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    Allied Trends: Past, Present, and Future

    A quick look at any recent “hot job” list is sure to reveal one thing: Healthcare is booming. It’s well known that the national nursing shortage is creating a plethora of opportunities, but now many allied health disciplines are feeling the staffing crunch…and a growing number of travel companies are offering a variety of career options to flexible clinicians. Of course, as with all professions, supply and demand for allied health careers is cyclical. Factors such as the economy, new technology, and insurance and reimbursement laws can drastically affect the number and kind of permanent, as well as supplemental, staff positions. So where are the opportunities right now? What are the emerging specialties that could give travelers a leg up on landing plum assignments? Here, we focus on the issues and concerns that are shaping the future of six allied health disciplines: physical therapy, occupational therapy, speech-language pathology, radiologic technology, respiratory therapy, and clinical laboratory science.

    Physical therapy What a difference five years makes! In 1999, the bottom had dropped out of the physical therapy market: Jobs were being lost, salaries were down, and unhappy providers were fleeing the profession. Today, physical therapy is one of the fastest growing occupations in the country and savvy practitioners can pick and choose the types and locations of their travel assignments.

    Why this drastic swing? It all started with the passage of the Balanced Budget Act (BBA) of 1997. This legislation substantially reduced reimbursement for therapists in rehabilitation settings-which was the major employer of both regular and traveling physical therapists (PTs). "The dark days of the profession occurred during 1998 and 1999," says Jules Rothstein, PhD, PT, FAPTA, editor-in-chief ofPhysical Therapy , the official journal of the American Physical Therapy Association (APTA). "After the BBA's enactment, the whole world seemed to be ending."

    "PTs were suddenly faced with a buyer's market instead of a seller's market," adds Rob Simmons, director of ATC Travelers, a division of ATC Healthcare, located in Melville, New York. "That dynamic made a tremendous impact on those services. The shortage of therapists suddenly became a surplus."

    Dr. Rothstein also cites the rise of health maintenance organizations (HMOs) as a reason for problems in the PT marketplace. "HMOs were flourishing and they often severely restricted their clients' ability to utilize the services of PTs. All of this led to these apocalyptic views. But none of the factors had the cataclysmic consequences that everybody thought they would."

    Dr. Rothstein believes that PTs have a lot to be optimistic about. On December 8, 2003, President George W. Bush signed the Medicare Prescription Drug, Improvement and Modernization Act of 2003, immediately removing a $1,590 cap on therapy services to Medicare patients. The law, which also applies to occupational therapists (OTs) and speech-language pathologists (SLPs), prevented a scheduled 4.5 percent cut in Medicare payments to therapists, instead replacing it with a 1.5 percent increase.

    Even before this historic legislation took effect, however, the need for PT services was becoming clear. In 1999, the continuation of commitment to children was seen through the implementation of the Individuals with Disabilities Education Act (IDEA) Amendments of 1997, where opportunities for PTs to provide care to students were further en-forced within school settings. "The renewal of this act," replies Dr. Rothstein, "may shape the nature of pediatric care."

    "Things really started to turn around in 2001," conveys Ginny Sorenson, director of operations at Destination Healthcare Staffing, based in Salt Lake City, Utah. With an ever-growing population of senior citizens-prone to the chronic and debilitating conditions that require therapeutic services-demand was on the rise. Additionally, a growing acceptance of health promotion and the idea of general well-being was gaining hold across the nation.

    "The aging po7pulation, combined with technological advances meant more patients needed physical therapy services, but less people were going into educational programs and also educational requirements increased," she explains, "fueling a variety of possibilities for those remaining in the profession." Many therapists began accepting positions outside of their traditional primary workplaces-acute care and rehabilitation settings-choosing to work for industrial organizations instead. Using their critical thinking and assessment skills, they evaluate environments, develop exercise programs, and teach safe work habits. "Anecdotally, corporations are finding that having a PT on the job can be a cost-effective way of keeping people at work," says Dr. Rothstein. "A number of companies have several PTs on staff or they have a therapist consultant."