R E P O R
T
resumes
ED 020 383
HEALTH MANPOWER 1966-75, A STUDY OF REQUIREMENTS AND SUPPLY.
REPORT NO. 323.
BUREAU OF LABOR STATISTICS (DEFT. OF LABOR)
PUB BATE JUN 67
EBRS PRICE MF-$0.25 HC-12.16 52P.
DESCRIPTORS- ^HEALTH OCCUPATIONS, ^MANPOWER NEEDS, EMPLOYMENT
STATISTICS, EDUCATIONAL PROGRAMS, ^EMPLOYMENT PROJECTIONS,
EMPLOYMENT OPPORTUNITIES, LABOR MARKET ,
POPULATION GROWTH, INCREASING. ABILITY OF INDIVIDUALS TO
FAY FOR HEALTH CARE, AND THE GROWING ABILITY OF HEALTH
PROFESSIONS TO PROVIDE MORE AND BETTER SERVICES ARE BASIC TO
THE FOLLOWING PROJECTIONS OF INCREASED NEEB--(l) HEALTH
PERSONNEL WITHIN THE HEALTH INDUSTRY, FROM 3.7 TO 5.35
MILLION, AND OUTSIDE THE INDUSTRY, FROM 4tiD,tHm TO 500,000,
(2) PHYSICIANS, FROM MORE THAN 290,000 TO 390,000, (3)
DENTISTS, FROM 97,500 TO 125,000, (4) OPTOMETRISTS, FROM
17.000 TO 20,000, (5) PODIATRISTS, FROM 8,000 TO 9,600, (6)
REGISTERED NURSES, FROM 620,000 TO 860,000, (7) LICENSED
PRACTICAL NURSES, FROM 300,000 TO 465,000, CO) AIDS,
ORDERLIES, AND ATTENDANTS, FROM 700,000 TO NEARLY 1.1
MILLION, (9) OCCUPATIONAL THERAPISTS, FROM 6,500 TO 16,500,
(10) PHYSICAL THERAPISTS, FROM 12,500 TO 27,000, (11) MEDICAL
TECHNOLOGISTS, FROM 40,000 TO 75,000, (12) MEDICAL LABORATORY
ASSISTANTS, FROM 50,000 TO 100,000, (13) PHARAMACISTS, FROM
120.000 TO 126,000, (14) DIETICIANS, FRC'M 30,000 TO NEARLY
38,000, (15) X-RAY TECHNICIANS FROM 72,000 TO 100,000, AND
(16) MEDICAL RECORD LIBRARIANS, FROM 12,000 TC* 18,000. THE
PERCENT INCREASE IN 1966 TRAINING WHICH WILL BE REQUIRED TO
MEET 1975 NEEDS RANGES FROM 15 PERCENT FOR PHARMACISTS TO 165
PERCENT FOR PODIATRISTS AND OCCUPATIONAL THERAPISTS. CONGRESS
HAS TAKEN ACTION TO MEET THE GROWING NEED FOR HEALTH WiDRKERS
THROUGH RECENT LEGISLATION, BUT ADDITIONAL ACTION IS
NECESSARY. EMPLOYMENT INFORMATION FOR EACH HEALTH OCCUPATION
and a selected bibliography relating to health manpower are
INCLUDED. (JK)
ED020383
U.S. DEPARTMENT OF HEALTH. EDUCATION & WELFARE
OFFICE OF EDUCATION
THIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROM THE
PERSON OR ORGANIZATION ORIGINATING IT. POINTS OF VIEW OR OPINIONS
STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION
POSITION OR POLICY.
hesith manpower
a study of rocRulromorita and supply
Rsport No. 3NS
duns 1337
UNITED STATES DEPARTMENT OF LABOR
Willard Wirtz, Secretary
BUREAU OF LABOR STATISTICS
Arthur M. Ross, Commissioner
O""
ERIC
FOREWORD
On May 7, 1966, the President’s Committee on Health Manpower was established by
Executive Order 11297. The duties of the committee are threefold; (1) Appraise the curi;*ent
and prospective national requirements for and supply of health manpower to meet the needs
of the civilian population and the Armed Forces; (2) evaluate existing and alternative policies,
programs, and practices of public agencies and private institutions and organizations for in-
creasing health manpower; and (3) develop appropriate recommendations for action by Gov-
ernment or by private institutions, organizations, or individuals for improving the availability
and utilization of health manpower. The Secretary of Labor was named a member of the
committee.
Recognizing that much of the work conducted within the Department of Labor is related
to the tasks of the President’s Committee onHealth Manpower, the Secretary of Labor estab-
lished a Department of Labor Committee on Health Manpower to coordinate the Department’s
health manpower activities. This intradepartmental committee asked the Bureau of Labor
Statistics to prepare a report on the current and prospective supply and demand for health
manpower, utilizing the research being done in its occupational outlook program. The report
presented here is in response to that request. The report presents a comprehensive discus-
sion of future requirements and supply of health manpower and can be used by government
officials and others as an aid in planning education and training programs and in assessing the
effect of recent Federal legislation designed to encourage the training of health workers. It
also can be used in vocational guidance as a source of information on employment opportun-
ities. Information on health occupations specifically designed for use in vocational guidance
is provided by the Bureau of Labor Statistics in the ^C2upational_OuHook_Haiidbo^^
In using the projections that appear on this study, several points should be kept in mind.
Among the most important of these is that the projections are based on a set of assumptions
describing the nature and composition of the economy in 1976 . (See page 8.) Use of other
assumptions would result in different estimates. The effects of using alternative assumptions
are illustrated in the report.
Another point to be kept in mind is that the projections of requirements were developed
without taking into account limitations in the future supply of personnel. Thus, the requirement
projections represent the Nation’s effective demand for workers in 1975 under stated assump-
tions; they are not predictions of what employment actually will be in that year. Furthermore,
they are not estimates of manpower needs to provide a specific standard of medical care.
Many factors, such as advances in medical science and new Federal legislation, are
continuously producing changes that have a major affect on the demand for health manpower.
The projections are an attempt to quantify the effect of all the known factors. As with all man-
power projections, however, they necessarily required the use of considerable judgment. In
cases where no patterns of change seemed clear, the assumption was made that recent trends
would continue. Because judgments change as new data and knowledge become available, these
projections will be reviewed and revised from time to time.
The report was prepared in the Bureau of Labor Statistics Division of Manpower and
Occupational Outlook under the direction Sol Swerdloff, Chief. The report was prepared by
Neal H. Rosenthal with the assistance of Armie Lefkowitz and Michael Pilot.
CONTENTS
Summary
Introduction
Part I. The medical and health services industry
Employment in 1966 * • •
Current needs
Projected manpower needs, 1975
Replacement needs
Alternative assumptions
Part II. The health occupations
Physicians
Dentists
Optometrists
Podiatrists
Pharmacists
Registered nurses
Licensed practical nurses . •
Aids, orderlies., and attendants
Occupational therapists
Physical therapists
Medical technologists
Medical laboratory assistants
Medical X-ray technicians
Medical record librarians
Dietitians
Appendixes
A. Statistical tables
B. Coverage and methodology
C. Selected bibliography.
Page
1
5
7
7
8
8
12
12
17
. 18
. 19
. 20
. 21
. 22
. 23
. 24
. 25
. 27
. 28
.28
. 29
. 30
. 31
. 32
.35
.35
.41
.45
V
Contents — Continued
Text tables
1. Most urgent staffing needs in hospitals and extended
care facilities, • •
2. Average number of physicians* visits per person per
year, by s^ge, July 1958 to June 1959 and July 1963
to June 1964
3. Projected 1975 employment requirements in the medical
and health services industry under illustrative “high,*
“judgment,* and “low* projections.
Appendix tables
A-1. Estimated employment in the medical and health
services industry, by selected occupation, 1966 36
A-2. Projected 1975 employment requirements in the medical
and health services industry, by selected occupation 36
A-3. Estimated manpower needs in selected health occupations
resulting from growth of employment requirements
and net replacements, 1966-75
Charts
1. Health manpower in the medical and health services
industry and in other industries, by selected
occupation, 1966
2. Comparison of national health expenditures and gross
national product , 1955-65
Vi
o
yc
HMMHH
■HlllMI
SUMMARY
The demand for health services is e3Q)ected to increase very rapidly over the next decade,
primarily because of the growth in jwpulation, the increasing ability of individuals to pay for
health care, and the growing ability of the medical professions to provide more and better
services. As a result, employment requirements in hospitals, nursing homes, physicians
offices, and other establishments in the health industry are ejq)ected to increase from 3.7
million to 5.35 million between 1966 and 1975 — an increase of about 45 percent. This repre-
sents an annual rate of increase similar to that of the 1960-66 period when employment
increased from 2.8 million to 3.7 million, or by nearly one-third. In addition to the need for
1.65 million workers to staff new positions, about 1.0 million workers will be needed to re-
place workers who are e:q>ected to die, retire, or leave the labor force for other reasons
over the 1966-75 period.
Manpower requirements for workers in health occupations employed outside of the
health industry — including those for nurses in manufacturing firms, pharmacists in retail
drug stores, and medical scientists in research laboratories— are ejqpected to increase by
about 100,000 from about 400,000 in 1966 to 500,000 in 1975. Net replacement needs resulting
from deaths, retirements, and other separations from the labor force are estimated at about
100,000 over the 9-year period.
Employment requirements in individual occupations are e>q)ected to show markedly
different rates of growth over the 1966-75 period. The demand for physicians is expected to
grow from more than 295,000 to about 390,000, or about one-third; and for dentists, from
about 97,500 to 125,000, or by more than one-fourth. In addition, about 50,000 physicians
and 17,500 dentists will be needed to replace those who die or leave the labor force for other
reasons. Requi rements for optometrists are e3q>ected to grow by about 3,000 (from 17,000 to
about 20,000), and about the same number will be needed for replacements. Manpower needs
for podiatrists are estimated to be 1,600 for growth (from 8,000 to 9,600) and 1,300 for
replacements.
In the nursing occupations, a very rapid increase in employment requirements is antici-
pated through the mid-1970*s. The need for registered nurses is expected to grow by 240,000,
from 620,000 to 860,000, despite the trend toward the greater utilization of licensed practical
nurses and nurse aids, orderlies, and attendants relative to registered nurses. In addition to
these growth requirements, about 150,000 registered nurses will be needed between 1966 and
1975 to replace those who will die or leave the labor force for other reasons. The demand for
licensed practical nurses is e?q)ected to increase from 300,000 to 465,000, and for aids,
orderlies, attendants from about 700,000 to nearly 1.1 million. Net replacement needs are
estimated at 125,000 for licensed practical nurses, and at more than 300,000 for aids, or-
derlies, and attendants.
The demand for occupational therapists and for physical therapists is e3q>ected to increase
much faster than in most other health occupations, rising from 6,500 to 16,500 and from 12,500
to 27,000 respectively, because of increasing emphasis on therapeutic programs. Replacement
^These are net replacement losses. They include gross separations from the labor force
minus qualified workers returning to the labor force.
- 1 -
needs are estimated at about 3,000 for occupational therapists and 5,000 for physical therapists
over the 9-year period. The need for medical technologists is e^^pected to increase by nearly
90 percent, from 40,000 to about 75,000, and medical laboratory assistants by 100 percent,
from about 50,000 to approximately 100,000. Net replacement needs for these workers are
estimated at about 15,000 and 20,000, respectively.
The growth of employment requirements for pharmacists will be relatively small, from
120.000 to 126,000. This small increase reflects the continuing trend toward preparation of
drugs by manufacturers, replacement of small drugstores by large establishments, and greater
use of pharmacist’s assistants. The greatest need for pharmacists will result from replace-
ment of those who leave the labor force--an estimated 32,000 over the 1966-75 period.
Employment requirements for dietitians are ejq>ected to increase from 30,000 to nearly 38,000.
Net replacement needs for these workers between 1966 and 1975 are estimated at 9,000. The
demand for medical X-ray technicians is expected to increase from 72,000 to 100,000, and for
medical record librarians from 12,000 to 18,000. Net replacement needs are estimated at
23.000 and 4,000, respectively, in these occupations.
Training Must be Expanded.
Thousands of workers complete specialized health manpower training programs each
year. Although most of these graduates enter the field for which they were trained, some enter
other occupations or choose not to work at all. In addition to those entering health occupations
directly after completing a specialized training program, many immigrants and persons em-
ployed in other occupations enter health occupations, as do persons outside the labor force,
many have previous experience.
How adequate is the current number of graduates in specialized health occupations? In
all occupations studied in this report, training must be e3q>anded significantly to meet future
needs. The tabulation below shows the percent that current (1966) output of graduates must be
increased if the projected 1966-75 requirements for growth and replacement are to be met.
(These calculations assume that recent patterns of entry to the health fields from sources
other than new graduates will continue.)
Occupation
Medical "practitioners" :
Physicians
Dentists
Optometrists
Podiatrists
Percent Increase In cur-
rent (1966) training re-
quired to meet estimated
1975 manpower needs
... 80
... 55
, . . . 75
, . . . 165
Nursing t
Registered nurses
Licensed practical nurses . .
Other professional and technical:
Medical technologists ....
Pharmacists
Occupational therapists ...
Physical therapists
25
30
60
15
165
130
- 2 -
To expand the output of training programs for health workers, actions are needed bote to
increase tte capacity of schools (as In the case of medical schcols which are presenUy fill^
to capacity) and to Ittraot additional students (as in the case of professional nwslng schools
which havf openings). Congress has taken action to meet tee growing imed for
through reoertt legislation. Including the Health Prefesslens Educatlenal Assls^e ^t 1963
the iJ^rse Training Act cl 1964. tee Allied Health
and the Manpewer Development and Training Act of 1962. .^.3 j
approved an^ funded under the Health Professions Educational Assistant* Ac
COTStructlon of schools that would increase tee enrollment capacity by atout 1.200 to medio^
schools and 600 In dental schools. Under the Manpower Development and ^
Qhniif R'i 000 trainees were enrolled in various occupational training programs in health field
from Au^st 1962 through necef^^^^^ fo tcre^set^^ S^rof
^aduIteTofhe^^^^ worker “fini^pro^Ls in all health occupations analyzed in this report.
INTRODUCTION
Health manpower traditionally has been soialyzed from two different vantage points. The
first includes all workers employed in hosp.:.als, nursing homes, offices of physicians^ and
other establishments in thembjiical and health services industry^Under this type of analysis,
secretaries, bookkeepers, janitors, and other workers not trained specifically to provide
health services would be included as well as those in health occupations (e.g., physician, nurse,
orderly).
The second way of examining health manpower is from an occupational viewpoint. In this
type of analysis, only workers who are emplo 3 red in a health occupation are included, regard-
less of the industry in which they are employed^?/ For example, nurses employed in health units
of manufacturing firms and pharmacists in retail drugstores would be included in this type of
analysis, as well as those employed in hospitals and nursing homes.
The distribution of workers engaged in providing health services in 1966, by occupation
and by industry, is illustrated in chart 1.
The first part of the report focuses on the medical and health services industry. It in-
cludes a discussion of 1966 employment and shortages and projected 1975 manpower require-
ments. The second part of the study is about health occupations, and also presents information
on 1966 employment and shortages and projected 1975 manpower requirements. In addition, it
includes a discussion of the projected supply of health workers, an analysis of supply and
demand, and recommendations on how supply can be expanded to meet projected needs. (Non-
health occupations in the medical and health services industry are not discussed separately;
they are only a small part of the Nation* s total employment in those occupations, and their
training is not significantly different from their training in other industries.) Following the
body of the report are several appendixes, including statistical tables, a discussion of the
methodology used to develop the projections, and a selective bibliography of health manpower
studies.
Medical and health services industry employment in this report includes private and
public wage and salary workers, unpaid family workers, and self-employed persons in medical
and other health services establishments (SIC 80, 9180, 9280, and 9380) as defined by the
Standarcl Industrial Classification Manual, 1967.
^Health occupations may be described as those that are fundamental or unique to the pro-
vision of health services, i.e., physician, professional nurse, hospital attendant.
Chart 1. Health Manpower In the Medical and Health Services
Industry and In Other Industries, by Selected Occupation, 1966
HEALTH OCCUPATIONS I
Aids, orderlies, and attendants
Dental laboratory technicians
Dentists
Dietitians
Licensed practical nurses
Medical laboratory assistants
Medical scientists
Medical technologists
Medical X-ray technicians
Occupational therapists
Optometrists
Pharmacists
Physical therapists
Physicians (M.D.’s and D.O’s)
Professional nurses
Veterinarians
All other health occupations
NONHEALTH OCCUPATIONS^
Clerical workers
Craftsmen
Operatives
Service workers-^
All other nonhealth occupations
Thousands of workers
) 100 200 300 400 500 600
t -T— I — I — I — I I I I I I ' T"
700
M Medical and health services industry
Other industries
I
t J For nonhealth occupations, only those employed in the medical and health services industry are shown on the chart.
2/ Totals exclude workers in these major occupation groups who are included above under health occupations.
- 6 -
o
PART I. THE MEDICAL AND HEALTH SERVICES INDUSTRY
Employment in 1966
About 3.7 million workers were employed
in the medical and health services industry in
1966, nearly one-third more than the 2.8 mil-
lion employed in 1960. Nearly two-thirds of the
workers in the health industry in 1966 were
employed in hospitals. The remainder were
employed in nursing homes, sanitariums,
medical and dental laboratories, offices of
physicians or other medical practitioners, or
were self-employed.
About two-fifths of all workers in the indus-
try, or about 1.5 million in 1966, were profes-
sional, technical, and kindred workers— about
one-fourth more than the 1.2 million employed
in 1960. Professional nurses, numbering about
585,000, were the largest professional occupa-
tion. Other professional occupations employing
large numbers include physician,'^/ 255,000;
medical and dental technician, 205,000; and
dentist, 95,000. The remaining professional
workers were employed in a variety of occu-
pations. (See appendix table A-1.)
Service workers constitute more than one-
third of all employees in the medical andhealth
services industry; about 1.3 million were em-
ployed in 1966. Between 1960 and 1966, employ-
ment increased from 940,000 to 1.3 million, or
by two-fifths. About half of all service workers
were nurse aids, orderlies, and attendants in
1966. Another large service occupation was
practical nurse, comprising nearly 255,000
worker Si^Smaller numbers of service workers
deludes Doctors of Medicine (M.D.*s)and
Doctors of Osteopathy (D.O.*s).
^Practical nurses are classified as service
workers in the census reports which provided
the basis for the classification of workers in
this report. It should be noted, however, that
the 3d edition of the Dictionary of Occupational
Titles classifies practical nurse as a profes-
sional occupation.
were employed as cooks (50,000) and as
cleaners and janitors (about 80,000). The re-
maining service workers, about 290,000 were
employed in a variety of occupations, including
guards, barbers, waiters and waitresses, and
kitchen workers.
Approximately 600,000 clerical and kindred
workers were employed in the medical and
health services industry in 1966 — about 16 per-
cent of the total. Clerical worker employment
increased from 440,000 to 600,000 between 1960
and 1966, or by about 36 percent. One-third of
all clerical workers were stenographers,
typists, and secretaries in 1966. The remainder
were employed as bookkeepers, accounting
clerks, office machine operators, reception-
ists, and in a variety of other clerical occu-
pations.
The remaining major occiq>ational groups—
managers, sales workers, craftsmen, opera-
tives, and laborers — each employed only a
small proportion ofthe workers in the industry.
Among the individual occupations in these
groups, the largest was laundry and drycleaning
operator in the operative group, accountingfor
about 45,000 employed in 1966.
The occupational distribution in hospitals
differs significantly from that in other medical
and health services industry segments com-
bined. There was a much higher proportion of
service workers in hospitals than in “other
health service establishments* (43 percent to
22 percent), primarily reflecting the large
numbers of nurse aids, orderlies, and attend-
ants in these institutions. On the other hand, the
proportion of professional and technical work-
ers was much lower jn hospitals (36 percent to
48 percent). Most medical practitioners, in-
cluding physicians, dentists, and optometrists,
are self-employed and thus, are included in the
“other medical and health services* rather than
in hospitals. The proportion of clerical workers
was higher in “other medical andhealth service
establishments* than in hospitals (24 percentto
7
12 percent), partly because of the large number
of receptionists and office attendants employed
in doctors* and dentists* offices.
Current Needs
Shortages of health personnel have been re-
ported for several years. Opinions have differ-
ed, however, on methods of measuring the
magnitude of these shortages. Realizing the
great need for reliable data on shortages on a
national basis, the Public Health Service and
the American Hospital Association conducted
a 1966 survey of staffing needs in all AHA
registered hospitals. The survey collected
information en most urgent staffing needs —
the five occupations having unfilled staffing
requirements most urgently in need of being
filled. Similar information for nursing homes
and other extended care facilities was obtained
in a 1966 survey conducted by the Public Health
Service. Both surveys excluded physicians and
other medical pratitioners.
More than three-fourths of all urgent needs
were for nursing per so nnel— registered
nurses, 62,000; aids, orderlies, and attendants,
29,000; and practical nurses, 22,000. Other
occupations in which urgent needs were sig-
nificant included medical technologists, diet-
itians, occupational therapists, physical
therapists, and social workers. (See table 1.)
Smaller needs were reported for laboratory
assistants, medical record personnel, surgical
technicians, and pharmacists. Some urgent
needs also were reported in nonhealth occupa-
tions, including food service, maintenance, and
clerical jobs, although needs in these occupa-
tions amounted to only a small percent of each
occupation* s total employment.
Projected Manpower Needs. 1975
Among the most significant factors that un-
derlie apy manpower projection, are the basic
assumptions describing the nature and com-
position of the economy in the target year. In
developing the occupational projections pre-
sented here, the basic assumptions were (1) a
gross national product (GNP) in 1975 of about
$1,058 trillion (in 1965 dollars); and (2) a res-
olution of the Vietnam conflict by 1970, and an
international situation prevailing similar to the
year or two immediately prior to the Vietnam
buildup. Other major assumptions are that the
economic and social patterns in our society,
including patterns of consiunption, will continue
to change at about the same rate as they have
in the recent past, and that the rate of scien-
tific and technological advances of recent years
will continue. Other more specific assumptions
underlying the demand for health manpower are
discussed later in the report where they speci-
fically apply.
Many factors affect the demand for health
manpower. The two most important are the
number of persons requiring health care and
the amount of funds spent on health care, from
public as well as private sources. The first
factor is a direct function of population and its
age and sex composition. The second factor is
influenced in large part by income levels and
consumer e;q)enditure patterns, the way in
which health care is financed, and government
policy. In developing the projections of health
manpower in 1975, these factors were analyzed
as were other factors affecting the need for
health manpower, including anticipated tech-
nological change, occupational utilization pat-
terns, and the need to eliminate current short-
ages.
Population. The population projections of the
United States used in this report indicate an
increase^ . of about 13.7 percent between 1966
and 1975, a somewhat slower rate of growth
than in the recent past. The number of per sons
over 65 and per sons under 5 are those who have
the greatest need of medical care andarepro-
. jected to increase faster than the population as
a whole J/The growth in the number of per sons
Series B developed by the Bureau of the
Census. (See Projections of the Population of
the United States by Age, Sex, and Color to
1990, with Extensions of Total Population to
2015, “Current Population Reports," Series
P-25, No. 359, Bureau of the Census, Feb-
ruary 20, 1967.)
Table 1. Most Urgent Staffing Needs in Hospitals and Extended
Care Facilities, 2J 1966
Occupation
Total, all personnel
Medical and professional. .
Registered nurses. . . .
Licensed practical nurses
Aids, orderlies, attendants.
Medical technologists
Dietitians .....
Occupational therapists
Physical therapists .
Social workers . . .
Laboratory assistants
Other
Other personnel
Food service
Housekeeping
Maintenance
Clerical . .
Other. . . .
Total
Hospitals
Extended care
facilities
144,600
120,300
24,300
131,100
108,600
22,500
62,000
56,900
5,100
21,800
14,100
7,700
29,000
21,800
7,200
4,100
4,100
2,100
1,600
500
1,600
1,200
400
1,500
800
700
2,200
2,000
200
800
800
— — —
6,000
5,300
700
13,500
11,700
1,800
3,500
2,600
900
3,200
2,800
400
3,100
2,800
300
2,900
2,900
—
800
600
200
1/ Includes nursing homes, sanitariums, convalescent homes, and other
institutions providing long-term health care.
Source: Based on preliminary data from a 1966 survey conducted by the
Public Health Service and The American Hospital Association of all AHA
registered hospitals and of a 1966 survey of extended care facilities
conducted by the Public Health Service. Both surveys excluded physicians
and other medical practictioners.
- 9 -
Source: Volume of Physicians Visits . U.S. Department of Health,
Education, and Welfare, Public Health Service, Vital and Health
Statistics, Series 10, No. 18, June 1965.
over 65 and under 5 is particularly significant
because physicians* visits per person per year
for persons 6 5 and over are nearly one and one-
half times as great as the average for the popu-
lation as a whole and for persons under 5 about
one and one-fifth times as large, according to
the National Health Survey. (See table 2.)
Health Expenditures. Health e^^nditures (in
1965 dollars) have increased rapidly in the past,
growii^ from less than $25 billion in 1955 to
about $41 billion in 1965, an increase of nearly
two-thirds. By 1975, health e^nditures may
increase by two-thirds to nearly $68 billion.!/
This assumes that the GNP will increase from
$681 billion to about $1,058. trillion between
1965 and 1975 (see p. 8 ), and that the 1955-65
relationship between health e^enditures and
GNP will continue.
Part of the rise in health e^nditures will
result from the extension of coveragje under
health insurance plans. Although a large pro-
portion of persons are covered by private health
insurance, covert^e under these plans is ex-
pected to increase even further. In addition, it
is estimated that as a result of Medicare, an
additional 10 million persons w’ere covered by
health insurance in 1966— about 5 percent of the
population— and it is ejqpected that this legisla-
tion will result in even greater coverage in the
future. Other recent Federal legislation that
should result in an increased need for health
manpower includes MedicaidS} which provides
funds for medical care of the poor. The Mental
Retardation Facilities and Community Mental
Health Construction Act of 1962, which calls
for the establishment of community health
centers, also will increase the need for health
manpower.
*^In current dollars, the growth of health
e^qpenditures between 1955 and 1965 would be
125 percent, from $18 billion to $41 billion.
If the cost of medical services continues to
rise between 1966 and 1975 as in the past 10
years (about 3 percent a year), estimated
health expenditures in 1975 in current dollars
would be about $93 billion.
Q
Medicaid, which was established under
Title XIX of the 1965 amendments to the So-
cial Security Act, provides health benefits
similar to the Medicare provisions. These
benefits are available to families haviii^de-
pendent children and aged, blind, or perma-
nently disabled people whose income and re-
sources cannot meet medical costs.
a
" 10 —
Technological Developments. §/ Technological
developments increasingly are becoming a
major factor affecting the demand for health
workers. Some technological developments will
result in increased employment requirements
in the medical and health services industry. The
development of complex electronic devices,
such as electronic flowmeters that regulate the
flow of human blood during heart-lung opera-
tions, physiological monitoring equipment, and
electronic microscopes, as well as other com-
plex laboratory equipment, will increase the
need for workers to operate these machines.
The increasing use of new and improved sur-
gical techniques, such as transplanting organs
and performing surgery by laser beams, also
will result in a need for additional health
workers.
Some technological developments, on the
other hand, will tend to limit the growth of
manpower requirements in the. health industry.
For example, the growing use of disposable
plastic and paper surgical gloves, caps, masks,
hypodermic needles, and other items is ex-
pected to reduce the need for workers who
perform laundry and sterilization duties in
hospitals. Also, new hospitals increasingly will
use \labor saving innovations such as new tray-
assembly lines for preparing and serving food,
thus reducing the need for kitchen workers.
Furthermore, the increasing use of data
processing equipment will reduce the need for
such clerical workers as bookkeepers, busi-
ness machine operators, and cashiers.
Growth in Requirements. Reflecting the antici-
pated rise in health e3q)enditures and popu-
lation, changing technology, the elimination of
shortages, and other factors, manpower re-
quirements in the medical and health services
^More detailed information on technologi-
cal developments in the health industry is pre-
sented in Technology and Manpower in the
Health Service Industry. 1965-1975. U.S. De-
partment of Labor, Office of Manpower Policy,
Evaluation, and Research, 1967.
industry are e^qpected to increase 45 percent
between 1966 and 1975, from 3.7 million to
about 5.35 million, or by 1.65 million. This
represents an annual rate of increase similar
to that of the recent past. Since some occupa-
tions are esqiected to grow faster than others,
the occupational structure of the industry will
change significantly over the period. In general,
growth will be fastest in those occupations in
which workers assist or supplement profes-
sional workers, including nurse aids, order-
lies, and attendants; licensed practical nurses;
and some technician occupations.
The number of professional and technical
workers is e3q>ected to grow from 1.5 million
to 2.1 million between 1966 and 1975, or by
about two-fifths. (See appendixtable A-2.) This
represents an annual rate of growth similar to
that of the recent past. The rate of growth will
be faster in hospitals (42 percent) than in
“other* medical and health services establish-
ments (37 percent).
Service worker employment in the medical
and health services industry is e^qpected to
grow very rapidly from about 1.3 million to
nearly 2.0 million, or by about one-half. (This
represents a slower annual rate of increase
than in the recent past.) The very rapid growth
of this occupational group is attributed to the
sharp rise in demand for licensed practical
nurses and nurse aids, orderlies, and attend-
ants, who, by 1975, will represent about seven-
tenths of all service workers in the industry.
The rising need for these workers will result
from increasing efforts of hospitals and nursing
homes to utilize them in order to free regis-
tered nurses for higher level tasks.
I’ll© demand for clerical workers in the
medical and health services industry also will
increase very rapidly between 1966 and 1975,
rising from about 600,000 to more than 900,000,
or by about one-half. This represents a slightly
slower ann ual rate of increase than in the 1960-
66 period. More clerical worker s will be needed
to handle the expanding volume of paperwork
that will result from the larger number of
patients. Furthermore, physicians and other
- 11 -
medical practitioners will continue to use more
clerical workers in an effort to free nursing
staff and others in health occupations for work
more directly related to patient care. The
growing need for clerical services, however,
is expected to be offset somewhat by the in-
creasing use of data processing equipment. The
employment of secretaries, stenographers, and
typists, who will not be affected significantly by
technological developments, will grow very
rapidly, from 195,000 to nearly 300,000, or by
one-half over the 9-year period.
Emplo 3 mient requirements for managerial
workers .(managers, officials, and proprietors)
in the medical and health services industry will
increase from nearly 95,000 to nearly 145,000
between 1966 and 1975, or by 52 percent, a rate
of growth slightly faster than that expected for
the industry as a whole. More managerial work-
ers will be needed as hospitals, nursing homes,
and other medical establishments grow in size
and complexity.
The rate of growth in employment require-
ments for craftsmen (nearly two-fifths) and
operatives (about one-fifth) is e^qpected to be
slower than average for the industry as a whole.
Employment of sales worker s and laborer s , two
very small groups, is expected to decline be-
tween 1966 and 1975.
Replacement Needs
In determining future manpower needs of
the medical and health services industry,
openings which result from deaths, retirer
ments, and other separations from the labor
force and from transfers to other industries
also must be considered. Data on which to base
estimates of such replacement losses, how-
ever, are very limited. Furthermore, it must
be remembered that many health workers who
have left the labor force for family responsi-
bilities or other reasons return to work at a
later period.
Losses to an industry’s work force because
of deaths, retirements, and other separations
from the labor force are determined primarily
by the size of the work force and the age and
sex distribution of the workers. For example,
replacement needs for women workers are
very high, since many leave the labor force
each year to get married and raise families.
This fact is especially significant in the med-
ical and health services industry, 80 percent
of whose work force are women (compared
with 34 percent in all industries). It is esti-
mated that a total of approximately 1.5 million
workers in the health industry will leave the
labor force between 1966 and 1975. However,
about 500,000 persons, mostly women, are
expected to return to the labor force during
this period. Thus, net replacement needs
because of deaths, retirements, and other
separations from the labor force over the 1966-
75 period are estimated at 1.0 million.
Information on the movement of workers
from the medical and health services industry
to other industries is almost completely lack-
ing. However, it may be assumedthat since the
bulk of these workers are in health related
occupations, and thus are not utilized to any
great extent in other industries, transfer losses
to other industries would be relatively small.
Furthermore, workers transferring into the
health industry from other industries may off-
set most, if not all, oftheselosses.lt has been
assumed, therefore, that transfers out of the
health industry will be offset by transfers ^
from other industries, resulting in no net loss
or gain.
Alternative Assumpiiong
As indicated above, perhaps the most im-
portant factors underlying any manpower pro-
jection are the assumptions used.'Therefore, it
is useful to develop projections under several
combinations of assumptions.^n this report.
The assumptions presented earlier are
called the “judgment* assumptions and under-
lie the resulting judgment projections. They
are distinguished from the alternative “high*
and “low* assumptions and projections pre-
sented here.
- 12 -
alternative projections were developed, using
different sets of assumptions for the two major
factors affecting the need for health manpower
—population and health care e;qpenditures.
The use of different assumptions about pop-
ulation in 1975 has little effect on estimates of
1975 requirements for health manpower. For
example, Bureau of the Census series A andC
population projections developed using dif-
ferent birth rate assumptions result in only a
2.0 percent difference in the total population
estimates from the seriesB projections used in
the judgment assumptions.^
On the other hand, different assumptions
about the level of health care expenditures
over the 1965-75 period would have a great
impact on the need for health manpower. Dur-
ing the 1955-65 period, health e;q)enditures
grew at a faster rate -than GNP, increasing
from 4.5 to nearly 6.0 percent of GNP. In the
basic projection model, it was assumed that
the trend in the relationship between health
expenditures and GNP would continue over the
1965-75 period.
The rate of increase of health e?q)enditures
relative to GNP was more rapid, however, in
the 1955-60 period than in the 1960-65 period.
(See chart 2.) Under the assumption that
health e^qienditures, as a proportion of GNP,
would increase in line with the e3q>erience of
the 1955-65 period but not in line with the
slower trend of the mid- 1960* s, health ex-
penditures would rise about 6 percent above
the levels indicated in the judgment projection
model. If the increases in manpower were
See “Current Population Reports,* Se-
ries P-25, No. 339, op. cit. Series D, which
reflects' the low birth rate during the early
1940* s, has a slightly greater difference, 4.0
percent.
roughly proportionate to the rise in expendi-
tures, i^4his would mean a need in 1975 for
about 6 percent more workers than in the
judgment projection, or about 5.7 million work-
ers. Growth requirements between 1966 and
1975 under this alternative “high** model would
be nearly 2.0 million compared with about 1.65
million in the judgment model.
Under the assumption that health e;q)enf'*i-
tures would grow only at the same rate as GNP
between 1965 and 1975, health expenditures in
1975 would be about 8 percent below the judg^
ment projection level. Again assuming a pro-
portionate increase in manpower as in expend-
itures, ^®4mployment requirements in 1975
would be about 8 percent below the judgment
projection level, or about 4.9 million workers.
Growth requirements under this illustrative low
model would be more than 1.2 million compared
with 1.65 million in the “judgment” model.
The factor s which would bring about changes
in the rate of growth of healthexpendituresfrom
those assumed in the judgment model include
great changes in the income distribution of fam-
ilies or in government policies related to health
care. For example, if the number of families
having incomes under $3,000 a year were to de-
crease to a lower proportion of the population
than indicated by current patterns, total health
care e;q)enditures would be much higher, since
higher income families spend proportionately
more on health care than do lower income
families.
12
E^qpenditures per employee in 1975 im-
plied in the “judgment” projection were used
in this analysis.
13
As in the “high” illustration, expenditures
per employee in 1975 used here was similar
to that implied in the “judgment” projection.
13
Table 3. Projected 1975 Employment Requirements in the Medical
and Health Services Industry Under Illustrative
"High," "Judgnient," and "Low" Projections
(Millions of workers )
Level of demand
Projected
1975
employment
requirements
Estimated growth
of employment
requirements
1966-1975
High
5.70
2.00
JudgmGnti ••••£••
5.35
1.65
Low
4.90
1.20
- 14 -
Chart 2. Comparison of National Health Expenditures
and Gross National Product, 1965-66
Health expenditures as a percent of gross national product, 1955-65
Percent
Percent
60
50
40
30
20
10
O
P©rc©nt growth - 1955”60 and 1900-05
Gross national product
I
1 1 Health expenditures
1 I
i.1
^v-'i i' ''i'" :i‘.
1955-60
urce: Basedon Information in"National Health Eapenditores, lS50-65." Sotip|?eci,ritvBullet| n. Februar, 1967,
Id ’’Social Welfare Expenditures. 1965-66," Social Security Bulletin. December 1966.
15
\
PART II. THE HEALTH OCCUPATIONS
In 1966, about 3o0 million workers were em-
ployed in the health occupations. All except
about 400, COO of these v/ere employed in the
health services industry described in Part I.
(Health workers in other industries include
nurses who provide emergency or other types
of health services in business firms and phar-
macists in the retail drug industry.) An analy-
sis of all health occupations is not presented
here for a variety of reasons, including lack
of data and staff and time limitations. However,
the 15 occupations discussed in this chapter re-
present nearly 2.5 million workers, or about 5
out of 6 of all those employed in health occu-
pations in 1966. The occupations discussed are
physician; dentist; optometrist; podiatrist;
professional nurse; licensed practical nurse;
aid, orderly, and attendant; pharmacist; med-
ical x-ray technician; medical laboratory as-
sistant; medical technologist; physical thera-
pist; medical record librarian; occupational
therapist; and dietitian. Those excluded are
primarily engaged in medical research; cler-
ical work; the collection, presentation, and
analysis of health statistics; social work; and
rehabilitation.
It bears repeating that the projections of
manpower needs presented here are estimates
of the effective demand for workers in 1975,
developed under a specific set of assumptions
rather than perceptions of needs based on pro-
vision of specific standards or goals of med-
ical care. For example, the estimate of phy-
sician requirements is based on the anticipated
increases in demand for their services result-
ing from such factors as population growth,
rising ejqjenditures for health care, rising re-
search expenditures, and the need to overcome
current shortages; it is not based on estimates
of the need for physicians to provide some pre-
determined standard of care. Similarly, esti-
mates of the needs for nursing personnel— pro-
fessional nurses, practical nurses, and nurse
aids, orderlies, and attendants— utilize a con-
tinuation of patterns of employer utilization.
rather than estimates of utilization that profes-
sional perceptions indicate would be needed to
provide some desired level (or goal) of nursing
care. Estimates of health manpower require-
ments based on professional perceptions of
needs are generally higher than the levels in-
dicated by projections of effective demand such
as those presented in this report. For example,
in Health Manpower Perspective; 1967. a re-
cent report prepared by the Public Health Ser-
vice, professional perceptions of needs for
dentists in 1975 are nearly 10 percent higher
than in this report, professional nurses 16 per-
cent higher, and physical therapists twice the
level indicated in this report.
The occupational projections presented
here were developed under the same basic
framework as the “judgment* industry pro-
jections and are directly comparable. Alter-
native occupational projections comparable to
the alternative industry projections were not
made because much of the information needed
to develop them is not available. Furthermore,
factors other than industry employment may
have a more significant bearing on manpower
needs. For example, the number of X-rays
to be taken in 1975 is more directly related to
the need for X-ray technicians than the health
industry employment level. Clearly, the devel-
opment of alternative projections of manpower
needs in ‘health occupations is an area of health
manpower research where additional work is
needed.
It also bears repeating that the occupational
projections are not meant to represent actual
employment levels in 1975. Actual employment
levels reflect the interaction oi demand and
supply. Since the requirement projections were
developed without taking into account limita-
tions of the future supply of personnel, the
projected numbers must be viewed as repre-
senting manpower needs and not actual employ-
ment.
17 -
Physicians
14/
Employment. Nearly 295,000 physicians*^
were professionally active in the United states
in mid-1966, about one-third more than the
220.000 employed in 1950. About 190,000, more
than three-fifths of the total, were engaged in
private practice in mid-1966. About 45,000
were interns or residents in hospitals. About
30.000 held full-time staff positions in hospi-
tals, nearly three-fifths of whom were ingov'
ernment hospitals. The remainder were em-
ployed in business firms. State and local health
departments, medical schools, researchfoun-
dations, and professional organizations.
Shorta<jres. Many reports have been concerned
about current shortages of physicians. How-
ever, identification of the extent of a “short-
age* of physicians in quantitative terms, is
very difficult to make. Not only is there lack
of information, but there also is no clear-cut
deHnition of “shortage.* Nevertheless, many
health e3q>erts indicate that shortages exist pri-
marily in some geographical areas ;md in some
medical specialities. Practitioners in almost
every 1 of the 35 recognized specialties have
indicated concern for unfilled needs. For ex-
ample, an analysis by the Public Health Ser-
vice of the need for physicians to improve stan-
dards of care, based on the staff fing patterns
of six pr^aid group practice organizations^
disclosed estimated imfilled needs for about
20.000 physicians. The Public Health Service
also reports unmet needs for 10,000 to 15,000
psychiatrists, and vacancies for about 10,000
hospital staff members, including interns and
residents.
Projected needs. Manpower needs for physi-
cians (M.D.’s and D.O.’s) are e:q}ected to rise
from nearly 295,000 to more than 390,900 be-
This includes 282,000 Doctors of Medi-
cine (M.D.^s) and 12,000 Doctors of Osteopathy
(D.O.*s),
15
Health Manpower Perspective: 1967 . Bu-
reau of ' th Manpower, Public Health Ser-
vice. (I' "" -
tween 1966 and 1975, or by about one-third. This
represents a faster annual rate of growth than
in the 1950-66 period. However, the number
of new graduates of medical schools limited
employment growth in the past, whereas the
projected 1975 requirements were made with-
out consideration of possible future supply li-
mitations.
In addition to growth needs of 95,000 phy-
sicians, about 50,000 will be needed to replace
those who are expected to die, retire, or sto^.
practicing because of other reasons between
1966 and 1975.^^
Many factors underlie the e3q>ected rapid
growth in requirements for physicians between
1966 and 1975. The most important factor is
the increasing population, particularly the in-
creasing number of older persons and the very
young. The number ofpersons aged 65 and over
is e3q)ected to increase from 18.5 million in
1966 to 21.2 million in 1975 and the number of
persons under 5 from 19.9 million to 24.4 mil-
lion. Accordingto data from the National Health
Survey, physicians’ visits per per son per year
for people 65 years and over was about one and
one-half times as great as the average number
of visits for all persons in 1964 and for persons
under 5 years about one and one-fifth as large.
It is e 3 q>ected that the differential will become
even greater for persons over 65 years in the
future, since Medicare provides for increased
expenditures for the medical care of older per-
sons.
The anticipated rise in medical expendi-
tures between 1965 and 1975 also is e^q)ected
to result in a rising effective economic demand
for physicians* services by all age groups.
Furthermore, it is e^qpected that the number of
16
See Appendix table A-3 for estimated
1966 employment, projected 1975 requirements,
and growth and replacement needs for physi-
cians and several other occupations analyzed
in this report.
18
persons having very low incomes, who often
are forced to forego medical care in order to
purchase other goods and services, will de-
crease as a proportion ofthe population, partly
because of increasingly favorable employment
opportunities and partly as a result ofthe Great
Society programs.
An increasing number of physicians also
will be needed to conduct research; it is ex-
pected that the number of physicians primarily
needed to conduct research may double from
the 4,600 employed in 1966. More and more em-
phasis is beingplaced on research into the pre-
vention a nd cure of disease. E 3 q)enditures for
research are e3q>ected to continue to increase
rapidly, althou^ the rate of growth may be
slower than in recent years. Furthermore,
new technological developments resulting from
this research— such as the discovery of new
surgpcal techniques, new drugs, and other
treatments for diseases— also should increase
the demand for physician services in private
practice.
Employment requirements for physicians
to teach in colleges and universities also are
e}q>ected to increase over the 1966-75 period.
More medical schools are being built, and ex-
isting facilities are being e3q>anded as a result
of the Health Professions Educational Assist-
ant Act of 1963. If enough physicians are to be
trained to meet the 1975 manpower needs in-
dicated in this report, the number of physicians
engaged primarily in teaching will have to be
increased from about 9,000 to about 15,500 be-
tween 1966 and 1975.
Sig)ply. New medical school graduates and im-
migrants are the primary sources of supply for
physicians in the United States.^To meet the
projected need for 145,000 new physicians be-
tween 1966 and 1975—95,000 for gprowth and
50,000 for replacement— these sources would
have to provide an annual average of about
16,100 new physicians over the 9-year period.
If the annual number of immigrant physicians
does not change significantly from the level of
recent years, and if the number of gpraduates
remains at the 1966 level, an annual average
of about 9,500 persons would enter the physi-
cian work force each year between 1966 and
1975. On this basis, the average annual output
of our medical schools would have to be in-
creased by more than 6,600 if requirements
presented above were to be met. Some of this
increase in the number of medical school gprad-
uates is e3q>ected as a result of assistance re-
ceived under the Health Professions Educa-
tional Assistance Act of 1963. For example,
projects to increase the enrollment of medical
schools by more than 1,200 were approved and
funded under this act as of March 1967.
17
About 15 percent of all entrants to the
United States physician work force were immi-
grants in 1966.
Dentists
Employment. About 97,500 dentists were em-
ployed in the United States in 1966, nearly 10
percent more than the 89,000 employed in 1956.
Nine out of ten dentists were in private prac-
tice in 1966. Approximately 6,500 dentists were
serving as commissioned officers in the Armed
Forces, and about 1,300 held other positions
in the Federal Government, chiefly in the hos-
pitals and clinics of the Veterans Adminstra-
tion and the Public Health Service. The re-
mainder were employed primarily in colleges
i universities, non-Federal hospitals, and
ite and Local health agencies.
Shortages. Measuring shortagee of dentists, as
for physicians and other health practitioners,
is very difficult. One measure, the ratio of
dentists to population, shows a decrease in re-
cent years. However, individual dentists have
been able to care for more patients because
of increases in efficiency due to new equipment
and the use of more auxiliary personnel.
ProlfiGted Needs. Maiq)Ower needs for dentists
are esqiected to rise from 97,500 in 1966 to a-
bout 125,000 in 1975, or about 28 percent. This
represents a faster annual rate of growth than
- 19 -
in the 195fi-66 period. However, the namber
of new graduates of dental schools limited em-
ployment growth in the past, whereas the pro-
jected 1975 requirements were made without
consideration of possible future supply limita-
tions.
In addition to growth needs of about 27,500,
about 17,500 dentists will be needed to replace
those who die or stop practicing for other rea-
sons over the 1966-75 period.
The factors underlying the expected rapid
growth in demand for dentists* services are
similar to those that will increase the demand
for all health workers, primarily growth in
population and the increasing ability of per sons
to pay for medical care. In addition, more
people are expected to seek dentists* services
because of the growing awareness of the im-
portance of regular dental care and the develop-
ment of new payment plans that make it easier
for people of moderate means to obtain dental
service. E 3 q>ansion of research activities in
the field of dentistry and the growth of dental
schools also will require more dentists; in
part, this development will be the result of
financial assistance obtained by dental schools
under the Health Professions Educational As-
sistance Act of 1963. More dentists also will
be needed to administer new dental public
health programs.
Technological developments, such as new
equipment and drugs, as well as the more ex-
tensive employment of dental hygienists, as-
sistants, and laboratory technicians, should
permit each individual dentist to care for more
patients. Although improved dental hygiene
and more widespread use of fluorides in com-
munity water supplies will prevent some tooth
and gum disorders, such measures probably
will increase rather than decrease the demand
for dental services, by preserving teeth that
might otherwise be extracted.
Supply. The supply of new dentists in the United
States is drawn primarily from graduates of
dental schools. To meet projected needs for
45,000 new dentists between 1966 and 1975—
27,500 for growth and 17,500 for replacement—
an average of 5,000 new dentists would have to
graduate each year over the 9-year period. In
1966, only about 3,200 dentists graduated from
these schools. Thus, to meet the projected re-
quirements presented above, the annual num-
ber of graduates of dental schools will have to
be increased substantially above current levels
between 1966 and 1975. Some increase in den-
tal school facilities is e 3 q>ected as a result
of financial assistance under the Health Pro-
fessions Educational Assistance Act of 1963.
For example, projects to increase enrollments
in dental schools by nearly 600 were approved
and funded as of March 1967 .
Optometrists
Employment. Approximately 17,000 optome-
trists were employed in the United States in
1966, almost unchanged from the early 1950* s.
More than nine-tenths of all optometrists em-
ployed in 1966 were self-employed. Most of the
remainder worked for established practition-
ers, health, clinics, hospitals, optical instru-
ment manufacturers, or government agencies.
A few taught in colleges ofoptometry and some
were servii^ in the Armed Forces.
Shortages. The very limited information avail-
able indicates that shortens of optometrists
currently exist in some areas of the country.
Generally, shortages are most acute in small
co mmuni ties J§/in most large Cities it is es-
timated that the demand for the services of
optometrists is being met by the existing sup-
ply of optometrists. For example, in the North-
eastern States the ratio of population to opto-
metrists is about 9,000 persons to one optome-
trist; in Virginia, North Carolina, Georgia, and
Alabama the ratio is 1-1/2 to 2 times as much.
^®See Mnnncrrflph on Optometry. American
Optometric Association, 1966.
- 20 -
Pyniftntpd Needs. Employment requirements
for optometrists are e3q)ected to increase from
17,000 to 20,000 between 1966 and 1975. In ad-
dition to the growth needs of 3,000 optometrists
about 3,100 will be needed to replace those who
are expected to die, retire, or leave the labor
force for other reasons between 1966 and 1975.
The demand for the services of optometrists
is expected to rise primarily as a result of
the basic factors that will increase the demand
for other health workers— population growth
and the increasing ability of individuals to pay
for health care. In addition, the general public
is becoming more conscious of the need for
regular vision examinations because greater
demands are being made on the eyes. In ad-
dition, there is increasingly greater recogni-
tion of the importance of good vision for ef-
ficiency at work and in school. The increasing
use of assistants and technicians in optome-
trists* offices, however, will tend to offset
somewhat the growth of employment require-
ments for optometrists.
Supply. N ew graduates of schools of optometry
are the primary source of supply for new op-
tometrists in the United States. To meet the
projected need for 6,100 optometrists between
1966 and 1975—3,000 for growth and 3,100 for
replacement — schools would have to provide an
annual average of nearly 700 graduates over
this period. In 1966, optometry schools pro-
duced only about 400 graduates. Thus, to meet
projected 1975 requirements, the average an-
nual number of graduates of our schools of op-
tometry must increase by about three-fourths.
Part of the increase is eiqpected to be met by
e 3 q)anded training facilities resulting from as-
sistance received under the Health Professions
Educational Assistance Act of 1963. For ex-
ample, projects to increase enrollments of
schools of optometry by about 80 were ap-
proved and funded as of March 1967 .
Podiatrists
Employment. Approximately 8,000 podiatrists
were employed in the United States in 1966.
This represents an increase of one-fourth over
the 1950 employment of about 6,400. Nearly all
podiatrists employed in 1966 were in private
practice. The few who held full-time salaried
positions worked primarily in hospitals, podi-
atry colleges, or for other podiatrists.
Shortages. As for plqrsicians and dentists, it is
difficult to identify or measure a shortage of po-
diatrists. One measure of shortage is the ratio
of podiatrists to population. According to the
American Podiatry Association, the ratio need-
ed to have a “desired* standard of care is much
higher than the actual ratio in 1966, and, there-
fore, a shortage is implied.
Projected Needs. Employment requirements
for podiatrists are ejq)ected to increase from
8,000 to 9,600 between 1966 and 1975, or by
about one-fifth. This represents an annual rate
of growth somewhat faster than over the 1950-
66 period.
The demand for the services of podiatrists
is expected to rise primarily as a result of the
basic factors that will increase the demand for
other health workers— population growth and
the rising ability of individuals to pay for health
care. Of special importance is the growth of the
number of older persons, the age group most
needing foot care. Furthermore, the trend
toward providing preventive foot care for chil-
dren is increasing.
In addition to podiatrists needed for growth
of the profession, about 1,400 will be needed to
replace those who die, retire, or stop practic-
ing for other reasons.
Supply. The supply of new podiatrists in the
United States is drawn primarily from new
graduates of podiatry colleges. To meet pro-
jected needs for 3,000 podiatrists between
1966 and 1975—1,600 for growth and 1,400 for
replacement— an average of about 330 newpod-
iatrists would have to be graduated each year
over the 9-year period. In 1966, only about 125
- 21 -
students graduated from podiatry schools.
Thus, to meet the projected requirements pre-
sented above, the average annual number of
graduates of podiatry colleges must be increas-
ed substantially above current levels between
1966 and 1975. Some increases in facilities are
e 3 q>ected as a result of funds piwided by the
Health Professions Educational Assistance Act
of 1963. However, a great deal of additional
action is necessary, both to increase the ca-
pacity of schools and to attract students to the
schools.
Pharmacists
Employment. Approximately 120,000 pharma-
cists were employed in the United States in 1966,
about 8 percentmore than the 11 1,000 employed
in 1955. In 1966, about 104,000 worked in retail
pharmacies — approximately half of these were
owners or part-owners of drugstores. Most of
the remainder were employed by pharmaceu-
tical manufacturers and wholesalers, or work-
ed in hospitals. Others worked in the clinics of
the Veterans Administration and the U.S. Pub-
lic Health Service, the Food and Drug Admin-
istration, taught in colleges of pharmacy, or
served in the Armed Forces.
Shortages. The limited information available
indicates that no general shortage of pharma-
cists exists, althou^ unfilled Job openings
have been reported in many localities. For
example, information on current urgent staff-
ing needs obtained in the 1966 AHA-PHS survey
of hospitals indicates urgent needs for about
600 pharmacists.
Projected Needs. Employment requirements
for pharmacists are expected to increase by
about 5 percent between 1966 and 1975, rising
ftom about 120,000 to 126,000. This represents
a slightly slower rate of growth than in the
1955-66 period. The demand for prescrip-
tions, however, is expected to increase rapidly
during the 1966-75 period, as a result of popu-
lation growth, esqsansion in the number of phar-
maceutical products, and the increasing ability
of persons to pay for drugs. Despite the ex-
pected increase in the use of drugs, however,
the continued trend towards pharmaceuticals
prepared by manufacturers (rather than in
drugstores), larger drugstores, and the greater
use of pharmacists assistants, will partially
offset the growth of employment requirements
for pharmacists.
The greatest maiqsower needs for pharma-
cists will be for replacement of those who die,
retire, or leave the labor force for other rea-
sons or transfer to other occupations. About
32,000 new pharmacists will be needed Just to
replace workers who die, retire, or otherwise
leave the labor force between 1966 and 1975.
Supply. The new supply of pharmacists in the
United States is drawn primarily from new
graduates of colleges of pharmacy. To meet the
projected need of 38,000—6,000 forgrowthand
32,000 for replacement — these schools would
have to provide an annual average of more than
4,200 new pharmacists over the 9-year period.
In 1966, about 3,700 students graduated ftom
colleges of pharmacy. Thus, to meetprojected
requirements, the averagje number of graduates
between 1966 and 1975 must be increased by
about 500 annually, or by more than one-eighth.
Since reports from colleges of pharmacy in-
dicate that not all schools are filled to capacity,
part of this increase could be met by programs
designed to attract students, including those
that publicize favorable employment opportun-
ities and the availability of financial assistance
for students. Construction of schools in new
locations also could increase the number of
students by attracting those who could not
attend schools that are far from their homes.
- 22 -
Registered Nurses
Rmniovment. About 620,000 registered profes-
sional nurses were employed in the United
States early in 1966, two-thirds more than the
375,000 employed in 1950. Approximately two-
thirds worked in hospitals and related institu-
tions in 1966. About 65,000 were private duty
nurses who cared for patients in hospitals and
private homes, and nearly 50,000 were em-
ployed in offices of physicians and other med-
ical practitioners. Public health nurses in
government agencies, visitii^ nurse associ-
ations, and clinics numbered about 40,000.
Nurse educators in nursing schools accounted
for more than 22,000 and occupational health
nurses in Industry for about 18,000. A few
th o u s^"o nurses were employed as staff mem-
bers of professional nurse organizations and
State boards of nursing or Were employed by
private research organizations.
ghnrfflpftfl. More attention has been focused on
the si '^age of registered nurses thanperhaps
on thai of any other of the health occupations.
A few hospitals have even reported closing
facilities because of the nursing shortage. Until
the recent American Hospital Association-
Public Health Service study was conducted,
however, quantification of the shortage, at least
on a national basis, was lackingJSfo 1966, ac-
cording to the AHA-PHS study, hospitals in-
dicated urgent needs for about 57,000 nurses.
The study of needs in nursing homes conducted
by the Public Health Service in 1966 indicated
an urgent need for an additional 5,000 nurses.
Protected Needs. Based on an analysis of the
number of patients who will need nursing care,
eiqtenditures for health care, technological
For example, the most extensive study of
nursing manpower conducted in recent years.
Toward Quflittv in Nursing , a report of the
Surgeon General's Consultant Group on Nurs-
ing; U.S. Department of Health, Education, and
Welfare, Public HealthService, February 1963,
did not quantify the current shortage.
developments, elimination of current short-
ages, and employer utilization patterns, em-
ployment requirements for registered nurses
are expected to rise from 620,000 to 860,000
between 1966 and 1975. This represents a
slightly faster rate of growth than in the 1950-
66 period.
In addition to the 240,000 needed to meet
growth requirements, an estimated 150,000
will be needed to replace nurses who leave the
labor force because of death, retirement, fam-
ily responsibility, or other reasons between
1966 and 1975. This replacement figure is a
“net* figure, after allowance is made for in-
active nurses who may return to the field.
About 300,000 nurses actually are esqpected to
leave the labor force between 1966 and 1975.
Many factors underlie the expected rapid
growth in requirements for reg^istered nurses.
One major factor is the growing number of
patients who will require nursing care result-
ing from the increasing population, and the
rising ejpenditures for health care, in pai^
resulting from Medicare. Increasing numbers
also will be needed to work in the growing num-
ber of physicians* offices, and many more will
be required to serve as occupational nurses in
business firms as total industry enq)loyment
increases.
Additional numbers of nurses also will be
needed to teach in nursing schools. More
schools are being built, and existing facilities
expanded as a result of the Health Professions
Educational Assistance Act of 1963 and the
Nurse Training Act of 1964. Furthermore, it
is expected that increasing numbers of young
women enroll in nursing schools as informa-
tion on enployment opportunities and financial
assistance (provided by the Nurse Training
Act) become more widely publicized.
Some technological developments also
should increase the demand for nurses. For
example, the development and more wide-
-23
spread use of new drugs, medicines, and other
treatments probably will result in many more
people seeking medical help, thereby creating
an increased demand for nursing care.
On the other hand, labor saving technological
developments will partially offset the growth
in demand for professional nursing care. The
most significant developments will take place
in hospitals and related institutions, including
changes in building design that eliminate time
spent walking; the use of computers to record
a patient’s physiological condition; and electric
monitoring devices that keep the nurse inform-
ed of a patient’s condition.
Hospitals and nursing homes are also ex-
pected to continue to employ larger numbers of
practical nurses and aids, orderlies, and atten-
dants relative to the number of registered nur-
ses, primarily because these workers are not
in as short supply as registered nurses and
their salaries are lower.
Supply. Graduates of nursing schools are the
primary source of new nurses in the United
States/^®'4’o meet projected needs for 390,000
20
Many nurses also reenter the labor force
each year. These workers were accounted for
in the discussion of replacement needs.
new nurses between 1966 and 1975 (240,000 for
growth and 150,000 for replacement) nursing
schools will have to provide an annual average
of about 43,000 over the 9-year period. In 1966,
about 35,000 persons graduated from these
schools, and not all of them, entered nursing.
Thus, to meet projected requirements, the an-
nual number of graduates must be increased by
an average of at least 8,000 a year between
1966 and 1975.
Assistance to nursing schools under the
Nurse Training Act of 1964 and the Health
Professions Educational Assistance Act of 1963
will result in some increase in the number of
nursing graduates. For example, as of April
1967, construction projects were approved
under these acts to increase enrollments by
about 3,000. However, nursing schools will be
facing increasing competition for students.
Employment opportunities for graduates in
other subject fields also are e;q)ected to con-
tinue to increase rapidly between 1966 and
1975, and students undoubtedly will be attract-
ed to other programs of study. Since nursing
schools currently are not filled to capacity,
action should be taken to- recruit young people
into nursing schools by increasing relative
salaries of nurses, improving working condi-
tions, or otherwise increasing the desirability
of work in the profession.
Licensed Practical Nurses
Employment,. About 300.000 4 H?adtical purses
were emplojred in the United States in 1966,
nearly two and one-fifth times as many as the
137,000 employed in 1950. Of the total in 1966,
approximately 150,000 were employed by hos-
pitals and an estimated 35,000 by nursing
homes and other extended care facilities. Many
were private duty practical nurses working in
the homes of their patients, or in hospitals.
Others were emplo 3 red by public health agen-
cies and welfare and religious organizations.
Shortages. According to surveys of hospitals
and nursing homes by the AHA and PHS, prac-
tical nursing is one of the greatest shortage
occupations in the health field. In hospitals,
it was estimated that more tlian 14,000 prac-
tical nurses were urgently needed. Among all
workers, only needs for professional nurses
and aids, orderlies, and attendants were signi-
ficantly greater. In nursing homes, urgent
needs for practical nurses (7,700) were greater
than for any other occupation.
Projected Ne^ s ^ Employment requirements
for practical nurses are e}q)ected to rise from
300,000 to about 465,000 between 1966 and 1975,
an increase of 55 percent. This represents an
24
•V
annual rate of growth somewhat slower than
in the 1950-66 period. In addition to growth
needs of 165,000, an estimated 125,000 will be
needed to replace practical nurses who leave
the labor force because of death, retirement,
family responsibility, or other reasons. This
replacement figure reflects “net” losses. The
number of practical nurses who are e3q)ected
to leave the labor force between 1966 and 1975
is actually much more than 125,000 but many
will return to their jobs and thus should not
require replacement. The limited information
available indicates that about one-third of all
licensed practical nurses who leave the labor
force eventually return.
The rapid growth in demand for practical
nurses is e;q)ected to result from the same
factors increasing the demand for other health
workers, including population growth, rising
health expenditures, e}q)ansion of prepayment
insurance plans, and growing public health pro-
grams. In addition, hospitals and nursing
homes are expected to continue to employ more
licensed practical nurses relative to profes-
sional nurses. These institutions are changing
the duties of nursing personnel so that some of
the less skilled nursing tasks may be done by
practical nurses, thereby freeing registered
nurses for more responsible jobs.
Technological developments will tend to
limit somewhat the growth in requirements for
licensed practical nurses. For example, the in-
creasing use of disposable items such as hy-
podermic syringes and surgical gloves will re-
duce the need for practical nurses who cleaim
and sterilize reusable items. On the other
hand, technological developments that will in-
crease the overall demand for health care,
described earlier, will have the effect of in-
creasing the demand for licensed practical
nurses.
Supply. Graduates of practical nurse training
programs are the primary source of new li-
censed practical nurses. SlA'o meet projected
needs for 290,000 newpractical nurses between
1966 and 1975—165,000 for growth and 125,000
for replacement — training programs would
have to provide an average of about 32,000
annually over the 9-year period. In 1966, a-
bout 25,000 persons graduated from these
programs, and not all of them became licensed
practical nurses. Thus, to meet projected re-
quirements, the annual number of graduates
would have to be increased by an average of
at least 7,000 a year between 1966 and 1975.
Some of this increase probably will result
from an increase in the capacity of schools.
However, since all schools currently are not
filled to capacity, action should be taken to in-
crease relative salaries of licensed practical
nurses, improve working conditions, or other-
wise improve the desirability of work as a
practical nurse.
21 Many licensed practical nurses also re-
enter the labor force each year. However, these
workers are excluded from the discussion of
supply because they were accounted for in the
discussion of replacement needs.
Aids, Orderlies, and Attendants
Employments Approximately 700,000 nurse
aids, orderlies, and attendants were employed
in the United States in 1966, more than three
times as many as the 220,000 employed in 1950.
About 500,000 worked in hospitals and more
than 150,000 were employed in nursing homes.
The remainder were employed in offices of
physicians and other medical practitioners, in
sanitariums, and in other institutions providing
facilities for care and recuperation.
Shortages. Shortages of aids, orderlies, and
attendants have been reported throughout the
country. According to the AHA-PHS surveys,
reported needs for these workers were great-
er than for any other occupation except reg^s-
- 25 -
tered nurses. Needs for 29,000 aids, orderlies,
and attendants were estimated— 22,000 in hos-
pitals and 7,000 in nursing homes.
P^^otecte d Needs. Employment requirements
for aids, orderlies, and attendants aree^qiect-
ed to increase from about 700,000 to nearly 1.1
million between 1966 and 1975, or by nearly
three-fifths. This r^resents a slower rate of
growth than in the 1950-66 period.
In addition to the growth needs of nearly
400,000, more than 300,000 of these workers
will be needed to replace those who leave the
labor force because ofdeath, retirement, fam-
ily responsibility, or other reasons between
1966 and 1975. This r^lacement estimate uti-
lizes a net loss concept. The number of aids,
orderlies, and attendants who are expected to
leave the labor force between 1966 and 1975 is
actually much greater than 300,000, but many
will return to their jobs and thus should not
require replacement.
The very rapid growth in demand for aids,
orderlies, and attendants will stem from the
same factors increasing the need for other
health workers, including population growth,
rising health e3q>enditures, es^ansion of pre-
payment insurance plans, and growing public
health programs. In addition, hospitals, nur-
sing homes, and other similar institutions are
e}q)ected to use more of these workers relative
to other nursing personnel (professional
nurses). The^ institutions also are changing
the job content of nursing jobs so that the less
complex duties can be performed by aids, or-
derlies, and attendants; this will allow the more
hig^y trained professional and practical nurs-
ing personnel more time for other duties.
Technological developments will tend to
limit the growth in requirements for aids, or-
derlies, and attendants. The use of electronic
monitoring devices, improved designs of hos-
pitals, and the use of disposable items will
have the effect of saving time for nursing per-
sonnel. On the other hand, some technological
developments, such as the development of new
techniques for treating disease, will increase
the demand for medical care and, therefore,
raise the employment needs for aids, order-
lies, and attendants as well as other workers.
Supply. Emplo}rers g^enerally do not require
nurse aids, orderlies, and attendants to have
occupational training prior to employment.
These workers are generally trained on the
job, sometimes in formal on-the-job training
progp?ams. The length of the progr am wfl y yayy
from seyeral days to a few months depending
on the policies of the hospital, the workers*
aptitude for the work, and the nature of the
assigned duties.
Because of the preyalence of on-the-job
training programs, the task of training workers
to meet requirements thus falls on the enq)loy-
ing institutions rather than on educational
institutions. Although some of the training in
recent years has been conducted under MDTA
institutional training programs, part of this
training is conducted in hospitals. (About 27,000
persons enrolled in MDTA institutional pro-
grams for aids, orderlies, and attendants be-
tween August 1962 and December 1966.)
Because persons without a high school
diploma generally can enroll in training pro-
grams for aids, orderlies, and attendants, it
is likely that the gross supply of these persons
would be sufficient to fill training programs.
The primary concern, therefore, is to attract
these workers to aid, orderly, and attendant
training progp^ams by publicizing (^portunities
for employment, and by establishing salary
structures which make these jobs competitiye
with others requiring similar educational
background.
26
Occupational Therapists
Emplovment t About 6(500 occupational thera-
pists were employed in 1966, three and one-
fourth times as many as the 2,000 employed
in 1950. In 1966, about 85 percent of the total
worked in hospitals, nursing homes, sanitar-
iums, or other extended care facilities. Some
were employed in special workshops, camps
for handicapped children, and State and local
health departments, and others were employed
in home-visiting programs for patients unable
to attend clinics or workshops.
Shortages. The AHA and PHS surveys of hos-
pitals and extended care facilities indicate that
occupational therapists are in very short sup-
ply. The hospital survey indicated an urgent
need for 1,200 occupational therapists and the
extended care facilities survey indicated a need
for 400. Thus, employment of occupational
therapists would have to be increased by about
one-fourth if current urgent staffing needs
were to be met.
Projected Needs. Employment requirements
for occupational therapists are e3q>ected to
continue to increase rapidly from about 6,500
to about 16,500 between 1966 and 1975, an in-
crease of more than 150 percent. This repre-
sents a faster annual rate of growth than in
the 1950-66 period. However, the number of
new graduates of occupational therapy pro-
grams limited employment growth in the past,
whereas the projected 1975 requirements were
made without consideration of possible future
supply limitations.
The demand for the services of occupational
therapists is e}q)ected to increase very rapidly
as interest in the rehabilitation of disabled
persons and the success of established occu-
pational therapy programs continues to in-
crease. There will be a particularly large in-
crease in the need for therapists to work with
psychiatric patients, children, and the aged, as
well as with persons suffering from cerebral
palsy, mental retardation, and heart disease.
In addition, more therapists will be needed for
work in home care programs and in community
health centers.
In addition to occupational therapists need-
ed for the growth of the occupation, about 3,000
will be needed to replace those who die, retire,
or leave the labor force for family or other
reasons. 22/
Supply. The primary source of supply of occu-
pational therapists is new bachelor’s degree
graduates of 4-year college programs in occu-
pational therapy. Others enter the occupation
after completing 2 years of a different college
curriculum and a 2-year occupational therapy
curriculum leading to a bachelor’s degree.
Some persons having bachelor’s degrees in
other fields enter the occupation after comple-
ting occupational therapy programs lasting 18
to 22 months and receiving a certificate in oc-
cupational therapy. All new therapists must
have 6 to 9 months of clinical experience.
In 1966, about 550 persons received a bach-
elor’s degree or a certificate in occupational
therapy. To meet projected needs for 13,000
therapists between 1966 and 1975—10,000 for
growth and 3,000 for replacements— training
programs will have to provide an annual aver-
age of about 1,450 graduates over the 9-year
period. Thus, over the 9-year period, grad-
uates must increase by an average of about
900 a year if requirem»*‘.nts are to be met. To
achieve this goal, action is necessary both to
increase the training capacity of occupational
therapy schools, and to attract students to
these courses.
22
These are estimatednet losses— separa-
tions from the labor force minus returnees.
-27
Physical Therapists
Employment. About 12,500 physical therapists
were employed in 1966, two and three-fourths
times as many as the 4,600 employed in 1950.
In 1966, about 8,500 worked in hospitals and
2,000 in nursing homes and other extended care
facilities. Others were employed in home-vi-
siting programs for patients unable to attend
clinics or workshops, camps for handicapped
children, and in State health departments.
Shortages. The reports of the AHA-PHS sur-
vey of extended care facilities indicate that
physical therapists are in very short supply.
Employment of physical therapists in nursing
homes would have to be increased by about
one-third if urgent staffing needs were to be
met, whereas a 10 percent employment in-
crease would be needed to fill hospital needs.
Projected Needs. Employment requirements
for physical therapists are ejq)ected to con-
tinue to increase rapidly from 12,500 to about
2.7,000 between 1966 and 1975, an increase of
116 percent. This represents a faster annual
rate of growth than in the 1950-66 period. How-
ever, the number of new graduates of physical
therapy programs limited emplo3mient growth
in the past, whereas the projected 1975 require-
ments were made without consideration of pos-
sible future supply limitations.
Manpower needs are ejq)ected to increase
between 1966 and 1975 as existing rehabilita-
tion centers are enlarged and new ones are
built. Growth of programs to aid crippled chil-
dren and increase vocational rehabilitation
activities should further raise the demand for
physical therapists. In addition, more physi-
cians are ejqpected to recommend physical
Medical '!
Employment. Approximately 40,000 medical
technologists were employed in 1966. An esti-
mated three-fourths of the total were employed
in hospitals. Most of the remainder were em-
ployed by public health agencies, blood banks.
therapy for their patients as techniques and
equipment for treatment improve.
In addition to the physical therapists need-
ed for the growth of the occupation, about
5,000 will be needed to replace those who will
die, retire, or leave the labor force for family
or other reasons over the 1966-75 period.-23/
Supply. There are two primary sources of new
physical therapists in the United States:
(1) Graduates of physical therapy programs
leading to a bachelor’s degree, and (2) gradu-
ates of 12 to 16 months certificate programs
offered to persons having a bachelor’s degree
in another field. To meet the projected need
for 19,500 physical therapists between 1966 and
1975 — 14,500 for growth and 5,000 for replace-
ments — these sources would have to provide an
annual average of about 2,200 graduates over
the 9-3^ar period. In 1966, only about 950 per-
sons graduated from these programs, and not
all of them became phs/sical therapists. 7’hus,
to meet projected needs, the annual average
number of graduates would have to more than
double over the 1966-75 period.
Nearly all schools of physical therapy are
filled to capacity. To increase the number of
graduates, therefore, it will be necessary to
expand existing institutions and to build new
ones. Some of this increase is erq)ected to re-
sult from contruction assistance under provi-
sions of the Allied Health Professions Person-
nel Training Act of 1966.
23
These are estimated net losses— separa-
tions from the labor force minus returnees.
private clinical laboratories, research insti-
tutions, and pharmaceutical manufacturers.
Shortages. Shortages of qualified medical tech-
nologists have been reported throughout the
- 28 -
country. According to the 1966 AHA-PHS sur-
vey of hospitals, it was one of the occupations
having great unmet needs. The reports showed
that to meet the most urgent needs of hospitals
in 1966, employment would have to increase
nearly 10 percent.
Projected Needs. Manpower requirements fdr
medical technologists are e3q)ected to increase
from about 40,000 to 75,000 between 1966 and
1975. In addition to this growth need of 35,000,
about 15,000 will be needed to replace those
who are e:q)ected to die, retire, or leave the
labor force for other reasons between 1966 and
1975 .^
The demand for medical technologists will
increase because of the same basic factors that
underlie the rising demand for all health man-
power. In addition, the need for medical tech-
nologists will grow as physicians depend
increasingly upon laboratory tests in the diag-
nosis <and treatment of disease. The growing
complexity of laboratory techniques and the use
24
These are estimated net losses — separa-
tions from the labor force minus returnees.
of more complex instruments also will require
more medical technologists.
Supply. Graduates of schools of medical tech-
nology accredited by the American Medical
Association are the primary source of new
medical technologists. To meet projected needs
for about 50,000 medical technologists between
1966 and 1975 — 35,000 for growth and 15,000 for
replacements — an annual average of ^bout
5.500 such graduates will be needed over the 9-
year period. In 1966, about 780 AMA accredited
schools of medical technology provided about
3.500 graduates, not all of whom became med-
ical technologists. Thus, to meet projected re-
quirements, the average annual number of
graduates must be increased by at least 2,000
between 1966 and 1975.
Reports from the institutions that train
medical technologists indicate that they cur-
rently are filled only to about two-thirds of ca-
pacity. Thus, to meet occupational needs,
additional students must be attracted to these
schools. Programs should be initiated to pub-
licize the availability of employment opportuni-
ties and to increase the desirability of work as
a medical technologist, particularly by raising
salary levels.
Medical Laboratory Assistants
Employment. Approximately 50,000 medical
laboratory assistants were employed in 1966.^
It is estimated that about three-fourths were
employed in hospitals. Others were employed
in public and private clinical laboratories,
public health agencies, pharmaceutical labora-
tories, and physicians* offices.
Shortages. Personnel shortages are estimated
to be smaller for medical laboratory assistants
25
Medical laboratory assistants in this re-
port included workers who generally require 1
to 2 years of post- secondary training or the
equivalent in experience.
than for more highly trained laboratory work-
ers such as medical technologists. For ex-
ample, according to the AHA-PHS survey of
staffing needs of hospitals in 1966, employment
of laboratory assistants would have to rise 5
percent to meet the most urgent needs, com-
pared with a 10 percent rise needed to meet the
most urgent staffing needs for medical techno-
logists.
Projected Needs. Employment requirements
for medical laboratory assistants are e}q)ected
to increase from about 50,000 to 100,000 be-
tween 1966 and 1975. In addition to these growth
needs of about 50,000, about 20,000 will be need-
ed over the 1966-75 period because of net losses
- 29 -
resulting from deaths, retirements, and other
separations from the labor force ^^g/
The demand for medical laboratory assis-
tants is 03q)ected to increase as a result of the
same basic factors that underlie the growing
demand for all health workers. Technological
developments that result in new laboratory
techniques and, thereby, permit more varieties
as well as increasing numbers of tests to be
performed are expected to be a significant fac-
tor underlying the increase in the demand for
assistants. On the other hand, the development
of automated equipment that reduces the need
for personnel to do simple repetitive tasks may
tend to partially offset the growth in demand for
the ser^ces of medical laboratory assistants.
26
Net losses include separations from the
labor force minus returnees.
Supply. Most medical laboratory assistants
employed in 1966 acquired their training on the
job. In recent years, however, an increasing
number have been trained in academic pr'^-
grams conducted by hospitals or by vocatio.^
schools and junior colleges in cooperation with
hospitals. Programs offered in hospitals gen-
erally last about 1 year, and those in vocational
schools and junior colleges generally last about,
2 years.
Since workers usually can enroll in training
programs for assistants with only a high school
diploma, it is assumed that the gross supply of
persons will be sufficient to fill training pro-
grams. The primary concern, therefore, is to
attract people to the training programs. This
can be done by publicizing opportunities for
employment and by establishing salary struc-
tures that make these jobs competitive with
others that require similar educational back-
grounds.
Medical X-ray Technicians
Employment. Approximately 72,000 medical
X-ray technicians were employed in 1966, about
two and one-third times as many as employed
in 1950. In 1966, about one-fourth were employed
by hospitals. The remainder were employed
primarily in medical laboratories, physicians*
and dentists* offices, clinics. Federal and State
health agencies, and school systems.
Shortages. The AHA-PHS survey of staffing
needs in hospitals in 1966 indicates that many
openings for technicians were unfilled. Pre-
liminary results of this survey show unfilled
needs for about 1,000 medical X-ray tech-
nicians.
increasing ability of persons to pay for health
care — should increase demand for X-ray tech-
nicians. In addition. X-ray equipment is
e:q)ected to be used more frequently in the di-
agnosis and trea.tment of disease. X-ray tech-
nicians also will be needed to administer radio-
therapy, as new knowledge of the medical bene-
fits of radioactive materials becomes more
widespread. Routine X-raying of large groips
of people will be extended as part of disease
prevention and control programs. For example,
many employers now require chest X-rays of
all employees, and most insurance companies
include a chest X-ray as part of the physical
examination required for an insurance policy.
Projected Needs. Employment requirements
for medical X-ray technicians are e;q)ected to
increase from about 72,000 to about 100,000
between 1966 and 1975, or by nearly two-fifths.
This represents an annual rate of growth some-
what slower than in the 1950-66 period. The
basic factors that underlie the e:^cted in-
crease in demand for other types of health
workers — including population growth and the
In addition to the medical X-ray technicians
needed for the growth of the occupation, about
23,000 will be needed because of net losses re-
sulting from deaths, retirements, or other
separations from the labor force over the 1966-
75 period.3Z/
27
Net losses include separations from the
labqr force minus returnees.
ERIC
-30-
Supply. Training programs in X-ray technology
offered by hospitals and by medical schools af-
filiated with hospitals are the primary source
of new medical technicians. These programs
usually last abc«ut 24 months, but a few are 3-
jrear programs or 4-year programs that lead
to a bachelor’s degree. Some junior colleges
coordinate academic training with work e:q)eri-
ence in hospitals in 3-year X-ray technician
programs and offer an associate of arts degree.
In 1966, approximately 1,000 schools of X-ray
technology were approved by the American
Medical Association. In addition to training
programs offered in hospitals, training also is
provided by the Armed Forces.
In 1966, about 4,200 persons graduated from
programs which were approved by the Ameri-
can Medical Association. To meet the require-
ments for about 51,000 additional X-ray
technicians between 1966 and 1975 (28,000)
for growth and 23,000 for replacements), an
annual average of about 5,600 persons will
have to be trained. Thus, if only relatively
few entrants come from the Armed Forces or
other sources, the average annual numer of
graduates of technology schools must be in-
creased by about one-third.
Reports from schools that provide training
for X-ray technicians indicate that the
school's are not filled to capacity. Thus, to meet
occupational needs, additional students must be
attracted to these schools. Programs should be
initiated to publicize the availability of enq>loy-
ment opportunities and to increase the desir-
ability of work as an X-ray technician, partic-
ularly by raising salary levels.
Medical Record Librarians
Employment. About 12,000 medical record li-
brarians were employed in 1966, mostly in
hospitals.^^The remainder were employed in
clinics, medical research centers, medical
departments of insurance companies, and in
State and local health departments.
Shortages. Reports from the AHA-PHS survey
indicate that many hospital positions for med-
ical record librarians were unfilled in 1966.
Preliminary survey results show that employ-
ment would have to be increased about 10 per-
cent, if the most urgent staffing needs for
medical record librarians were to be filled.
projected Needs . Employment requirements
for medical record librarians are expected to
increase from about 12,000 to 18,000 between
1966 and 1975. The increasing number of
hospitals and the growing volume and complex-
ity of hospital records will continue to create
a strong demand for medical record librarians.
Information contained in medical records will
About 3,700 are registered with the
American Association of Medical Record Li-
brarians.
become more important as a result of the in-
creasing amount of clinical data needed for
research on diseases, new drugs, and methods
of treatment. More consultants and group
siq>ervisors also will be needed to help stand-
ardize records in areas where medical record
librarians are not available.
In addition to the medical record librarians
needed for the growth of the occupation, about
4,000 will be needed to replace those who die,
retire, or leave the labor force for family or
other reasons over the 1966-75 period.
Supply. In 1966, 28 schools approved by the
American Medical Association offered training
in medical record library science or medical
record administration. These schools, which
are located in colleges and universities and in
a few hospitals, have programs lasting about
a year are offered to students who have
previously completed 2 years or more of
college.
OQ
These are estimated net losses — separa-
tions from the labor force minus returnees.
In 1966, about 190 persons graduated from
these programs, far fevrer than the number
needed even for replacement needs. However,
many other persons have entered the work
force as medical record librarians, mostly
after being trained on the job and/ or with ex-
perience as assistants to medical record li-
brarians. The task of training medical record
librarians, therefore, will continue to fall
primarily on employers. Thus, it would be
beneficial if training for these workers in
academic programs were expanded.
Dietitians
Employment. Approximately 30,000 dietitians
were e mp loyed in 1966, an increase of 36 per-
cent over the 22,000 employed in 1950. In 1966,
more than two-fifths were employed by hos-
pitals. Large numbers also were employed by
nursing homes and other extended care facil-
ities. Others worked for ^lieges and univer-
sities as teachers, or forschool systems as
dietitians in food- service programs. Most of
the remainder worked for public health agen-
cies, restaurants, and large companies that
operate food- service programs for their em-
ployees.
Shortages. The \HA-PHS and PHS surveys in-
dicate that many openings for dietitians are
unfilled. These surveys indicate urgent needs
for about 1,600 dietitians in hospitals and 500
in nursing homes and other extended care facil-
ities. The limited information available indi-
cates that shortages also exist in other types
of employment.
Projected Needs . Employment requirements
for dietitians are ejqpected to increase from
about 30,000 to nearly 38,000 between 1966 and
1975, or by one-third. This represents a faster
annual rate of growth than in the 1950-66
period. The expected increase in the patient
load of hospitals, nursing homes, and other ex-
tended care facilities, primarily because of
population growth and the increasing ability of
the population to pay for institutional care,
should result in an increase in demand for die-
titians* services. In addition, more dietitians
will be needed to directfood- service pro^ams
for the growing number of schools, day care
centers, and industrial plants, and to work in
research and public health programs.
In addition to those needed to staff new po-
sitions, more than 9,000 dietitians will be
needed to replace those who die, retire, or
leave the labor force for family or other rea-
sons over the 1966-75 period.22/
Supply. Graduates of bachelor* s degree pro-
grams offered in home economics departments
of colleges and universities are the major
source of new dietitians. A few enter after
receiving bachelor’s degrees in other fields of
study.
To meet the projected need for 17,000 die-
titians between 1966 and 1975—8,000 for growth
and 9,000 for replacements— these programs
will have to provide an annual average of about
1,900 graduates over the 9-year period.
Although more than 5,000 persons received
degrees in home economics in 1966, only about
one-fifth were estimated actually to have be-
come dietitians. Another 100 entered the field
from other degree programs. Thus, the number
of entrants from these programs was only about
1,100 in 1966. The projected requirements for
1,900 dietitians a year could be met by (1) in-
creasing the proportion of home economics
graduates entering the labor force as dietitians;
(2) by increasing the number of graduates of
home economics curriculums; or (3) by in-
creasing the number who enter from other
30
These are estimated net losses — separa-
tions from the labor force minus returnees.
31
After completion of 4 years of college,
the profession encourages completion of a one
year internship program.
- 32 -
fields of study. Since the current number of
graduates from home economics curriculums
would be sufficient to meet employment re-
quirements if two-fifths rather than one-fifth
entered work as dietitians, the simplest solu-
tion is to attract these graduates to work as
dietitians. This possibly could be done by pub-
licizing employment opportunities, and by
increasing salaries (at least to the level of
other positions requiring similar educational
and training backgrounds). However, attracting
new home economics graduates to dietitian
positions could create shortages of home eco-
nomists. Therefore, an increase in the number
of home economics graduates also is needed to
avoid shortage s-in other occupations.
APPENDIX A. STATISTICAL TABLES
In the following tables, absolute figures are
rounded to the nearest hundred, and percentages
shown to two decimal places • Presentation of the
figures in this form should not be construed as in^
dlcatlng that they have exactly this degree of pre-
cision.
Since all totals and percentages were calcula-
ted on the basis of unrounded figures, they do not
always correspond exactly to those indicated by
rounded figures in the tables.
35
Table A*«l. Estimated Employment in the Medical and Health
Services Industry, by Selected Occupation 1/^ 1966
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-36-
Table A-1. Estimated Employment In the Medical and Health
Services Industry, by Selected Occupation, 1966 - continued
1
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Percent
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U.S. Department of Labor, Bureau of Labor Statistics.
Table A~3. Estimated Manpower Needs in Selected Health Occupations
Resulting from Growth of Employment Requirements and
Net Replacements, 1966-75
Manpower needs 1966-75 for
Occupation
Em-
ployment
1966
Employment re-
quirements ,
projected 1975
Growth and
net re-
placements
Growth
Net
replace-
ments ]J
Medical "professions"
Physicians
295,000
390,000
145,000
95,000
50,000
Dentists
97,500
125,000
45,000
27,500
17,500
Optometrists . .
17,000
20,000
6,100
3,000
3,100
Podiatrists
8,000
9,600
3,000
1,600
1,400
Nursing
Aids, orderlies, and
attendants
700,000
1,080,000
690,000
380,000
310,000
Professional nurses
620,000
860,000
390,000
240,000
150,000
Licensed practical
nurses
300,000
465,000
290,000
165,000
125,000
Other professional and
technical
Pharmacists
120,000
126,000
38,000
6,000
32,000
Medical X-ray
technicians
72,000
100,000
51,000
28,000
23,000
Medical laboratory
assistants
50,000
100,000
70,000
50,000
20,000
Medical technologists ^/.
40,000
75,000
50,000
35,000
15,000
Physical therapists
12,500
27,000
19,500
14,500
5,000
Medical record
librarians
12,000
18,000
10,000
6,000
4,000
Occupational therapists*.
6,500
16,500
13,000
10,000
3,000
Dietitians
30,000
38,000
17,000
8,000
9,000
Net replacements Include separations from the labor force because of deaths,
retirements, family responsibilities, or other reasons, minus workers qualified
In the occupation returning to the labor force.
2_^/ Includes Doctors of Medicine (M.D.) and Doctors of Osteopathy (D.O.).
Includes workers who require 4 years of post-secondary training or the e-
qulvalent In experience.
Source: U.S. Department of Labor, Bureau of Labor Statistics
- 40 -
APPENDIX B. COVERAGE AND METHODOLGY
This appendix details the coverage of the statistics
used in the report and describes the methodology used in
preparing the estimates of future manpower needs.
41
Coverage and definitions
Tbis report covers all workers who are engaged in providing the Nation’s health care* It
includ e s all workers employed in medical and health services establishments as defined by the
Standard Industrial Classification Manual, 1967, and workers in health occupations employed
in industries other than the health services.
The Standard Industrial Classification Manual, 1967,idescribes medical and health service
establishments as follows:
THE MA JOR GROUP AS A WHOLE
This major group includes establishments primarily engaged in furnishing medical,
surgical, and other health services to persons. Associations or groups primarily engaged
in providing medical or other health services to members are included, but those which
limit their services to the provision of insurance against hospitalization or medical costs
are classified in Major Group 63.
Group Industry
No. No.
801 OFFICES OF PHYSICIANS AND SURGEONS
8011
802
8021
803
8031
804
Offices of physicians and surgeons
Establishments of licensed practitioners having the
degree of M.D. and engaged in the practice of general
or specialized medicine and surgery* Establishments
such as gro\q> clinics, in which a group of physicians are
associated for the purpose of carrying on their profes-
sion, are included in this industry.
OFFICES OF DENTISTS AND DENTAL SURGEONS
Offices of dentists and dental surgeons
Establishments of licensed practitioners engaged in
the practice of general or specialized dentistry.
OFFICES OF OSTEOPATHIC PHYSICIANS
Offices of osteopathic physicians
Establishments of licensed practioners engaged in
the practice of general or specialized osteopathy.
OFFICES OF CHIROPRACTORS
8041
Offices of chiropractors
806
8061
807
8071
8072
809
8092
8099
Establishments of licensed practitioners eng^ed in
the practice of chiropraxis.
HOSPITALS
Hospitals
Establishments primarily ei^aged in providing hos- •
pital facilities, and clinics or dispensaries. Institutions
such as sanatoria, rest homes, convalescent homes, and
curative baths or spas in which medical or surgical
services are not a main function of the institution are
classified in Industry 8092.
MEDICAL AND DENTAL LABORATORIES
Medical laboratories
Medical laboratories providing professional analysis,
diagnosis, or treatment services to the medical profes-
sion, or to the patient on prescription of the physician.
Dental laboratories
Establishments primarily engaged in making dentures
and artificial teeth to order for the dental profession. The
manufacture of artificial teeth other than to order is clas-
sified in Industry 3843.
HEALTH AND ALLIED SERVICES, NOT ELSEWHERE
CLASSIFIED
Sanatoria, and convalescent and rest homes
Institutions such as sanatoria, convalescent homes,
and rest homes, in which medical or surgical services
are not a main function of the institution.
Health and allied services, not elsewhere classified
Establishments engaged in renderii^ health and allied
services, not elsewhere classified. Establishments of
registered nurses engaged in the independent practice of
their profession are included here, but nurses* registries
are classified in Industry 7361. Associations or groups
43 -
formed primarily to provide medical or other health
service to their members, and which themselves provide
these facilities, are included in this industry. Establish-
ments, such as Blue Cross and Blue Shield plans, whose
members are supplied these services by independent
physicians or. hospitals under contract are classified in
Industry 6324.
Government medical and health establishments are classified by the Standard Industrial
Classification Manual as industry numbers 9180 (Federal Government), 9280 (State Govern-
ment), and 9380 (local government). In this report government establishments are included
with those in private industry accordingto the industry division described above. For e^mple.
Federal Government-operated hospitals are classified under SIC 806.
nocunations are defined in this report as those whose work is fundamental or
unique to the provision of health services,i.e., physician. nurse, orderly. Health manpower on
the other hand, indicates all workers employed in medical and health service establishments
whether or not they are in a health occupation, as well as all workers in health occupations
employed in other industries.
Methodology
The finriinga of this report result from a detailed analysis of all available data on em-
ployment of health workers and the factors affecting past and Icurrent employment needs. The
vast body of statistical and other information continually being developed by the Bureau of
Labor Statistics ps part of the extensive research and statistical collection programs were
a primary source of information. Other data were drawn from the collection and analysis
programs of the Public Health Service, and from various associations and organizations con-
cerned with health manpower or the provision of health services.
The methodology used to develop projected 1975 requirements was similar to that used
in other Bureau of Labor Statistics studies of future occupational needs. In brief, an analysis
was made of the factors that affect the demand for workers, and how these factors may affect
occupational demand in the future. These factors include the impact of e:q)ected change in
Federal programs, technology, employer utilization patterns, and patterns of consumer ex-
penditures. A somewhat more detailed discussion of the methodology used to develop occu-
pational projections within the Bureau may be found in America*s Industria l and Occupational
Mantx)wer Requirements. 1964-75 . a report prepared for the National Commission on Auto-
mation, Technology and Economic Progress.
APPENDIX C. SELECTED BIBLIOGRAPHY
This bibliography lists a selected group of reports,
books, and articles published in recent years on subjects
relating to health manpower. Because of space limita-
tions, however, no attempt has been made to include all
the many fine studies published.
The selected items are grouped into sections: (I)
Health Manpower Statistics; (I) Health Care Statistics;
and Wages «
45
I. HEALTH MANPOWER STATISTICS
A. General
“Hospitals", 7<j ^nrnal of the Ame rican Hospital AssociatlQn>_August 1, 1966, Part 2
U.S. Department of Labor
of Labor Statistics, January 1966.
Emnlov^T^"* Earnings Statistics for th e United StateSt_1909-:66, Bureau of
Labor Statistics, Bulletin 1312-4, December 1966.
Health Careers Guidebook . Bureau of Emplojnnent Security, 1965.
Occupational Outlook Handbook. 1966-67 Edition , Bureau of Labor Statistics, Bul-
letin 1450, 1965.
Projections 1970, Bureau of Labor Statistics, Bulletin 1536, 1966.
Technology and Manpower in the Health Ser vice Industry, 1965-1975, Office of
Manp nwftr Policy, Evaluation, and Research, 1967 .
U.S. Department of Health, Education, and Welfare
Employees in Nursirjg and Personal Care H omes. United States, May- June 19^
Vital and Health Stati stics Series, Public Health Service, National Center for Health
Statistics, Series 12, Number 5, September 1966.
Health Manpower Perspective; 1967 . Bureau of Health Manpower, Public Health
Service. (In Press)
Health Manpower Source Book. Section 17. Industry and O ccupation D^ta
Cftnatia. bv State. Public Health Service, 1963.
Health Manpower Source Book. Section 19, Location of Manpower in 8 Oc cupations,
Public Health Service, 1965.
Health Resources Statistics; 1965, Public Health Service, Publication 1509,1966.
Dentists,
Dental Students* Register, American Dental Association, 1965-66 and prior annual
issues.
— 46 -
American Dental Association, 1966 and prior annual issues.
-Number of Dental Graduates RequiredAnnuallyto 1985", The Journal of the Amer^
can Dental Association. September 1965, pp. 694-698.
Facts About Nursing. American Nurses* Association, 1966 Edition.
U.S. Department of Health, Education, and Welfare
Manpower Source Book. Section 2. Nursing Persoi^ . Public Health
Service, Revised January 1966.
Niiraes in Public Health. Public Health Service, January 1964.
Occupational Health Nurses. An Initial Suryey ^Public Health Service, May 1966.
Optometrists
-1964 Economic :rn„rnni of the American Optometric Associatj^ Aj^il
1966, May 1966, June 1966, July 1966, August 1966, September 1966, and October
1966.
Osteopathic physicians
A Statistical studvof the Osteopathic Profession , American Osteopathic Association,
issued annually.
Physicians
American Medical Association
hy Practice , issued quarterly.
Directory of Approved Internships and Residencies, issued annually.
rastrihutlon of Physicians. and Hospital Beds in the U.S. by Ce n g HS
Region. State. Countv. and Me tropolitan Area. 1966,
Nurses
1C
Toward QusHtv in Nursing. Needs an^ Ocala. Report of the Surgeon Geaeral*s
Consultant Group on Nursing. Public Health Service, February 1963.
Physicians
Group on
1959.
- 47 -
ipodiatrists
“1964 Survey of the Podiatry Profession by the Special Studies Division, American
Podiatry Association", Journal of the American Podiatry Association, 1965, Re-
print No. 1:66:01.
Miscellaneous.
Tjflfinnni Conference on X-ray Technician Training. Public Health Service, 1966.
The Psychiatric Aide in State Mental Hospitals. Public Health Service, 1965.
Resources for Medical Research: Manpower for Medic al Research Reauirement.S.
and Resources . 1965-1970. Public Health Service, Report No. 3, January 1963.
II. HEALTH CARE STATISTICS
A. Expenditures
Report of the Commission on The Cost of Med ical Care. Volumes I, II, III, and IV
American Medical Association, 1963 and 1964.
Source Book of Health Insurance Data. 1966 , Health Insurance Institute, 1967.
U.S. Department of Health, Education, and Welfare
A Report to the President on Medical Care Pric es. February 1967.
The Extent of Health Insurance Coverage in the United States: Research Re-
port No. 10^ Social Security Administration, July 1965.
Health Insurance Coverage, United States. July 1962- June 1963 , Public Health
Service, National Center for Health Statistics, Series 10, Number 11, August
1964.
Health Insurance: Type of Insuring Organization and Multiple C overage. United
States. July 1962-June 1963 . Vital and Health Statistics ^ries. Public Health
Service, National Center for Health Statistics, Series 10, Number 16, April
1965.
“National Health E^nditures, 1950-65". Social Security Bulletin^ February
1967, pp. 3-13.
Personal Health Expenses. Distribution of Persons bv Am ount and Type
Expense. United States; Julv-December 1962 . Vital and Health Statistics
Series, Public Health Service, National Center for Health Statistics, Series
10, Number 22, September 1965.
- 48 -
Personal Health Expenses. Per Capita A nnual Expenses. United States:
December 1962, Vital and Health Statistics Series, Public Health Service,
National Center for Health Statistics, Series 10, Number 27, February 1966.
B, Type, frequency, and other characteris tics of care
U.S. Deapartment of Health, Education, and Welfare, Vital and Health Statistics
Series.
Acute Condmons. Incidence and Associated Disab ility, United States,
1961" June 1962. Public Health Service, National Center for Health Statistics,
Series 10, Number 1, May 1963.
Acute Conditions. Incidence and Associated Disabi lity. United States, July
iflfi2-June 1963. Public Health Service, National Center for Health Statistics,
Series 10, Number 10, June 1964.
Acute Conditions. Incidence and Assoc i ated Disability, United States, Ju|y
1963-June 1964. Public Health Service, National Center for Health Statistics,
Series 10, Number 15, April 1965.
Acute Conditions. Incidence and Associ a ted Disability. United States* .July
1964"June 1965. Public Health Service, National Center for Health Statistics,
Series 10, Number 26, December 1965.
A^ Patterns in Medical Care. Illness , and Disability, United States, J^
iQfia-June 1965 . Public Health Service, National Center for Health Statistics,
Series 10, Number 32, June 1966.
Chftrftgteristics of Patients of Selecte d Types of Medical Sp^pialist? aM
Practitioners. United States. July 19 63-June 1964. Public Health Service,
National Center for Health Statistics, Series 10, Number 28, May 1966.
Dftntftl Care. Volume of Visits. United Sta tes. July 1957-June 1959. Hoallik
Statistics from the U.S. National Health Suryejr , Public Health Service, Se-
ries B-No. 15, April 1960.
•p fjtnn-y Tnnnme in Relation t o Selected Health Characterl St, ica. United St a t e s ,
Public Health Service, National Center for Health Statistics, Series 10,
Number 2, July 1963.
Mfiriinal Cflfft. Healt h Status, and Family Income^! Tnitfld States . Public
Health Service, National Center for Health Statistics, Series 10, Number 9,
May 1964.
49 -
Persons Hospitalized bv Number of Hospital Ep isodes and Days in a Y6^>
United States, July 1060-June 1962. Public Health Service, National Center
for Health Statistics, Series 10, Number 20, June 1965.
of Physician Visits. United States. July 1957 -June 1959. Health
Statistics from the U.S. National Health Survey . Public Health Service, Se-
ries B-No. 19, August 1960.
nf Physician Visits bv Place of Visit and Type of Service. United
States. July 1963-June 1964. Public Health Service, National Center for
Health Statistics, Series 10, Nmnber 18, June 1965.
III. WAGES
U.S. Department of Labor
Earnings and Supplementary Benefits in Hospitals. M id-1960, Bureau of
Labor Statistics, Bulletin 1294, May 1961.
Industry Wage Survey. Hospitals, Mid- 1963, Bureau of Labor Statistics,
Bulletin 1409, June 1964.
Industry Wage Survey. Hospitals. July -1966 , Bureau of Labor Statistics,
Bulletin 1553, 1967.
Industry Wage Survey. Nursing Homes and Related Facilities . April 1965^
Bureau of Labor Statistics, Bulletin 1492, April 1965.
U.S. Department of Health, Education, and Welfare
State Salary Ranges. Division of State Merit Systems, issued semiannually.
- 50 -
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