderate growth in the demand for veterinarians who specialize in small animals. One reason for this is that the large baby-boom generation is aging and will probably acquire fewer dogs and cats than earlier. However, as non-necessity income generally increases with age, those who own pets may be more inclined to seek veterinary services. In addition, pet owners are becoming more aware of the availability of advanced care and may increasingly take advantage of nontraditional veterinary services, such as preventive dental care, and may more willingly pay for intensive care than in the past. Finally, new technologies and medical advancements should permit veterinarians to offer better care to animals. Veterinarians who enter small animal practice will probably face competition. Large numbers of new graduates continue to be attracted to small animal medicine because they prefer to deal with pets and to live and work near highly populated areas. However, an oversupply does not necessarily limit the ability of veterinarians to find employment or to set up and maintain a practice in a particular area. Such an oversupply could result in veterinarians taking positions requiring much evening or weekend work to accommodate the extended hours of operation that many practices are offering. Others could take salaried positions in retail stores offering limited veterinary services. Most self-employed veterinarians will probably have to work hard and long to build a sufficient clientele.

The number of jobs for large animal veterinarians is expected to grow slowly, because productivity gains in the agricultural production industry mean demand for fewer veterinarians than before to treat food animals. Nevertheless, job prospects may be better for veterinarians who specialize in farm animals than for small animal practitioners, because most veterinary medical college graduates do not have the desire to work in rural or isolated areas.

Continued support for public health and food safety, disease control programs, and biomedical research on human health problems will contribute to the demand for veterinarians, although such positions are few in number. Also, anticipated budget tightening in the Federal Government may lead to low funding levels for some programs, limiting job growth. Veterinarians with training in public health and epidemiology should have the best opportunities for a career in the Federal Government.

Earnings

Median annual earnings of veterinarians were $50,950 in 1998. The middle 50 percent earned between $39,580 and $78,670. The lowest 10 percent earned less than $31,320 and the highest 10 percent earned more than $106,370.

Average starting salaries of 1998 veterinary medical college graduates varied by type of practice, as indicated by table 1.

Veterinarians have extensive training in physical and life sciences, and some do scientific and medical research, closely paralleling occupations such as biological, medical, and animal scientists.

Animal trainers, animal breeders, and veterinary technicians work extensively with animals. Like veterinarians, they must have patience and feel comfortable with animals. However, the level of training required for these occupations is substantially less than that needed by veterinarians.

Sources of Additional Information

For more information on careers in veterinary medicine and a list of U.S. schools and colleges of veterinary medicine, send a letter-size, self-addressed, stamped envelope to:

American Veterinary Medical Association, 1931 N. Meacham Rd., Suite 100, Schaumburg, IL 60173-4360.

For information on scholarships, grants, and loans, contact the financial aid officer at the veterinary schools to which you wish to apply.

For information on veterinary education, write to:

☛ Association of American Veterinary Medical Colleges, 1101 Vermont Ave. NW., Suite 710, Washington, DC 20005.

For information on the Federal agencies that employ veterinarians and a list of addresses for each agency, write to:

National Association of Federal Veterinarians, 1101 Vermont Ave. NW., Suite 710, Washington, DC 20005.

Dietitians and Nutritionists

(O*NET 32521)

Significant points

Employment of dietitians is expected to grow about as fast as the average for all occupations through the year 2008 due to increased emphasis on disease prevention by improved health habits.

Dietitians and nutritionists need at least a bachelor's degree in dietetics, foods and nutrition, food service systems management, or a related area.

Nature of the Work

Dietitians and nutritionists plan food and nutrition programs and supervise the preparation and serving of meals. They help prevent and treat illnesses by promoting healthy eating habits, scientifically evaluating clients' diets, and suggesting diet modifications, such as less salt for those with high blood pressure or reduced fat and sugar intake for those who are overweight.

Dietitians run food service systems for institutions such as hospitals and schools, promote sound eating habits through education, and conduct research. Major areas of practice are clinical, community, management, research, business and industry, and consultant dietetics.

Clinical dietitians provide nutritional services for patients in institutions such as hospitals and nursing homes. They assess patients' nutritional needs, develop and implement nutrition programs, and evaluate and report the results. They also confer with doctors and other health care professionals in order to coordinate medical and nutritional needs. Some clinical dietitians specialize in the management of overweight patients, care of the critically ill, or of renal (kidney) and diabetic patients. In addition, clinical dietitians in nursing homes, small hospitals, or correctional facilities may also manage the food service department.

Community dietitians counsel individuals and groups on nutritional practices designed to prevent disease and promote good health. Working in places such as public health clinics, home health agencies, and health maintenance organizations, they evaluate individual needs, develop nutritional care plans, and instruct individuals and their families. Dietitians working in home health agencies provide instruction on grocery shopping and food preparation to the elderly, individuals with special needs, and children.

Increased interest in nutrition has led to opportunities in food manufacturing, advertising, and marketing, in which dietitians analyze foods, prepare literature for distribution, or report on issues such as the nutritional content of recipes, dietary fiber, or vitamin supplements.

Management dietitians oversee large-scale meal planning and preparation in health care facilities, company cafeterias, prisons, and schools. They hire, train, and direct other dietitians and food service workers; budget for and purchase food, equipment, and supplies; enforce sanitary and safety regulations; and prepare records and reports.

Consultant dietitians work under contract with health care facilities or in their own private practice. They perform nutrition screenings for their clients, and offer advice on diet-related concerns such as weight loss or cholesterol reduction. Some work for wellness programs, sports teams, supermarkets, and other nutritionrelated businesses. They may consult with food service managers, providing expertise in sanitation, safety procedures, menu development, budgeting, and planning.

Working Conditions

Most dietitians work a regular 40-hour week, although some work weekends. Many dietitians work part time.

Dietitians and nutritionists usually work in clean, well-lighted, and well-ventilated areas. However, some dietitians work in warm, congested kitchens. Many dietitians and nutritionists are on their feet for most of the workday.

Employment

Dietitians and nutritionists held about 54,000 jobs in 1998. Over half were in hospitals, nursing homes, or offices and clinics of physicians.

State and local governments provided about 1 job in 6-mostly in health departments and other public health related areas. Other jobs were in restaurants, social service agencies, residential care facilities, diet workshops, physical fitness facilities, school systems, colleges and universities, and the Federal Government-mostly in the Department of Veterans Affairs. Some were employed by firms that provide food services on contract to such facilities as colleges and universities, airlines, correctional facilities, and company cafeterias.

Some dietitians were self-employed, working as consultants to facilities such as hospitals and nursing homes, and seeing individual clients.

Training, Other Qualifications, and Advancement

High school students interested in becoming a dietitian or nutritionist should take courses in biology, chemistry, mathematics, health, and communications. Dietitians and nutritionists need at least a bachelor's degree in dietetics, foods and nutrition, food service systems management, or a related area. College students in these majors take courses in foods, nutrition, institution management, chemistry, biochemistry, biology, microbiology, and physiology. Other suggested courses include business, mathematics, statistics, computer science, psychology, sociology, and economics.

Twenty-seven of the 41 States with laws governing dietetics require licensure, 13 require certification, and 1 requires registration. The Commission on Dietetic Registration of the American

Dietetic Association (ADA) awards the Registered Dietitian credential to those who pass a certification exam after completing their academic coursework and supervised experience. Since practice requirements vary by State, interested candidates should determine the requirements of the State in which they want to work before sitting for any exam.

As of 1999, there were 235 bachelor's and master's degree programs approved by the ADA's Commission on Accreditation/ Approval for Dietetics Education (CAADE). Supervised practice experience can be acquired in two ways. There are 51 ADAaccredited coordinated programs combining academic and supervised practice experience in a 4- to5-year program. The second option requires completion of 900 hours of supervised practice experience, either in one of the 225 CAADE-accredited internships or in one of the 25 CAADE-approved preprofessional practice programs. Internships and preprofessional practice programs may be full-time programs lasting 9 to 12 months, or part-time programs lasting 2 years. Students interested in research, advanced clinical positions, or public health may need a graduate degree.

Experienced dietitians may advance to assistant, associate, or director of a dietetic department, or become self-employed. Some dietitians specialize in areas such as renal or pediatric dietetics. Others may leave the occupation to become sales representatives for equipment, pharmaceutical, or food manufacturers.

Job Outlook

Employment of dietitians is expected to grow about as fast as the average for all occupations through 2008 due to increased emphasis on disease prevention by improved dietary habits. A growing and aging population will increase the demand for meals and nutritional counseling in nursing homes, schools, prisons, community health programs, and home health care agencies. Public interest in nutrition and the emphasis on health education and prudent lifestyles will also spur demand, especially in management. Besides employment growth, job openings will also result from the need to replace experienced workers who leave the occupation.

The number of dietitian positions in hospitals is expected to grow slowly as hospitals continue to contract out food service operations. On the other hand, employment is expected to grow fast in contract providers of food services, social services agencies, and offices and clinics of physicians.

Employment growth for dietitians and nutritionists may be somewhat constrained by some employers substituting other workers such as health educators, food service managers, and dietetic technicians. Growth also is constrained by limitations on insurance reimbursement for dietetic services.

Occupational therapists help people improve their ability to perform tasks in their daily living and working environments. They work with individuals who have conditions that are mentally, physically, developmentally, or emotionally disabling. They also help them to develop, recover, or maintain daily living and work skills. Occupational therapists not only help clients improve basic motor functions and reasoning abilities, but also compensate for permanent loss of function. Their goal is to help clients have independent, productive, and satisfying lives.

Occupational therapists assist clients in performing activities. of all types, ranging from using a computer, to caring for daily needs such as dressing, cooking, and eating. Physical exercises may be used to increase strength and dexterity, while paper and pencil exercises may be chosen to improve visual acuity and the ability to discern patterns. A client with short-term memory loss, for instance, might be encouraged to make lists to aid recall. A person with coordination problems might be assigned exercises to improve hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision making, abstract reasoning, problem solving, and perceptual skills, as well as memory, sequencing, and coordination--all of which are important for independent living.

For those with permanent functional disabilities, such as spinal cord injuries, cerebral palsy, or muscular dystrophy, therapists instruct in the use of adaptive equipment such as wheelchairs, splints, and aids for eating and dressing. They also design or make special equipment needed at home or at work. Therapists develop computer-aided adaptive equipment and teach clients with severe limitations how to use it. This equipment enables clients to communicate better and to control other aspects of their environment.

Some occupational therapists, called industrial therapists, treat individuals whose ability to function in a work environment has been impaired. They arrange employment, plan work activities, and evaluate the client's progress.

Occupational therapists may work exclusively with individuals in a particular age group, or with particular disabilities. In schools, for example, they evaluate children's abilities, recommend and provide therapy, modify classroom equipment, and in general, help children participate as fully as possible in school programs and activities. Occupational therapy is also beneficial to the elderly population. Therapists help senior citizens lead more productive, active and independent lives through a variety of methods, including the use of adaptive equipment.

Occupational therapists in mental health settings treat individuals who are mentally ill, mentally retarded, or emotionally disturbed. To treat these problems, therapists choose activities that help people learn to cope with daily life. Activities include time management skills, budgeting, shopping, homemaking, and use of public transportation. They may also work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress related disorders.

Recording a client's activities and progress is an important part of an occupational therapist's job. Accurate records are essential for evaluating clients, billing, and reporting to physicians and others.

In large rehabilitation centers, therapists may work in spacious rooms equipped with machines, tools, and other devices generating noise. The job can be tiring, because therapists are on their feet much of the time. Those providing home health care may spend time driving from appointment to appointment. Therapists also face hazards such as back strain from lifting and moving clients and equipment.

Therapists are increasingly taking on supervisory roles. Due to rising health care costs, third party payers are beginning to encourage occupational therapy assistants and aides to take more hands-on responsibility. By having assistants and aides work more closely with clients under the guidance of a therapist, the cost of therapy should be more modest.

Employment

Occupational therapists held about 73,000 jobs in 1998; about 1 in 4 worked part time. About 1 in 10 occupational therapists held more than one job in 1998. The largest number of jobs was in hospitals, including many in rehabilitation and psychiatric hospitals. Other major employers include offices and clinics of occupational therapists and other health practitioners, school systems, home health agencies, nursing homes, community mental health centers, adult daycare programs, job training services, and residential care facilities.

Some occupational therapists are self-employed in private practice. They see clients referred by physicians or other health professionals, or provide contract or consulting services to nursing homes, schools, adult daycare programs, and home health agencies.

Training, Other Qualifications, and Advancement

A bachelor's degree in occupational therapy is the minimum requirement for entry into this field. All States, Puerto Rico, and the District of Columbia regulate occupational therapy. To obtain a license, applicants must graduate from an accredited educational program, and pass a national certification examination. Those who pass the test are awarded the title of registered occupational therapist.

In 1999, entry-level education was offered in 88 bachelor's degree programs; 11 post-bachelor's certificate programs for students with a degree other than occupational therapy; and 53 entry-level master's degree programs. Nineteen programs offered a combined bachelor's and master's degree and 2 offered an entry-level doctoral degree. Most schools have full-time programs, although a growing number also offer weekend or part-time programs.

Occupational therapy coursework includes physical, biological, and behavioral sciences, and the application of occupational therapy theory and skills. Completion of 6 months of supervised fieldwork is also required.

Persons considering this profession should take high school courses in biology, chemistry, physics, health, art, and the social sciences. College admissions offices also look favorably at paid or volunteer experience in the health care field.

Occupational therapists need patience and strong interpersonal skills to inspire trust and respect in their clients. Ingenuity and imagination in adapting activities to individual needs are assets. Those working in home health care must be able to successfully adapt to a variety of settings.

Job Outlook

Employment of occupational therapists is expected to increase 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 occupational therapists in the near term. Because of the effects of these provisions, the majority of expected employment growth for occupational therapists is expected to occur in the second half of the projection period.

Over the long run, the demand for occupational therapists should continue to rise as a result of growth in the number of individuals with disabilities or limited function requiring therapy services. The baby-boom generation's movement into middle age, a period when the incidence of heart attack and stroke increases, will increase the demand for therapeutic services. The rapidly growing population 75 years of age and above (an age that suffers from a high incidence of disabling conditions), will also demand additional services. Medical advances now enable more patients with critical problems to survive. These patients may need extensive therapy.

Hospitals will continue to employ a large number of occupational therapists to provide therapy services to acutely ill inpatients. Hospitals will also need occupational therapists to staff their outpatient rehabilitation programs.

Employment growth in schools will result from expansion of the school-age population and extended services for disabled students. Therapists will be needed to help children with disabilities prepare to enter special education programs.