Medicine and Health

Overview

There is an enormous range of job opportunities in the medical and health care industry-hundreds of different occupations to choose from in both health care practice and business-oriented occupations. And some areas in health care, like nursing, feature great job prospects in the short and long term as well as rising compensation levels.

Health care practitioners include everyone from doctors, emergency medical technicians, and physical therapists to physician assistants, radiology technologists, respiratory therapists, nurses, home health aides, and speech pathologists. If you're interested in healing people and keeping them healthy, there's almost certainly a job for you somewhere in the health care industry.

The industry also employs a whole host of other types of workers-everyone from techies with expertise in health care enterprise IT issues, to business, sales and marketing, and administrative types, to public policy workers, to medical writers, editors, and transcribers, to clinical research lab workers (the folks who do things like develop and conduct procedures like Pap smears and cholesterol tests). And the industry's even bigger if, like some observers, you define it to include manufacturers of medical equipment and pharmaceutical and biotechnology companies in addition to hospitals, managed-care providers, long-term and home-care providers, clinical research labs, nursing homes, diabetes care providers, MRI clinics, and other health care providers. There's no doubt about it: This industry is big-time, and the source of a dizzying array of career opportunities.

In the U.S., health care is an industry in crisis. Where once the country's health care system offered some of the finest facilities and most innovative care options around-today U.S. health care quality pales in comparison to health care in many other countries. Indeed, among the 24 industrialized nations making up the Organization for Economic Cooperation and Development, today the United States is only 16th in terms of female life expectancy, 17th in terms of male life expectancy, and 21st in terms of infant mortality rates.

There have been great strides made in medical techniques and technologies in the past few decades, but today, many Americans can't afford access to them. Fully 45 million Americans don't have health insurance, and many more only have disaster insurance. Even if you have a full-time job, there's a good chance your employer doesn't offer insurance that's affordable for you. If you belong to an HMO, you can only visit doctors who are part of the HMO's network. If you have to have an expensive procedure, chances are good that your insurance plan will make it as difficult as possible for you to get their approval for it. If approved, that procedure might take place at a non-hospital clinic rather than at a hospital-and even if it takes place at a hospital, they'll discharge you from the hospital much more quickly than they would have a generation ago. And health care costs continue to skyrocket, meaning health insurance keeps getting more and more expensive.

What's Going On
Perhaps the biggest issue facing those in the health care industry today is the impact of the managed-care approach to health services. Starting in the mid-1970s, in an effort to keep down skyrocketing medical costs, insurance companies started taking a much more active role in the health care industry.

Rather than simply continuing to pay for the treatments prescribed by doctors, who were often in private practice or employed by nonprofit hospitals, insurance companies began forming groups, such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs), that combined the functions of hospitals and insurance companies.

While there are many different examples of these organizations-and each has its own set of complex rules-they share a common goal: to deliver medical services to their members at reduced rates by giving health care providers incentives to keep costs down. Managed care in its various forms has swelled in popularity as employers have flocked to the cheaper plans, particularly HMOs.

Critics contend that managed-care plans lower the quality of health care by making doctors overly subject to cost constraints. Many charge that the cost savings achieved by managed-care plans come at the expense of patients' health. Others say that managed care is necessary to keep medical cost inflation under control, and to keep health care affordable and accessible to more people.

Both sides of the debate agree that the managed-care system has permanently changed the way medical services are delivered, and that patients and practitioners alike must adapt to the model.

Physicians typically work in clinics, hospitals, or private practices. As managed-care systems have come to dominate the health-services industry, however, doctors have had to learn how to work within the new managed-care structure, which generally means working in some capacity for an HMO or other health network.

Because there are so many different variations in HMOs and other managed-care plans, doctors are affiliated with them in different ways. Sometimes doctors are hired directly by a managed-care plan as salaried employees. This is known as a staff-model HMO.

It may be more common for doctors to become members of medical groups or independent practice associations (IPAs), which contract their services to a managed-care plan. Depending on the group, a member physician may be a salaried employee (a group-model HMO) or may be in private practice and simply affiliated with the group (an IPA-model HMO).

Requirements

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In every state, doctors must be licensed. Licenses are granted to graduates of accredited medical schools who have passed a licensing exam (the USMLE, United States Medical Licensing Examination) and completed one to seven years of graduate medical school (residency) in an accredited program. Most specialists also become board certified in their specialty in order to gain an edge in a competitive job market, though board certification is not a state requirement.

Accredited medical schools are those that have been approved by the Liaison Committee on Medical Education (LCME). A list of accredited medical programs is available at LCME's website. Accredited residency programs have been approved by the Accreditation Council for Graduate Medical Education (ACGME). A list of accredited residencies is available on the ACGME site.

After completing a residency program, a doctor will typically find employment with either a medical group or hospital. Entering private practice so early in one's career is rare, however. Common job paths include working as a salaried employee of an HMO, medical group, or hospital. With more experience, doctors can expect salary increases and sometimes will earn shares of the organization they work for.

While some doctors pursue advancement into management positions, most simply continue to practice medicine. As a doctor's career advances, he or she will typically develop a base of regular patients and accept fewer new ones. The heavy workloads and long hours of a doctor's early career will also generally slow down as the doctor approaches retirement.

Other health care professionals, including RNs and nurse practitioners, also require licenses to work.

Job Outlook

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Because the U.S. health care industry is enormous (this is the largest industry in the U.S., and health care spending currently accounts for a full 15 percent of the country’s Gross National Product), it employs many, many Americans—13.5 million, according to the U.S. Department of Labor's Bureau of Labor Statistics (BLS). And as the baby boomers retire and need more and more health care services in coming years, the number of people employed in health care is expected to skyrocket; indeed, according to the BLS, the number of jobs in the industry will grow by more than 27 percent between 2004 and 2014.

Managed care has affected the career opportunities of doctors and other health professionals in a number of significant ways, some positive, and some negative. As part of their cost-cutting initiatives, HMOs and other managed-care plans emphasize preventative care and steer patients toward primary-care physicians rather than more expensive specialists—and toward even less expensive nurse practitioners where possible.

Consequently, the job outlook is good for general and family practitioners, general internists, general pediatricians, and nurse practitioners. Nurses, too, enjoy a buyer's market when it comes to jobs.

The aging population of the U.S. has repercussions for medical professionals. Geriatric specialists will likely be in high demand as the U.S. population grows older and advances in medical technology make it possible to live longer.

While the demand for many specialists has waned since the advent of managed care, certain specialties, such as cardiology, will likely remain in demand as the population ages and experiences diseases and conditions that are common in older adults, such as heart disease, hypertension, and stroke.

Career Tracks

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When most people think about health care, they think of doctors—and sure enough, in the descriptions that follow, you'll find details about some of the options open to those considering careers as physicians. But keep in mind that the medical and health care field isn't just for doctors. We've also included several other important health care professions—such as registered nursing, the largest single health care profession—to give you an idea of the breadth of possible careers.

Physicians: MDs and DOs
Doctors belong to a complex and challenging profession, but have a simple goal: to treat and heal people who are suffering from injury or disease. As part of their practice, doctors examine patients, evaluate medical histories, perform and interpret medical tests, make medical diagnoses, and prescribe and administer treatments that may include surgery, drugs, or physical therapies.

Many of these activities are done in conjunction with other professionals such as nurses and clinical laboratory technologists, but ultimately the doctor is responsible for diagnosing the patient and deciding upon a course of treatment.

Increasingly, doctors are also involved in keeping patients healthy through preventative care, which often includes counseling patients about diet, exercise, and stress reduction. Preventive medicine has become more popular in recent years as managed care emphasizes cost controls and the prevention of illnesses that may be expensive to treat.

There are two types of physician: MDs (doctors of medicine, also known as allopathic physicians) and DOs (doctors of osteopathic medicine). Both can perform the full range of medical services for patients, including surgery and drug therapy. The main difference is that DOs are more focused on the proper functioning of the body's musculoskeletal system and place more emphasis on preventative medicine. Both MDs and DOs can be found in general medical practices or various specializations.

General Practitioners
General or family practitioners have always been common in the medical field, but are more prevalent than ever today due to the dominance of managed care. Managed-care systems emphasize the role of the primary-care physician: the patient's regular doctor, who typically must authorize referrals to specialists or nonemergency admissions to the hospital.

Primary-care physicians generally specialize in internal medicine, family medicine, pediatrics, or geriatrics. Because general practitioners have become increasingly responsible for their patients, they must be able to recognize a wider range of conditions, to recommend appropriate treatments, and to refer patients to specialists.

Specialists
Medical specialists focus on a specific area of the body, a particular type of illness or condition, or a certain procedure. Body-related specialties include cardiopulmonary medicine (heart and lungs), gynecology (female reproductive system), dermatology (skin), immunology (immune system), endocrinology (endocrine glands), gastroenterology (digestive organs), hematology (blood, spleen and lymph glands), hepatology (liver and biliary tract), neurology (brain, spinal cord, and nervous system), ophthalmology (eye), otolaryngology (ear, respiratory and upper alimentary systems), rheumatology (joints, muscles, bones, and tendons), and urology (adrenal gland and genitourinary system).

Condition-related specialists focus on allergy (reactions to irritating agents), oncology (cancer and other benign or malignant tumors), toxicology (poisoning cases), and obstetrics (pregnancy, labor, and delivery).

Procedure-related specialties include anesthesiology (managing patients' pain and consciousness during and after operations and other procedures), radiology (using radiation to diagnose and treat patients), and surgery (using invasive operative techniques to diagnose and treat patients). Many specialties have subspecialties—for instance, a doctor might specialize in head and neck surgery, radiation oncology (use of radiation to treat cancer), or pediatric cardiovascular surgery.

Managed-care plans are still evolving, and these models are sometimes combined into hybrids and other configurations. But whatever models ultimately prevail, it's clear that traditional fee-for-service plans and independent careers in private practice are mostly a thing of the past.

Other Health Professions
Registered nurses (RNs) make up the largest health care profession; there are approximately 2 million working RNs. Registered nurses play an important role in helping patients and do a wide range of work in clinical settings. RNs often work with physicians, but may also work alone on certain aspects of patient care.

State laws regulate the scope of RNs' work, so their job descriptions will vary by state. Typically, RNs perform or assist with activities such as examining patients, taking medical histories, devising treatment plans, administering medication and other treatments, observing and evaluating patients' symptoms and responses to treatment, and performing follow-up evaluations and care. For more detailed information on nursing, see our section on careers in nursing.

Physician assistants (PAs) offer health care services under the supervision of physicians. Depending on state regulations, they may examine patients, order tests and x-rays, make diagnoses, treat injuries, and prescribe medications.

Medical assistants perform a combination of administrative and simple clinical tasks. Their duties may include answering phones, managing medical records, drawing blood, and educating patients about how to take medications.

Clinical laboratory technologists perform tests on bodily fluids, tissues, and cells, and evaluate the results of such tests.

Cardiovascular technologists administer various tests to diagnose heart disease and related conditions. Procedures include electrocardiograph (EKG) tests and stress testing.

Physical therapists (PTs) work to improve function and mobility and to relieve pain in patients suffering from disease or injury. PTs often prescribe exercise regimens, and may use other techniques such as electrical stimulation or massage.

Compensation

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Following are average salary ranges for a sampling of health care professions:

• Dentist: $95,000 to $150,000
• Dental hygienist: $50,000 to $80,000
• Dietician: $40,000 to $55,000
• Home health aide: $17,000 to $20,500
• Emergency medical technician/paramedic: $21,000 to $26,000
• Occupational therapist: $50,000 to $65,000
• Optometrist: $80,000 to $110,000
• Pharmacist: $85,000 to $105,000
• Physical therapist: $50,000 to $70,000
• Anesthesiologist: $220,000 to $320,000
• Cardiovascular surgeon: $200,000 to $350,000
• Ophthalmologist: $170,000 to $260,000
• Dermatologist: $160,000 to $250,000
• ER physician: $170,000 to $230,000
• Gastroenterologist: $200,000 to $325,000
• Family practice physician: $125,000 to $175,000
• Orthopedic surgeon: $200,000 to $360,000
• Psychiatrist: $140,000 to $185,000
• Oncologist: $170,000 to $305,000
• Podiatrist: $90,000 to $180,000
• OB/GYN physician: $180,000 to $260,000
• Nurse practitioner: $60,000 to $85,000
• Registered nurse: $50,000 to $65,000
• Licensed practical nurse: $30,000 to $40,000