CAREERS IN ALLIED HEALTH

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CAREERS IN ALLIED HEALTH

Northern California Region

A P R I L 2 0 0 9

C

ENTER OF

E

XCELLENCE

Northern California Region

Los Rios Community College District 1410 Ethan Way Sacramento, CA 95825 (916) 563-3221 milant@losrios.edu

www.coeccc.net

An Initiative of

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Mission: The Centers of Excellence, in partnership with business and industry, deliver regional

workforce research customized for community college decision making and resource development.

Vision: We aspire to be the premier source of regional economic and workforce information and

insight for community colleges.

Centers of Excellence, Economic and Workforce Development Program

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Health care employers estimate that 5.1 percent of their current workforce, approximately

6,400 employees, will retire in the next three years in Northern California.

– Source: BW Research

Executive Summary

Population growth, the aging population, and the aging workforce are key factors driving demand for new workers in the health care industry. Between 2002 and 2007, the health care industry grew twice as fast as the overall economy, adding over 17,000 jobs in Northern California. The number of health care establishments grew by 11 percent from about 5,300 organizations in 2002 to 5,900 organizations in 2007. During this same time period, total wages increased by 46 percent.

In the next ten years (2007-2017), the health care industry is projected to grow by 23 percent in Northern California, with the greatest growth in the Greater Sacramento Region (21,200 new jobs), followed by the Northern Inland Region (5,400 new jobs), and the Northern Coastal Region (1,950 new jobs).

According to the Institute of Medicine of the National Academies, California (and the nation) is not ready to support the health care needs of the aging population. By 2011 the first baby boomers will turn age 65 and by 2030 the number of older adults will almost double, substantially increasing demand for health care services.

In this report, the Center of Excellence partnered with the North Far North Regional Health Occupations Resource Center (RHORC) to survey nearly 250 health care organizations. There were three main objectives of the survey: (1) identify employment projections for ten high demand allied health occupations, (2) assess educational and training requirements, and (3) identify recruitment and retention challenges.

According to the survey findings, Northern California health care employers expect to grow by less than 1 percent over the next twelve months, indicating that the recession is suppressing short-term growth. As the economy recovers and more workers begin to retire, the overall industry growth rate is expected to increase. Currently, replacement demand is expected to outpace new job growth in the majority of surveyed occupations.

The survey findings also revealed that the occupational growth rates vary from urban to rural regions. Greater Sacramento employers project a decline in six of the ten occupations, while the Inland and Coastal regions project growth in all ten occupations.

• In the Greater Sacramento region, registered nurses are expected to have the most openings from growth (790 jobs), followed by medical assistants (330 jobs), and medical and clinical laboratory technicians (50 jobs).

• In the Inland region, pharmacy technicians are projected to have the most openings from replacements with 50 jobs in the next twelve months, followed by registered nurses with 40 jobs, and medical assistants with 30 jobs. These three occupations are also expected to have the most new job openings.

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• In the Coastal region, Medical assistants, registered nurses, and pharmacy technicians are expected to have the largest number of job openings, generated by both growth and replacement demand.

The study also compiles the current supply of newly trained graduates for key occupations in the allied health sector. The research findings, which are being fully released for the first time in this report, indicate a small shortage between the supply and demand of several allied health occupations. In addition, the data shows an oversupply of a few occupations, such as medical assistants in the Greater Sacramento Region and respiratory therapists in the Inland Region.

The majority of employers in all three regions reported difficulty in finding qualified entry-level sonographers, radiological techs, and clinical laboratory technologists. There are many

challenges that impact the supply of a trained allied health workforce. Among the challenges are financial barriers to developing new programs, bottlenecks in core courses, and limited availability of qualified faculty.

As the economy recovers and more people begin to retire, the need to build capacity or develop new training programs will grow with increasing speed. This represents an opportunity for Northern California colleges to partner with local health care organizations to develop creative solutions that address challenges at the regional level. The goal of this report is to provide data to help guide these conversations and efforts.

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Introduction

Health care is one of the largest industries in northern California, providing excellent career opportunities for thousands of individuals. Despite the fact that health care, like most other industries, is impacted by the recession, the need for quality health care services is an indispensable facet of our society.

Under the direction of the California Community Colleges Economic and Workforce

Development Program (EWD), the mission of the Centers of Excellence is to identify industries and occupations that have unmet employee development needs at a regional level. The main objective of this study is to provide a detailed overview of the health care industry with a specific focus on high demand allied health occupations and potential training gaps in three Northern California regions:

• Greater Sacramento: Sacramento, El Dorado, Nevada, Placer, Sutter, Yolo and Yuba counties

• Northern Inland: Butte, Colusa, Glenn, Lessen, Modoc, Plumas, Shasta, Sierra, Siskiyou, Tehama and Trinity counties

• Northern Coastal: Del Norte, Humboldt, Lake, and Mendocino counties

Allied health is defined as a set of occupations with the core tasks of identification, prevention and treatment of diseases and disorders. Allied health occupations typically exclude doctors and nurses; however, because of the key role community colleges play in training registered nurses, this occupation was included in the analyses.

This Environmental Scan includes an overview of the industry, the top ten occupations selected for the study, employer needs and challenges, a high-level supply and demand analysis, major challenges facing the community college system, and recommendations on how to respond.

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Industry Overview

Industry Composition and Growth

In Northern California, there are approximately 5,900 health care organizations, ranging from small outpatient facilities to long-term care units to large urban hospitals. As shown in Exhibit 1, nearly half of all healthcare jobs are in the ambulatory health care services sector, one third reside in hospitals, and the remaining 19 percent are classified as nursing and residential care facilities.

Exhibit 1 – Health Care Organizations by Industry Sector in Northern California1

Exhibit 2 shows the distribution of health care employers by size. Although the majority of firms in the healthcare industry are small – employing less than 5 workers – organizations with 100 or more employees comprise more than half of the industry’s jobs. In the Northern Inland region, for example, three percent of the organizations represent more than half of the region’s

healthcare jobs. The distribution ratios are similar for all three regions in Northern California.

Exhibit 2 – Health Care Organizations by Size of Employment in Northern California2

Percent of organizations with 21 - 100 employees:

8%

19%

2%

Percent of organizations with less than 5 employees:

63% Percent of organizations with 501

+ employees: 0.4%

1 Economic Modeling Specialists, Inc., Fall 2008 2 InfoUSA Data, 2007

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Between 2002 and 2007, the health care industry added 17,000 jobs in Northern California, growing twice as fast as the overall economy (15 percent compared to seven percent). Based upon EMSI’s estimate of employment in 2007, the health care industry is projected to grow 23 percent by 2017 with the largest growth in the Greater Sacramento region.3 _{However, allied}

health employers in Northern California anticipate much more modest growth in the very near term –less than one percent over the next 12 months, indicating that the economic recession has restrained short-term growth.4

Table 1 – Ten Year Projections for the Health Care Industry by Region3 Industry

Description

Inland Coastal Sacramento Northern California _Total 2007 2017 _Chg% 2007 2017 _Chg% 2007 2017 _Chg% 2007 2017 _Chg% Ambulatory health care services 12,817 16,718 30% 6,252 7,293 17% 41,672 52,649 26% 60,741 76,660 26% Hospitals 8,223 8,573 4% 3,950 4,588 16% 29,813 36,020 21% 41,986 49,181 17% Nursing and residential care facilities 5,456 6,629 21% 1,746 2,028 16% 16,770 20,789 24% 23,972 29,446 23% Total 26,497 31,920 20% 11,947 13,909 16% 88,255 109,458 24% 126,699 155,287 23%

Factors Driving Growth

The demand for allied health workers is being propelled by four factors: (1) population growth, (2) the aging population, (3) the aging workforce, and (4) legislative policy.

Population Growth

The need for additional health care services will steadily increase as the population grows. Between 2002 and 2007, the population in Northern California grew by 9 percent, slightly faster than the state’s overall growth rate of 7.1 percent. During this same time period, the number of health care establishments grew by nearly 11 percent from about 5,300

establishments in 2002 to 5,900 in 2007. Total wages also increased by 46 percent,5

indicating a substantial expansion of existing health care payroll.

Table 2 shows the population growth rates by region. The Greater Sacramento region grew aggressively with the addition of over 220,000 people (10.7 percent), while the Inland and Coastal regions grew modestly with the addition of 34,000 (5.7 percent) and 10,435 (3.4 percent) residents respectively.

3 Economic Modeling Specialists, Inc., Fall 2008

4 BW Research, Allied Health Survey Results, January 2009

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Table 2 – Recent Population Growth by Region6

2002 2007 _{Absolute Change}2002 - 2007 2002 - 2007 % _Change

Inland 606,226 640,661 34,435 5.7%

Coastal 304,020 314,451 10,431 3.4%

Greater Sacramento 2,139,696 2,368,861 229,165 10.7%

Northern California Total 3,049,942 3,323,973 274,031 9.0%

California 35,063,959 37,559,440 2,495,481 7.1% Over the next 30 years (2007 – 2037), the California Department of Finance estimates that the Inland and Greater Sacramento regions will grow by 60.9 and 51.6 percent respectively, which is significantly faster than the state’s overall expected growth rate of 40.4 percent. The Coastal region is expected to grow at a modest rate of 30 percent.

Table 3 – Population Projections by Region6

2007 2037 _{Absolute Change}2007 - 2037 2007 - 2037 % _Change

Inland 640,661 1,030,685 390,024 60.9%

Coastal 314,451 408,695 94,244 30.0%

Greater Sacramento 2,368,861 3,592,267 1,223,406 51.6% Northern California Total 3,323,973 5,031,647 1,707,674 51.4% California 37,559,440 52,749,782 15,190,342 40.4% Overall, northern California will see more than a million and half new residents in the next thirty years, requiring health care organizations to expand their service capacity by building new facilities and adding allied health professionals to their payroll.

Aging Population

According to the Institute of Medicine of the National Academies, California (and the nation) is not ready to support the health care needs of the aging population. By 2011 the first baby boomers will turn age 65 and by 2030 the number of older adults will almost double to 11.4 million (see Exhibit 3 below). This will have a significant impact on the health care industry for two key reasons. First, the majority of older adults suffer from at least one chronic illness and are likely to visit a physician’s office twice as often as the average person. Second, the baby boomer generation is expected to live longer than any previous

generation, increasing and shifting demand for certain types of care.

‘California is not ready

to support the health

care needs of the aging

population’

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Exhibit 3 –Percent Change in Population Distribution between 2010 and 20307 0% 20% 40% 60% 80% 100% 120% 140% 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ Age Per ce nt Ch an ge Aging Workforce

As the population ages and baby boomers retire in larger numbers, the demand for allied health care professionals will outpace the current training systems capacity to produce new graduates. In 2000, 14 percent of the state’s population was over the age of 60. By 2020, it’s estimated that 20 percent of California’s population will be over the age of 60.8

In the short term, Northern California allied health employers estimate that 5.1 percent of their current employees will retire in the next three years.9_{When applied to industry employment}

estimates, about 6,400 new workers will be needed to fill in behind employees retiring from the health care system.

Legislative Policy

The California state legislature enacts scope of practice (SOP) laws that regulate the delivery of health care services. SOP laws establish the scope of services that may be provided by specific professions, sometimes increasing the overall demand. For example, the 2004 change in nurse staffing ratios significantly increased the demand for RNs across the state.

In addition, the California Department of Public Health Laboratory Field Services (subsequent to a California legislative mandate) established a licensing process for medical laboratory technicians (MLT). The new SOP law allows MLTs to perform routine laboratory tests for

diagnosis and treatment under the supervision of a clinical laboratory scientist (CLS). Unlike the four years of advanced education necessary to become a clinical laboratory scientist, MLTs are

7_{California Department of Finance, California Age Projections}

8_{Calculation based on California Department of Finance, California Age Projections} 9_{BW Research, Allied Health Survey Results, January 2009}

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required to complete only 60 units of education with an emphasis in science – e.g. an Associate of Science Degree in Medical Laboratory Technology. This new requirement may help to reduce the current and projected shortage of CLSs by increasing the pipeline of trained laboratory workers.

Occupational Overview

The Center of Excellence, in partnership with the RHORC, analyzed 60 allied health

occupations in terms of job growth, replacement demand, and minimum education requirements. Of the occupations examined, nine were selected for further investigation based on the

following criteria:

• Curriculum and employment requirements are relevant for community college instruction; • The projected growth plus replacements equal at least 25 or more jobs per year (250 or

more over 10 years) to substantiate offering a program; and, • The occupation must pay a living wage for the region.10

In addition, the diagnostic medical sonographer occupation was added to the list. Pre-survey interviews revealed that employers are having significant difficulty filling open diagnostic medical sonographer positions. Those that employ sonographers cited lengthy delays in hiring, extensive and expensive recruitment efforts, and interest in the development of a diagnostic medical sonographer training program at the community college level.

Table 4 displays the ten occupations selected for further investigation, including the employment and projection estimates.

• Registered nurse is the largest occupation with an annual demand of about 840 new and replacement workers.

• Medical assistants and pharmacy technicians are also large in size with an annual demand of 250 and 160 new and replacement workers, respectively.

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Table 4 – Top Ten Allied Health Occupations in Northern California11

Description 2007 _Jobs 2017 _Jobs New _Jobs Replace_-ments Total Annual _Demand Median _Wage Diagnostic medical

sonographers12, 13 580 680 100 80 180 20 $35.40

Medical and clinical laboratory

technicians 1,180 1,430 250 180 430 40 $16.71

technologists 940 1,090 150 140 290 30 $34.51

Medical assistants 6,120 7,860 1,740 760 2,500 250 $13.57 Medical records and health

information technicians 1,150 1,360 210 310 520 50 $14.87

Pharmacy technicians 2,450 3,330 880 750 1630 160 $17.36 Radiologic technologists and

technicians 1,420 1,670 240 190 440 40 $28.54

Registered nurses14 _19,860 _24,970 _5,110 _3,280 _{8,390 840} _$37.43

Respiratory therapists 920 1,150 230 140 370 40 $28.83

Surgical technologists 720 910 190 220 410 40 $21.57

Table 5 displays the education, state licensing, and clinical internship/externship requirements for the ten occupations profiled in this report. Most of the occupations require a minimum of an associate degree, and over half require a license to practice in California. For those

occupations that do not have a state licensing requirement, national certification is available and is required by some employers.

In a few cases, national accrediting associations require that students complete a clinical internship or externship during the educational program. Though clinical internships are not required for the majority of training programs, internships are often included in a program as a way to reinforce classroom curriculum.

11_{Economic Modeling Specialists, Inc., Fall 2008}

12_{The 2007 job estimate is extrapolated from the BW Research allied health survey. The survey findings indicated}

that this occupation is larger than the EMSI estimates, which is likely a result of data suppressions in smaller counties. Ten year projections and replacements job estimates were calculated using EMSI rates.

13_{Due to the sampling plan, the diagnostic medical sonographer employment estimate is derived from a}

representation of acute hospitals and clinical sites with limited data from free standing imaging centers. This may have further suppressed the estimate.

14_{Allied health typically includes occupations related to the identification, prevention and treatment of diseases and}

disorders, and excludes doctors and nurses. However, because of the potential long-term nursing shortage, the RN occupation was included in the occupational review.

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Table 5 – Education, Licensing and Clinical Experience Requirements for Top Ten Allied Health Occupations15,16

Education

Requirement Occupation State Licensing? Clinical Internship/ Externship?

On-the-Job-Training Medical assistants No No

Certificate Pharmacy technicians_{Surgical technologists} Yes_No _YesNo

Associate Degree

Diagnostic medical sonographers No Yes Medical and clinical laboratory

technicians Yes

Medical records and health

information technicians No No

Radiologic technologists and

technicians Yes No

Registered nurses Yes Yes

Respiratory therapists Yes No

Bachelor Degree Medical and clinical laboratory _{technologists} Yes No Appendix B includes a profile of the top ten allied health occupations, including a brief

description, educational, licensure and/or registration requirements, and a table of community colleges that provide related programs in northern California.

Appendix C provides the typical education requirements of successful applicants reported by employers in Northern California. There is some variation among the education requirements provided by the Bureau of Labor Statistics (BLS) and reported by employers in Northern California. For example, Northern California employers typically hire medical records and health information technicians with the completion of a high school degree or equivalent, while the national education standard is an associate degree.

Employer Needs and Challenges

To learn more about the top ten high demand occupations, 250 health care organizations were surveyed in three regions of northern California (Greater Sacramento, Inland, and Coastal). The purpose of the survey was to (1) identify short-term employment projections and

replacement demand, (2) assess educational requirements, and (3) identify recruitment and retention challenges.

In addition to data collected via the survey instrument, nine interviews with human resource professionals and workforce development managers were conducted. These interviews provided additional insight on specific workforce issues impacting the health care industry in northern California. This section reviews the findings from both the survey and executive interviews.

15_{Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition} 16_{America’s Career InfoNet}

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Greater Sacramento Region

In the Greater Sacramento Region, 124 health care organizations completed the occupation survey questions between December 2008 and February 2009. Table 6 provides a summary of the projected growth and replacement demand over the next twelve months. As shown, several allied health occupations are projected to decline, reflecting the current economic climate of the area. Of the four occupations projected to grow, registered nurses are expected to have the most openings from growth (790 jobs), followed by medical assistants (330 jobs), medical and clinical laboratory technicians (50 jobs), and surgical technologists (10 jobs). Replacement demand is expected to outpace new job growth in all but two of the ten occupations. Job openings created by replacements include turnover within the industry, and general separations from workers leaving the industry, as well as retirements. Accordingly, some of the openings from replacements will be filled by trained workers moving to the region or changing employers within the region.

Table 6 – Allied Health Job Openings in the Next 12 Months in the Greater Sacramento Region17

Occupation _EmploymentCurrent Replacements Next 12 Months Openings from Replacements Growth Next 12 Months Openings from Growth Total Openings*

Diagnostic medical sonographers18 _{260 3.3% 10 -0.4% 0 10}

technicians or MLT's 940 3.1% 30 5.7% 50 80

technologists or CLS’s18 720 9.2% 70 -0.6% 0 60

Medical assistants 4,060 4.0% 160 8.1% 330 490

information technicians 720 6.8% 50 -0.7% -10 40

Pharmacy technicians 1,620 1.9% 30 -5.1% -80 -50 Radiological technologists and

technicians 960 5.4% 50 -0.9% -10 40

Registered nurses or RN’s 15,080 6.7% 1,010 5.3% 790 1,800

Respiratory therapists18 _{650 5.7% 40 -4.1%}_{-30 10}

Surgical technologists 540 8.2% 40 1.4% 10 50

Summary 25,550 5.8% 1,490 4.1% 1,050 2,540

*Totals may not add due to rounding.

Exhibit 4 displays the level of difficulty reported by employers in finding entry-level applicants in the Greater Sacramento Region.

• Employers reported the greatest difficulty recruiting entry-level diagnostic medical sonographers with 42 percent reporting great difficulty and another 32 percent reporting some difficulty.

17_{BW Research, Allied Health Survey Results, January 2009}

18_{Survey data for this occupation did not meet normal COE survey criteria (minimal criteria states that more than 15}

percent of employers surveyed provide information on this occupation). However, data is included because the total occupational employment of surveyed employers is greater than 15 percent of the current employment in the region.

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• Although less pronounced, 18 percent of the survey respondents reported great difficulty and another 43 percent reported some difficulty recruiting entry-level radiological technologists and technicians. In particular, employers reported difficulty finding

radiological techs with specialized training in areas of computed tomography, magnetic resonance imaging, and mammography. 19

• 13 percent of survey respondents reported great difficulty and another 63 percent reported some difficulty recruiting entry-level medical and clinical laboratory

technologists. This challenge was echoed by employers during the executive interviews. However, most thought the shortage would diminish as their organizations adjusted their operating practices to reflect current legislative changes that allowed licensed MLTs to perform routine laboratory work, under the supervision of medical and clinical

laboratory technologists.

• Lastly, only 57 percent of the survey respondents reported difficulty recruiting entry-level registered nurses. In recent years, vacancy rates for registered nurses have declined considerably, due to an increase in supply and fewer workers retiring than expected. This has decreased the level of difficulty in finding qualified applicants.

Exhibit 4 – Level of Difficulty Finding Qualified Entry-Level Applicants in the Greater Sacramento Region20

10% 11% 13% 14% 18% 42% 13% 25% 36% 31% 39% 33% 35% 43% 43% 32% 63% 70% 64% 60% 56% 56% 52% 43% 39% 26% 25% 6% 5% 0% 0% 100%

Medical records and health information technicians Respiratory therapists Medical assistants Medical and clinical laboratory technicians or MLT's Pharmacy technicians Surgical technologists Registered nurses or RN's Radiological technologists and technicians Diagnostic medical sonographers Medical and clinical laboratory technologists or CLS's

Great difficulty Some difficulty No difficulty

19_{Executive Interviews, Sacramento Region Health Care Employers} 20_{BW Research, Allied Health Survey Results, January 2009}

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Northern Inland Region

In the Northern Inland Region, 62 health care organizations completed the occupation survey questions between December 2008 and February 2009. Unlike the Greater Sacramento Region, employers in the Inland area expect to add workers in all 10 occupations. The growth rate ranged from 1.8 percent for diagnostic medical sonographers to 5.5 percent for surgical technologists. The largest absolute growth is expected for registered nurses (100 jobs), followed by medical assistants (60 jobs) and pharmacy technicians (30 jobs).

Replacement demand is expected to outpace new job growth in eight of the ten occupations. Pharmacy technicians are projected to have the most openings from replacements with 50 jobs in the next twelve months, followed by registered nurses with 40 jobs, and medical assistants with 30 jobs. These three occupations are also expected to have the most new job openings.

Table 7 – Allied Health Job Openings in the Next 12 Months in the Northern Inland Region21

Occupation _EmploymentCurrent Replacements Next 12 Months Openings from Replacements Growth Next 12 Months Openings from Growth Total Openings*

Diagnostic medical sonographers 170 1.8% <5 1.8% <5 10 Medical and clinical laboratory

technicians or MLT's 180 2.0% <5 2.0% <5 10

technologists or CLS’s22 180 7.1% 10 4.3% 10 20

Medical assistants 1,310 2.2% 30 4.5% 60 90

information technicians 290 6.2% 20 4.5% 10 30

Pharmacy technicians22 _{570 8.0% 50}_4.6%₃₀₇₀

Radiological technologists and

technicians 360 6.5% 20 3.3% 10 30

Registered nurses or RN’s 3,260 1.3% 40 2.9% 100 140

Respiratory therapists22 _{200 5.7% 10}_4.9%₁₀₂₀

Surgical technologists 150 6.6% 10 5.5% 10 20

Summary 6,670 3.0% 200 3.6% 240 440

*Totals may not add due to rounding

Employers in the Northern Inland region reported the greatest difficulty recruiting entry-level radiological technologists and technicians with 43 percent reporting great difficulty and another 36 percent reporting some difficulty.

The majority of Northern Inland employers also reported difficulty in finding qualified entry-level medical assistants, CLSs, diagnostic medical sonographers, MLTs, surgical technologists, and registered nursing applicants. Similar to the Greater Sacramento Region, the vacancy rate for registered nurses is beginning to diminish as workers concerned about the economy

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postpone retirement. However, as the economy recovers, the demand for registered nursing will increase as these workers begin to exit the system in larger numbers.

Exhibit 5 – Level of Difficulty Finding Qualified Entry-Level Applicants in the Inland Region23

11% 12% 18% 29% 33% 9% 43% 40% 41% 33% 35% 41% 36% 36% 33% 59% 36% 60% 59% 56% 48% 47% 45% 36% 33% 31% 21% 17% 0% 0% 0% 100% Pharmacy technicians Medical records and health information technicians Respiratory therapists Registered nurses or RN's Surgical technologists Medical and clinical laboratory technicians or MLT's Diagnostic medical sonographers Medical and clinical laboratory technologists or CLS's Medical assistants Radiological technologists and technicians

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Northern Coastal Region

In the Northern Coastal Region, 64 health care organizations completed the occupation survey questions between December 2008 and February 2009. All of the occupations, with the exception of medical and clinical laboratory technicians (CLS), are expected to grow in the next twelve months. The CLS occupation is projected to have no new job growth during this time period.

Medical assistants, registered nurses, and pharmacy technicians are expected to have the largest number of job openings, generated by both growth and replacement demand. Similar to the Northern Inland Region, the replacement rate for pharmacy technicians is expected to be high at 12 percent, which translates into 30 job openings.

Table 8 – Allied Health Job Openings in the Next 12 Months in the Coastal Region24

Occupation _EmploymentCurrent Replacements Next 12 Months Openings from Replacements Growth Next 12 Months Openings from Growth Total Openings

Diagnostic medical sonographers 150 4.8% 10 0.0% <5 10 Medical and clinical laboratory

technicians or MLT's 60 9.2% 10 4.2% <5 10

technologists or CLS’s 40 13.5% 10 0.0% <5 10

Medical assistants 750 9.0% 70 10.1% 80 140

information technicians 140 4.5% 10 3.0% <5 10

Pharmacy technicians 270 12.0% 30 4.0% 10 40

Radiological technologists and

technicians 100 0.0% <5 3.8% <5 <5

Registered nurses or RN’s 1,520 2.4% 40 4.8% 70 110

Respiratory therapists25 _{70 9.7% 10}_3.2%_<5₁₀

Surgical technologists 30 10.0% <5 10.0% <5 10

Summary 3,120 5.4% 170 5.6% 170 340

*Totals may not add due to rounding

In the Northern Coastal Region, the majority of survey respondents reported difficulty in finding qualified entry-level applicants for nine of the 10 occupations. Medical records and health information technician is the only occupation in which more than half (63 percent) reported no difficulty finding qualified applicants. The remaining 36 percent reported some difficulty. As shown in Exhibit 6, 100 percent of the survey respondents reported difficulty recruiting diagnostic medical sonographers, with over half reporting great difficulty. Because diagnostic medical sonographer is a small occupation (150 jobs in 2007) with a very small annual

projected demand for new workers, the development of a training program would oversupply workers in this area. Consequently, employers are forced to recruit from outside the region.

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Exhibit 6 – Level of Difficulty Finding Qualified Entry-Level Applicants in the Coastal Region26

20% 38% 23% 36% 13% 50% 57% 33% 39% 40% 39% 25% 46% 36% 63% 36% 43% 63% 45% 40% 39% 38% 31% 27% 25% 14% 0% 22% 3% 16% 0% 100%

Medical records and health information technicians Medical assistants Pharmacy technicians Registered nurses or RN's Respiratory therapists Medical and clinical laboratory technicians or MLT's Radiological technologists and technicians Surgical technologists Medical and clinical laboratory technologists or CLS's Diagnostic medical sonographers

26

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Northern California Workforce Issues

As shown in Exhibit 7, 70 percent of the employers in Northern California are experiencing difficulty replacing workers with qualified candidates from outside the organization, with 50 percent reporting some difficulty and 20 percent reporting great difficulty. About half of the employers are experiencing some to great difficulty replacing workers with qualified

employees within the organization. However, more than half of the survey respondents reported no difficulty in retraining/educating entry-level workers for advanced positions or keeping current workers trained on new technologies.

Exhibit 7 –Workforce Issues and Challenges for Northern California Allied Health Employers27

8% 37% 36% 43% 50% 60% 53% 47% 29% 7% 2% 20% 2% 5% 3% 2% 0% 100%

Keeping current workers properly trained on new technologies and software applications

Retraining and educating entry-level employees so they can advance to a new position with greater pay and/or responsibilities Replacing workers with qualified employees within the organization Replacing workers with qualified candidates from outside the organization

Don't know/Not applicable

When asked if there was a preference for applicants from a public community college or private vocational college, 87 percent of the survey respondents reported no preference, 8 percent preferred community college applicants, and 3 percent preferred private vocational schools. Although there was some variance in the preference for the private vocational schools among the three regions, the preference for community colleges was consistently reported at 8 percent. Most employers echoed the no preference sentiment in the executive interviews, but a few presented a very different view. The employers that stated preference for community college applicants find that these graduates come with better technical skills, interpersonal skills and writing ability. The reasons cited for the difference in quality include: longer programs with a general education foundation, better trained faculty, and more rigor in the curriculum. The ability to transfer to a four year university and affordable fees were also cited as desirable aspects of the community college system since they encourage continuous, life long learning. Over 40 percent of the organizations surveyed provide tuition assistance or reimbursement and 74 percent provide flexible work hours for employees enrolled at a college or university.

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Current Training Supply & Demand

Community colleges, private education institutions, and regional occupational programs (ROPs) throughout California offer allied health training programs. Some programs, however, have not applied for or obtained the appropriate accreditation and therefore, provide limited

opportunities to their graduates.

Table 9 provides an estimate of the gap between the supply of newly trained workers and the projected number of job openings in the next 12 months. The total number of degrees awarded is an estimate based on data provided by the California Post Secondary Commission and a survey conducted by the COE and Sacramento Employment and Training Agency (SETA). The survey data are approximate, based on self-reporting from ROPs and private institutions. The total job openings in the next 12 months include growth and replacement estimates. Because replacement estimates include turnover within the industry, the difference between the supply and demand does not reflect an exact shortage or oversupply. In addition, migration data on trained workers is not available, also impacting the projected shortage or oversupply. Though there are several data limitations to supply and demand analysis, it does provide a starting point to assess potential training challenges. For example, there is a large difference between the supply and demand of medical assistants in all three regions. In the Greater Sacramento Region, it appears that the education system is training too many medical assistants for which there will not be enough jobs.

The data also suggests a significant gap between supply and demand of registered nurses in the Greater Sacramento Region. However, over 1,000 of the total openings are replacement jobs, indicating that turnover within the industry may be exaggerating the potential shortage. However, in the Northern Inland and Coastal regions, the data suggests that training systems are not supplying enough medical assistant graduates to meet the annual demand. This

assessment is supported by survey findings revealing that more than 50 percent of respondents are experiencing difficulty recruiting medical assistants. In the Northern Inland region, the survey revealed this occupation as the second most difficult occupation to fill.

In addition, there appears to be a significant shortage of pharmacy techs in the Northern Inland region. However, Boston Reed College, located in Oroville, recently launched a

pharmacy technician that should help close that gap. In the table, deficits (i.e., too few program completers) are noted in red.

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Table 9: Allied Health Supply and Demand by Region28, 29

Greater Sacramento Inland Coastal

Total # of Degrees Awarded Total Job Openings Next 12 Months Difference Total # of Degrees Awarded Total Job Openings Next 12 Months Difference Total # of Degrees Awarded Total Job Openings Next 12 Months Difference Diagnostic medical sonographers 0 10 -10 0 10 -10 0 10 -10 Medical and clinical laboratory technicians 0 80 -80 0 10 -10 0 10 -10 Medical and clinical laboratory technologists 21 60 -39 0 20 -20 0 10 -10 Medical Assistants 1134 490 644 35 90 -55 52 140 -88 Medical records and health information technicians 396 40 356 8 30 -22 1 10 -9 Pharmacy Technicians 409 -50 459 12 70 -58 6 40 -34 Radiological technologists and technicians 45 40 5 0 30 -30 0 <5 0 Registered nurses or RNs 524 1800 -1276 212 140 72 129 110 19 Respiratory Therapists 29 10 19 40 20 20 0 10 -10 Surgical Technologists 113 50 63 0 20 -20 0 10 -10

In Northern California, several community colleges have plans to develop new allied health programs and some colleges are in the process of assessing the workforce need for a new program. Below is the list of programs currently planned or under consideration:

• Butte College – Physical Therapy Assistant or Occupational Therapy Assistant (Considering)

• Folsom Lake College – MLT (Summer 2010); Phlebotomy (January 2010); Rad Technicians (Considering)

28_{Total number of public and private degrees awarded in the 2007-2008 fiscal year: California Community}

Colleges Chancellor’s Office Data Mart, COE/SETA survey of private education institutions, and California Post Secondary Commission (CPEC). 2006-2007 CPEC data is used for 4-year universities and private education institutions when 07-08 data was not available. Survey data is incomplete; some private education institutions were contacted, but chose not to respond. 60 of 94 programs offered by private education institution are represented in the dataset.

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• College of the Redwoods – Paramedic (Fall 2009); Physical Therapy (Fall 2010); and expanding Medical Assisting (Fall 2010)

• Cosumnes River College – Allied Health Tech (Considering); Surgery Tech (Considering); Ultrasound Tech (Fall 2011)

• American River College – Health Care Interpreter (Spring 2010)

• Feather River College – Personal Care Attendant; Home Health Aid (Planned) • Shasta College – Revising Medical Front Office

Community College Challenges

There are significant challenges restricting the supply of allied healthcare professionals. Some of the challenges require a shift in institutional policy while others require a shift in public policy. The key challenges include:

• Inefficient funding available for allied health programs. Community colleges receive a state reimbursement based on full time equivalents, regardless of program type. Allied health programs cost substantially more than traditional academic programs because of licensing regulations that limit the number of students per course. For example, it costs a community college approximately $20,000 to provide a two-year nursing program, yet the reimbursement is only $7,000.30_{Allied health programs also have large start-up}

costs, especially those that require specialized equipment. Specialized equipment for training and educational purposes can be extremely expensive and state funding for these purposes is minimal.

• Limited availability of qualified faculty. Community college teaching salaries do not compete well with practitioner salaries in the allied health professional marketplace. In some cases, experienced allied health professionals can earn twice as much in their respective health care field than they can as community college instructors. Further, it is expensive to obtain a Masters degree in an allied health profession, which places pressure on graduates to pursue employment that will maximize their salary potential. • Lack of clinical sites. Hands-on experience and observation at a clinical site is a

licensure requirement of several allied health occupations. However, the limited availability of clinical sites makes it difficult to expand or develop new programs. • Bottleneck in core courses. Anatomy, physiology and microbiology courses are

prerequisites for several allied health programs, creating significant demand for every available seat. In many cases, the lack of space in core courses forces students to extend their preparatory time by a semester or more. This is slowing the pipeline of new workers entering the allied health field as well as encouraging some students to pursue other career paths. Appendix E provides a table of core courses in the ten occupations profiled in this report.

• More quality applicants than available spaces. With occupations that have high vacancy rates, such as registered nurses, the lack of available training spaces is a significant challenge. Even though there is sufficient interest by candidates that have

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completed the prerequisites, qualified students are placed on waiting lists for long periods of time.

• High student attrition rates. High attrition rates in allied healthcare programs are common due to a range of variables. Students may enter a program with inadequate preparatory skills, a lack of awareness/understanding about allied health occupations, and/or an inability to navigate the educational system. In addition, the use of the lottery system to admit students is known to impact completion rates.

• Lack of articulation among colleges. Some variation among course prerequisites and program curriculum prevent students from easily transferring between colleges to take courses. This leaves seats unfilled and prevents some students from completing a program in a timely manner.

• Competition from private education institutions. With larger advertising budgets, private education institutions run ads that promote allied health careers and career training. These institutions promote flexible, short-term training programs with fees that are significantly higher than the community college system.

Studies also cite changing licensure requirements, limited awareness of various allied healthcare professions, and the lack of consistent workforce data as factors that impact the supply of qualified professionals.31

Conclusion and Recommendations

Building upon existing partnerships with the allied healthcare industry employers, Northern California community colleges should use this report to open a discussion of the challenges and potential solutions to meeting local industry needs. The Center of Excellence would like to offer several recommendations for consideration. These recommendations can serve as a starting point and road map for colleges to address the current and long term allied healthcare employment needs.

• Provide additional sections of allied health core courses • Expand student support services

• Increase collaboration among colleges in northern California to articulate programs • Identify and convene local allied healthcare employers

• Explore creative solutions to barriers in program development

Provide additional sections of allied health core courses

Anatomy, physiology, microbiology, medical terminology, chemistry, and others serve as core courses and prerequisites in many allied health programs. Colleges report that there are typically student waiting lists for these core courses. The development or expansion of allied health core courses would diminish the “bottleneck” effect of students waiting for prerequisites. Appendix E provides an overview of the core courses required for the ten allied health

occupations profiled in this report.

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Expand student support services

Students drop courses or fail to complete their educational goals for a variety of reasons – lack of basic skills, financial barriers, unreliable transportation and/or child care services. These factors contribute to a bottleneck in core courses as well as reduce the number of graduates entering the workforce. Expansion of student support services would help to increase retention rates. Appendix I highlights a model program that increased student retention and success rates by adopting merit-based criteria and proactively connecting students to support services.

Increase collaboration among colleges in Northern California to articulate programs

Many community college allied health programs are accredited by national health care

associations. To meet the accreditation standards, specific content is included in the curricula, which can be presented in a variety of courses/formats. As long as the program meets the standards in the curricula, the program can apply for accreditation. Consequently, the composition of courses for the same allied health program often differs from college to college, preventing students from taking courses at other campuses. Increased collaboration to articulate programs would streamline the pipeline of new workers entering the system as well as provide students more options to complete a program (thus helping to reduce overall attrition across the system).

Identify and convene local allied healthcare employers

Colleges in Northern California currently benefit from partnerships with allied healthcare employers. Through the identification and convening of local allied healthcare employers, colleges and employers can use the data in this report to begin conversations on program development as a region. The Regional Health Occupations Resource Center (RHORC) is a key player in facilitating these relationships.

• Many of the hospitals in the region have equipment in place to allow students to receive training. Colleges can work with employers to develop a shared use of the facility or donate clinical time for students. By providing access to equipment already in place, these partners help offset the costs of developing and implementing a new or expanded program and may actually speed the development of new programs.

• Additionally, employers may be able to provide release time for employees to serve as instructors for allied healthcare courses. The results would be highly beneficial for colleges, employers, and students while sharing some of the costs of developing a new program. However, strong partnerships are required before engaging in such discussions. • Industry partners could help community colleges with the high cost of allied healthcare

programs through innovative working arrangements, monetary contributions and supportive advocacy to increase funding for high priority programs like health care education. A great example of this type of partnership is the Sutter Center for Health Professions. To address the shortage of registered nurses, the Los Rios Community College District partnered with Sutter Health to launch an accelerated Nursing Program that is partially funded by both organizations. With specific screening criteria and ongoing student support, the attrition rate has been substantially cut compared to other programs in the state.

These processes will strengthen colleges’ strategic partnerships with businesses in the allied healthcare industry to maximize use of clinical and teaching resources. Convening employers would also allow for colleges to be responsive to industry needs in program development while at the same time working together to collaborate and strategically implement programs that will have the largest impact on the regional allied healthcare workforce.

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Explore creative solutions to barriers in program development

There are many strategies and solutions that can be used to overcome barriers and develop new programs. By using the data presented in this report, the North Far North Regional Consortium can identify the regional educational needs, determine how many programs are warranted and which colleges will respond to specific occupational needs, and collaboratively design programs designed to serve the entire region.

One of the workforce challenges identified in this report is the shortage of diagnostic medical sonographers in the Coastal Region. All of the survey respondents in the Northern Coastal Region reported difficulty finding qualified entry-level sonographers. However, because the overall job growth and replacement need is fewer than five each year, the development of a program focused just on sonographers would oversupply the workforce. A possible solution to this challenge may be the development of an imaging program that focuses on several related occupations.

Community colleges in Northern California have a unique opportunity to proactively respond to a potential workforce crisis in the allied health care industry. As the provider of the majority of trained allied healthcare professionals, community colleges are positioned to educate new workers, replacement workers and incumbent workers for the allied healthcare industry. They can play an integral role in helping to alleviate a crisis and impact their surrounding community and the state with their efforts.

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References

Access to Career Ladders at U.S. Community Colleges, American Association of Community

Colleges, http://www.aminef.or.id/careerladder America’s Career InfoNet, http://www.acinet.org/

California Community Colleges Chancellor’s Office Data Mart, Degrees Awarded by Discipline, 2007-2008

California Community Colleges Statewide Health Occupations Directory, http://www.healthoccupations.org/

California Department of Finance, E-4 Population Estimates for Cities, Counties and the State, 2001-2008, with 2000 Benchmark

California Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000–2050. California Employment Development Department, Labor Market Information Division,

Quarterly Census of Employment and Wages

California Post Secondary Commission (CPEC), Degrees Awarded by Discipline, 2006-2007 Career Prep System, http://www.careerprep.org/careerpath.htm

Closing the Health Workforce Gap in California: The Education Imperative, Health Workforce

Solutions, November 2007.

COE/SETA Survey of Private Education Institutions

Economic Modeling Specialists, Inc. (EMSI) Complete Data, http://www.economicmodeling.com/

Environmental Systems Research Institute (ESRI) Business Analyst Software. InfoUSA 2007 Data.

Health Professions Education Data Book 2007-2008, American Medical Association

The Career Ladder Mapping Project, Shirley Ware Education Center, SEIU, Local 250 AFL-CIO, December 2002

U.S. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition

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Appendix A: How to Utilize this Report

This report is designed to provide current industry data to:

• Define potential strategic opportunities relative to an industry’s emerging trends and workforce needs;

• Influence and inform local college program planning and resource development; • Promote a future-oriented and market responsive way of thinking among stakeholders;

and,

• Assist faculty, Economic Development and CTE administrators, and Community and Contract Education programs in connecting with industry partners.

The information in this report has been validated by employers and also includes a listing of what programs are already being offered by colleges to address those workforce needs. In some instances, the labor market information and industry validation will suggest that colleges might not want to begin or add programs, thereby avoiding needless replication and low enrollments.

About the Centers of Excellence

The Centers of Excellence (COE), in partnership with business and industry, deliver regional workforce research customized for community college decision making and resource

development. This information has proven valuable to colleges in beginning, revising, or

updating economic development and Career Technical Education (CTE) programs, strengthening grant applications, assisting in the accreditation process, and in supporting strategic planning efforts.

The Centers of Excellence Initiative is funded in part by the Chancellor’s Office, California Community Colleges, Economic and Workforce Development Program. The total grant amount (grant number 08-305-017 for $205,000) represents funding for multiple projects and written reports through the Center of Excellence. The Centers aspire to be the premier source of regional economic and workforce information and insight for California’s community colleges. More information about the Centers of Excellence is available at www.coeccc.net.

About the North Far North Regional Health Occupations Resource Center

The purpose of the California Community Colleges Health Care Delivery Initiative is to identify workforce needs of healthcare delivery systems and develop solutions through a comprehensive problem solving process. This process may include assessment and analysis, planning and development, and implementation and evaluation. The Health Care Delivery Initiative is

composed of a network of strategically located Regional Health Occupations Resource Centers placed throughout California. The Regional Health Occupations Resource Center serving the North Far North region is hosted by Butte College.

The role of the Regional Health Occupations Resource Centers is to facilitate collaboration between the education segments and the health care delivery system to respond to identified needs. The RHORC’s discern and react to regional health care delivery system needs with a variety of solutions. Each has an industry advisory committee and works cooperatively with the community college health occupation educational programs to broker services to identified

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needs. They conduct regional surveys and serve as a vital link between academic programs and the regional needs of employers. Additionally, the RHORC’s are able to capitalize on their network to develop and disseminate programs where regional need exists.

This [publication/project] was supported by Economic and Workforce Development funds awarded to Butte Community College by the Chancellor's Office, California Community Colleges. It was produced pursuant to grant agreement number 07-315-012.

More information about the North Far North Regional Health Occupations Resource Center is available at http://www.healthoccupations.org/rhorc/1/.

Important Disclaimer

All representations included in this report have been produced from primary research and/or secondary review of publicly and/or privately available data and/or research reports. Efforts have been made to qualify and validate the accuracy of the data and the reported findings; however, neither the Centers of Excellence, COE host District, nor California Community Colleges Chancellor’s Office are responsible for applications or decisions made by recipient community colleges or their representatives based upon components or recommendations contained in this study.

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Appendix B: Occupational Profiles

Diagnostic Medical Sonographers

Diagnostic medical sonographers use specialized equipment to create images of structures inside the human body that are used by physicians to make a medical diagnosis. Sonographers have extensive, direct patient contact that may include performing some invasive procedures. They must be able to interact compassionately and effectively with people who range from healthy to critically ill. They must also be knowledgeable about and limit the risk from possible exposure to blood and body fluids. Many sonographers also assist in electronic and clerical scheduling, record keeping and computerized image archiving.

Diagnostic medical sonographers must complete training in a formal education program, which includes a minimum of 60 semester credits and a clinical internship/externship. Programs receive accreditation through the Council for Higher Education Accreditation or United States Department of Education. In addition to obtaining a certificate or degree in diagnostic medical sonography, certification is available through the American Registry for Diagnostic Medical Sonography and is required by most employers.

With additional training, diagnostic medical sonographers may specialize in the following areas: • Abdomen: evaluation of all the soft tissues, blood vessels and organs of the abdominal

cavities (i.e., liver, spleen, urinary tract, pancreas).

• Obstetrics/Gynecology: evaluation of the female reproductive system and/or fetus. • Echocardiography: (adult echo, pediatric echo, fetal echo) evaluation of the anatomy

and hemodynamics (blood flow) of the heart, its valves and related blood vessels. • Vascular Technology: evaluation and analysis of the hemodynamics (blood flow) or

cerebral peripheral and abdominal blood vessels. • Neurosonology: evaluation of the brain and spinal cord.

• Breast: frequently used to evaluate breast abnormalities that are found through screening or diagnostic mammography, and especially to differentiate breast cysts (benign) from potentially cancerous masses.

• Ophthalmology: evaluation of the eye, including orbital structures and muscles Currently, there are no diagnostic medical sonographer community college programs in the region. However, Cosumnes River College is developing an ultrasound technician certificate program.

College Program

Cosumnes River College Ultrasound Technician (Certificate planned fall 2011)

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Medical and Clinical Laboratory Technicians

Medical laboratory technicians perform tests which play a role in the detection, diagnosis, and treatment of disease. Technicians examine and analyze body fluids and cells to look for

bacteria, parasites, and microorganisms. Technicians also analyze the chemical content of fluids, match blood for transfusions, test drug levels in blood, prepare specimens for examination, count cells, and look for abnormal cells in blood and body fluids. With increasing reliance on computer technology, the role of medical laboratory technicians has become less hands-on and more analytical. Technicians may work in several areas of the clinical laboratory or specialize in one area.

An Associate Degree in Medical Lab Technology is typically the minimum requirement to become a medical laboratory technician. Coursework consists of Chemistry, Biological sciences, Microbiology, Mathematics, and Statistics. Associate Degrees for Medical Lab Technology are accredited through the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), the Commission on Accreditation of Allied Health Education Programs, and the Accrediting Bureau of Health Education Schools.

Folsom Lake College is currently developing an Associate of Science degree program in

Medical Laboratory Technicians, which will be followed by a certificate degree. The program is scheduled to be launched fall of 2010. Although the main focus is to prepare students for MLT careers in the most efficient possible way, Folsom Lake College may articulate with UC Davis to create a seamless career pathway from MLT to CLS.

Folsom Lake College Medical Laboratory Technicians (A.S. / _{Certificate planned summer 2010)} Source: O*Net, American Society for Clinical Laboratory Scientists, http://www.ascls.org

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Medical and Clinical Laboratory Technologists

Medical and clinical laboratory technologists, otherwise known as clinical laboratory scientists (CLS), generate accurate laboratory data that are needed to aid in detecting cancer, heart attacks, diabetes, infectious mononucleosis, and identification of bacteria or viruses that cause infections, as well as in detecting drugs of abuse. In addition, CLS are responsible for (1) analyzing laboratory findings to check the accuracy of the results, (2) entering data from analysis of medical tests and clinical results into computer for storage, (3) operating, calibrating and maintaining equipment used in quantitative and qualitative analysis, such as

spectrophotometers, calorimeters, flame photometers, and computer-controlled analyzers and (4) establishing and monitoring quality assurance programs and activities to ensure the accuracy of laboratory results.

The minimum educational requirement of clinical laboratory scientists is the completion of an accredited baccalaureate degree program in clinical laboratory science. CLS education programs are typically accredited by the National Accrediting Agency for Clinical Laboratory Sciences and the Western Association of Schools and Colleges. Upon completion of the degree program, graduates are eligible for national certification through the National Credentialing Agency for Laboratory Personnel (NCA). In addition, CLS must be licensed by the California Department of Health Services.

In northern California, UC Davis is the only education institution that offers an accredited Clinical Laboratory Science program.

College / University Program

University of California, Davis Clinical Laboratory Science/Medical _{Technology/Technologist (Master’s Degree)} California State University,

Sacramento Clinical Laboratory Science (Bachelor’s Degree)

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Medical Assistants

Medical assistants perform administrative and clinical tasks to keep the offices of physicians, podiatrists, chiropractors, and other health practitioners running smoothly. Administration duties may include scheduling appointments, maintaining medical records, and billing and coding for insurance purposes. Clinical tasks may include taking medical histories, recording vital signs, explaining treatment procedures to patients, preparing patients for examination, and assisting the physician during examination.

Most employers prefer graduates of formal programs in medical assisting. Such programs are offered as a certificate or Associates Degree. Certificate and degree programs are accredited through the Commission on Accreditation of Allied Health Programs and the Accrediting Bureau of Health Education Schools. Coursework in the programs include Anatomy, Physiology, Medical terminology, Laboratory techniques, Clinical and diagnostic procedures, and administration of medication. Certification, although not mandatory, is available through the American

Association of Medical Assistants, American Medical Technologists, and the California Certifying Board of Medical Assistants.

Currently, two community colleges in Northern California offer programs in Medical Assisting.

Butte College Medical Front Office Assistant (A.S. / Certificate)

College of the Redwoods Medical Assisting (A.S. / Certificate) _{Medical Office Business Skills (Certificate)} Cosumnes River College Medical Assisting (A.S. / Certificate) Medical Assisting, Administrative (Certificate)

Medical Assisting, Medical Insurance Billing (Certificate) Lake Tahoe Community

College Medical Office Assistant, Administrative (A.A. / Certificate) Medical Office Assistant, Clinical (A.A. / Certificate) Lake Tahoe Community

College Medical Office Assistant: Administrative (A.A. / Certificate) Medical Office Assistant: Clinical (A.A. / Certificate)

Mendocino College Medical Office Technology (Certificate)

Shasta College Medical Office Specialist (A.S.)

Yuba College Medical Office Procedures (Certificate) _{Medical Office Skills (A.S.)}

Source: O*Net; American Association of Medical Assistants, http://www.aama-ntl.org; The Medical Board of California

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Medical Records and Health Information Technicians

A broad category of technicians serving in practitioner and health care delivery facilities, the medical records and health information technicians serve in many support capacities. In the area of processing medical records, there are Medical Records Clerks and Technicians. Medical Records Analysts and Directors interpret, complete and manage medical records in health care delivery sites. This category also includes file clerks, receptionists, coders and health information systems technicians.

The general education requirement is an associate degree in health information / medical records. Most employers prefer applicants that are certified by the American Health Information Management Association (AHIMA) as Registered Health Information Technicians (RHIT). The RHIT certification can be obtained by completing a 2 year associate degree

program accredited by the Commission on Accreditation for Health Informatics and Information Management Education and passing an exam administered by AHIMA.

Presently only one community college provides training in this area.

Cosumnes River College Health Information Technology (A.S.) _{Health Information Coding Specialists (Certificate)}

Butte College Medical Billing and Coding (Classes)

Mendocino College Medical Billing / Coding Specialist (Certificate)

Shasta College Medical Billing Specialist (Certificate)

Source: O*Net; Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition

CAREERS IN ALLIED HEALTH