Health Care: Adequacy of Pharmacy, Laboratory, and Radiology	 
Workforce Supply Difficult to Determine (10-OCT-01, GAO-02-137R).
								 
Growing concerns about the supply of health care workers and the 
future needs of an aging population have led to recent		 
congressional hearings and media reports.  Shortages of nurses	 
and nurse aides, the two largest categories of health care	 
workers, are of particular concern. Although the number of	 
pharmacists has grown during the past decade, the increasing	 
demand for pharmacy services is outpacing the growth in supply,  
according to the Department of Health and Human Services. High	 
vacancy rates and a decline in new entrants to the laboratory and
radiologic fields have been reported by provider and professional
associations. However, employment and earnings data for 	 
laboratory and radiologic technologists and technicians do not	 
indicate a balance of supply and demand for these workers.	 
Demographic changes, technological advances, and management	 
decisions on how staff and technology are used will affect the	 
future demand for health care workers.				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-02-137R					        
    ACCNO:   A02291						        
  TITLE:     Health Care: Adequacy of Pharmacy, Laboratory, and       
Radiology Workforce Supply Difficult to Determine		 
     DATE:   10/10/2001 
  SUBJECT:   Employment 					 
	     Health care personnel				 
	     Human resources utilization			 
	     Labor supply					 
	     Labor statistics					 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Testimony.                                               **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-02-137R
     
GAO- 02- 137R Supply of Selected Health Workers United States General
Accounting Office

Washington, DC 20548

October 10, 2001 The Honorable W. J. ?Billy? Tauzin Chairman Committee on
Energy and Commerce House of Representatives

Subject: Health Care: Adequacy of Pharmacy, Laboratory, and Radiology
Workforce Supply Difficult to Determine

Dear Mr. Chairman: Concern is growing about the supply of health care
workers for meeting current demand as well as the future needs of an aging
population. Emerging shortages of both nurses and nurse aides, the two
largest categories of health care workers, have recently been the subject of
several congressional hearings and numerous media reports. 1 Now some health
care providers and professional organizations also are beginning to report
difficulty recruiting sufficient numbers of pharmacists and laboratory and
radiologic technologists and technicians. In response to these concerns, you
asked us to describe the current and projected supply and demand for
pharmacists and laboratory and radiology workers and trends in their
employment and earnings. In this correspondence, we provide information on
(1) current workforce trends for pharmacists, (2) current workforce trends
among laboratory and radiologic technologists and technicians, and (3)
factors that may affect the supply and demand for these workers in the
future.

To provide this information, we relied primarily on published reports and
data from the Department of Labor?s Bureau of Labor Statistics (BLS) and the
Department of Health and Human Services? Health Resources and Services
Administration (HRSA). While BLS data on earnings for these occupations were
available through 2000, reliable data on total employment were available
only through 1998. We also obtained data from professional associations
representing the various disciplines and from provider and employer
organizations. We reviewed the relevant professional and research literature
and interviewed industry and professional association representatives,
researchers, and other experts. We performed our work during September 2001
in accordance with generally accepted government auditing standards.

1 A list of related GAO products is in the enclosure.

GAO- 02- 137R Supply of Selected Health Workers 2 In summary, while the
number of pharmacists has grown over the past decade, there

is evidence of increasing demand for pharmacy services, which, according to
HRSA and others, is outpacing the growth in supply. Earnings for pharmacists
have risen significantly in recent years, and employers and professional
associations are reporting increased vacancy rates and difficulties in
hiring. Key factors that may be contributing to greater demand include an
increase in the number of prescriptions filled, growth in the number and
hours of retail pharmacy outlets, and an expansion of pharmacists? roles.
While demand has continued to increase in recent years, the number of
pharmacy school graduates has declined.

Higher vacancy rates and declining numbers of new entrants to the laboratory
and radiologic fields have been reported by provider and professional
associations. However, employment and earnings data for laboratory and
radiologic technologists and technicians do not produce a clear picture
about the current balance of supply and demand for these workers. While
total employment for these workers grew from 1988 to 1998, reliable data to
describe more recent trends are not available. Although significant growth
in wages has been reported for segments of the laboratory workforce, overall
earnings growth for both laboratory and radiologic technologists and
technicians has lagged behind the rate of earnings growth for all workers
from 1998 to 2000.

Demographic changes, technological advances, and management decisions on how
both staff and technology are utilized will affect the demand for workers in
the future. Population changes associated with the aging of the baby boom
generation can be expected to increase the demand for pharmacy, laboratory,
and radiology services and to limit the supply of workers available to
provide them. However, the impact of scientific and technological advances
is difficult to predict. Improvements in some technologies may raise the
productivity of the existing workforce, but other advances in science may
increase the volume and complexity of health care services and create a need
for additional workers with more sophisticated skills. The demand for
workers also may be affected by management decisions on how to employ
technology and how to use workers with differing skills and qualifications.

BACKGROUND After nurses, nurse aides, and physicians, three of the largest
groups of health care workers are pharmacists, laboratory technologists and
technicians, and radiologic technologists and technicians. Pharmacists are
licensed by state pharmacy boards to prepare and dispense drugs. They also
may educate patients about medications, monitor patients? responses to
medications, and track adverse drug reactions and interactions. Currently,
most pharmacy students are enrolled in a 6- year program of postsecondary
education leading to a doctor of pharmacy degree. 2 In 1998, BLS

2 Currently, there are two degree programs eligible for accreditation by the
American Council of Pharmaceutical Education: Bachelor of Science in
Pharmacy, a 5- year program, and Doctor of Pharmacy. After 2003, only the 6-
year Doctor of Pharmacy program will be eligible for accreditation.

GAO- 02- 137R Supply of Selected Health Workers 3 reported that there were
approximately 185,000 pharmacists employed in the United

States, with median annual earnings of $66,227. 3 Of these pharmacists, 25
percent worked in hospitals; 59 percent worked in retail settings, such as
chain drug stores and grocery stores; and the remaining 16 percent worked in
other settings, such as nursing homes and pharmacy schools.

Laboratory technologists and technicians, often referred to as clinical or
medical technologists and technicians, perform a variety of diagnostic tests
on blood and tissue samples. 4 They may specialize in specific branches of
laboratory science, such as cytology (the study of cells and cell
abnormalities), histology (the study of tissue structure and organization),
microbiology, or immunology. Also included are phlebotomists, who collect
blood samples for testing or blood donations for blood banks. Training for
technologists typically consists of a 4- year baccalaureate degree program.
Educational preparation for technicians may consist of an associate?s degree
from a community college; a certificate from a hospital, vocational school,
or the armed forces; or on- the- job training. Eleven states require
licensing of laboratory technologists, and most technologists are certified
by a professional association. 5 BLS reported that there were approximately
313,000 employed laboratory technologists and technicians in 1998, with
median annual earnings of $37,274 for technologists and $26,291 for
technicians. Forty- nine percent of laboratory technologists and technicians
were employed in hospitals in 1998, 20 percent in physicians? offices, 14
percent in medical or dental laboratories, and the remaining 17 percent
primarily in government, research, and educational settings.

Radiologic technologists and technicians perform a variety of diagnostic
imaging procedures such as X- rays, magnetic resonance imaging (MRI),
computer assisted tomography (CT) scans, sonograms, and mammograms. As with
training for laboratory workers, training for radiologic technologists and
technicians varies. Although 2- year training programs are most common for
technologists, educational preparation for technologists and technicians can
range from 1 to 4 years and lead to a certificate or an associate?s or
bachelor?s degree. Most radiologic technologists are certified, and 34
states require licensure for these workers. 6 According to BLS, there were
approximately 162,000 radiologic technologists and technicians employed in
1998, with median annual earnings of $32,885. Sixty percent were employed in

3 1998 is the last year for which we have BLS data on both employment and
earnings for pharmacists, laboratory workers, and radiology workers. Data on
total employment for 2000 will be available from BLS? Office of Employment
Projections in November 2001.

4 Technologists, both laboratory and radiologic, typically have a higher
level of training and expertise than technicians. 5 The American Society of
Clinical Pathologists? Board of Registry is the primary organization for the
voluntary certification of professionals in laboratory medicine. 6 The
American Registry of Radiologic Technologists is the primary organization
for the voluntary certification of radiologic technologists.

GAO- 02- 137R Supply of Selected Health Workers 4 hospitals, 30 percent in
physicians? offices, 6 percent in medical and dental

laboratories, and the remaining 4 percent in various other settings.
PHARMACY WORKFORCE PRESSURES REFLECT GROWING DEMAND

While the number of active pharmacists has grown steadily since 1991, demand
for pharmacist services is increasing and, according to HRSA and others, may
be outpacing the growth of supply. Several provider and professional
associations are reporting higher vacancy rates for pharmacists and
increasing difficulties in hiring. At the same time, earnings for
pharmacists have grown significantly, rising 17 percent from 1998 to 2000.
The current pressures affecting the pharmacist workforce appear to be the
product of an increased demand for pharmacy services and a declining number
of graduates from schools of pharmacy.

Increased Earnings and Higher Vacancy Rates Reported

Total employment of pharmacists grew from 162,000 in 1988 to 185,000 in
1998, an increase of 14 percent, just slightly less than the 19- percent
employment growth rate for the workforce overall. From 1988 to 1998,
pharmacists? earnings grew by 48 percent, compared with earnings growth of
36 percent for all workers. More recently, from 1998 to 2000, pharmacists?
earnings increased much faster than those of all workers. (See fig. 1.)
Median weekly earnings for pharmacists grew from $1,063 in 1998 to $1,243 in
2000, an increase of 17 percent, compared with a 10- percent growth in
earnings for all workers.

GAO- 02- 137R Supply of Selected Health Workers 5 Figure 1: Cumulative
Percentage Increases in Earnings for Pharmacists and All

Workers, 1988- 2000 Note: Growth for any specific 2- year period cannot be
directly determined from the figure because data represent cumulative
earnings growth from 1988.

Source: GAO analysis of median weekly earnings for pharmacists and all
workers as reported by BLS using data from the Current Population Survey.

At the same time that salaries have increased, employers have reported
greater difficulty filling pharmacy positions. According to HRSA?s recent
pharmacy workforce study, several provider and professional associations
have reported increased vacancy rates and greater difficulty in hiring. 7, 8
A recent American Hospital Association (AHA) survey of hospitals reported an
average pharmacist vacancy rate of 21 percent in 2001, and half of all
hospitals reported more difficulty in hiring pharmacists than in the
previous year. 9 An American Society of Health- System

7 The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists
(Washington, D. C.: HRSA, Dec. 2000). 8 Caution should be used when
comparing vacancy rates from different studies. Vacancy rates reported by
provider and professional organizations vary, and not all studies identify
the methods used to calculate these rates.

9 AHA and The Lewin Group, ?The Hospital Workforce Shortage: Immediate and
Future,? TrendWatch, Vol. 3, No. 2 (June 2000).

0 10

20 30

40 50

60 70

80 Percentage change 1988 1990 1992 1994 1996 1998 2000 Year

Pharmacists All workers

GAO- 02- 137R Supply of Selected Health Workers 6 Pharmacists survey of its
pharmacy- director members reported that the average

pharmacist vacancy rate was 11 percent in 2000. In February 2001, the
National Association of Chain Drug Stores (NACDS) reported a 6- percent
vacancy rate for chain community pharmacies. The Department of Veterans
Affairs (VA) recently reported that many of its facilities have filled fewer
than half of their authorized pharmacist positions. According to HRSA, as a
result of staffing shortages, some federal facilities have cut back on
pharmacy services, and in others, pharmacists are being required to work
longer hours.

Demand for Pharmacists May Be Outpacing Growth in Supply

HRSA?s recent pharmacy workforce report suggested that several factors could
be contributing to a rising demand for pharmacy services. One factor is an
increased use of prescription medications, owing to the growth in the
elderly population, improved insurance coverage of prescription drugs, and
the continuing development of new medications. According to HRSA, from 1992
to 1999, the number of prescriptions filled by community pharmacies grew by
44 percent to nearly 2.8 billion, and the percentage of retail prescriptions
covered by insurance increased from 44 to 78 percent. Another factor that
may contribute to increased demand for pharmacists is competition among
retail pharmacies, resulting in new stores and expanded hours of operation.
Finally, although difficult to quantify, rising demand may also result from
the expansion of the pharmacist?s practice to include participation in
multidisciplinary patient care teams, increased responsibility for ensuring
patient safety, and patient education. According to HRSA, there is a lack of
reliable current data on the increased roles and responsibilities of
pharmacists. The last census survey of the pharmacy profession was conducted
in 1991.

While the number of employed pharmacists continued to grow through 1998,
both pharmacy school applications and graduations have declined in recent
years. The number of pharmacy school applications fell by 29 percent from
1996 to 2000, and the number of graduates fell by 9.3 percent from 1996 to
2000. While the reasons for these declines are not clear, HRSA?s pharmacy
workforce report indicated that the decline in applications may be temporary
and the number should begin to increase again in response to rising
salaries.

CONCERNS EMERGING ABOUT LABORATORY AND RADIOLOGY WORKFORCE SUPPLY

Employment and earnings data for laboratory and radiologic technologists and
technicians do not produce a clear picture about the current balance of
supply and demand for these workers. Although total employment for these
workers grew from 1988 to 1998, the rate of growth fluctuated, and data to
describe the most recent trends are not available. During that decade,
earnings for laboratory workers grew about as fast as earnings for all
workers, and earnings for radiology workers grew faster. Despite reports of
significant wage increases among certain segments of the

GAO- 02- 137R Supply of Selected Health Workers 7 laboratory workforce from
1998 to 2000, overall earnings growth among laboratory

and radiology workers lagged during this period compared with that of the
overall workforce. Some professional and industry groups have reported
rising vacancy rates for certain categories of laboratory and radiologic
technologists and technicians. There is also concern that the numbers of new
entrants to these fields may be declining.

Recent Trends in Employment and Earnings Are Unclear

Data on recent trends in employment and earnings are not sufficient to draw
conclusions about the current balance of supply and demand for laboratory
and radiologic technologists and technicians. Overall employment for these
workers grew from 1988 to 1998, yet the rate of growth fluctuated, and
reliable data are not available to describe trends in employment beyond
1998. From 1988 to 1998, total employment of laboratory technologists and
technicians grew by 29.3 percent, exceeding the 19.0- percent rate of
overall employment growth. (See fig. 2.) The strongest period of growth for
laboratory workers during this period occurred from 1996 to 1998 (9.8
percent). Among radiologic technologists and technicians, total employment
grew by an estimated 22.7 percent from 1988 to 1998, just slightly more than
the rate of overall employment growth. From 1996 to 1998, however, total
employment among these workers declined by 6.9 percent.

GAO- 02- 137R Supply of Selected Health Workers 8 Figure 2: Cumulative
Percentage Increases in Employment for Laboratory

Technologists and Technicians, Radiologic Technologists and Technicians, and
All Workers, 1988- 98

Note: Growth for any specific 2- year period cannot be directly determined
from the figure because data represent cumulative employment growth from
1988.

Source: BLS, Office of Employment Projections. From 1988 to 1998, median
weekly earnings for laboratory technologists and technicians combined grew
by 35.7 percent, about as fast as earnings for all workers, and earnings for
radiology workers grew by 49.5 percent, faster than the rate of growth for
the overall workforce. Most recently, from 1998 to 2000, the rate of
earnings growth for laboratory and radiology workers lagged behind that of
the workforce overall. (See fig. 3.) While earnings for all workers grew by
10.1 percent from 1998 to 2000, median weekly earnings for laboratory
workers increased by 4.9 percent, from $566 to $594. Among radiology
workers, median weekly earnings grew by 5.9 percent, from $631 in 1998 to
$668 in 2000. However, for certain segments of the laboratory workforce,
professional and industry groups are reported higher increases in wages from
1998 to 2000.

0 5

10 15

20 25

30 35

1988 1990 1992 1994 1996 1998 Percentage growth

Laboratory technologist/ technician Radiology technologist/ technician All
workers

Year

GAO- 02- 137R Supply of Selected Health Workers 9 Figure 3: Cumulative
Percentage Increases in Earnings for Laboratory Technologists

and Technicians, Radiologic Technologists and Technicians, and All Workers,
1988- 2000

Note: Growth for any specific 2- year period cannot be directly determined
from the figure because data represent cumulative earnings growth from 1988.

Source: GAO analysis of median weekly earnings for laboratory and radiologic
technologists and technicians and all workers as reported by BLS using data
from the Current Population Survey.

While the laboratory workforce overall has experienced only modest recent
earnings growth, the American Society of Clinical Pathologists (ASCP)
reported significant increases in wages for certain categories of laboratory
technologists and technicians. 10 (See table 1.) From 1998 to 2000, wages
increased faster for these workers than during any 2- year period since this
information was first collected in 1992. Wage increases ranged from 8.5
percent for medical laboratory technicians to

10 ASCP, 2000 Wage and Vacancy Survey of Medical Laboratories. This biennial
survey of laboratory managers who are listed with the ASCP?s Board of
Registry documents average wage levels and vacancy rates for several
laboratory positions. Wage increases were calculated by comparing the
medians of the average wage levels reported for each position.

0 10

20 30

40 50

60 70

Laboratory technologist/ technician Radiology technologist/ technician All
workers

Percentage change 1988 1990 1992 1994 1996 1998 2000 Year

GAO- 02- 137R Supply of Selected Health Workers 10 15.4 percent for
histotechnologists. While little trend information has been collected

on radiologic technologists by professional organizations, available data
suggest there have been recent increases in wages for some of these workers.
For example, according to a recent industry survey, median salaries for
radiographers, a radiologic subspecialty, increased an average of 5.0
percent per year from 1997 to 2001, more than the average increase of 3.4
percent per year from 1992 to 1997. 11

Table 1: Percentage Increase in Wages for Selected Medical Laboratory
Specialties, 1992- 2000

Laboratory specialty 1992- 94 1994- 96 1996- 98 1998- 2000

Cytotechnologist 5.1 2. 5 5.6 12.1 Histotechnologist 9.8 0. 5 4.0 15.4
Medical technologist 5.4 4. 3 3.9 11.9 Phlebotomist 3.9 6. 3 5.9 10.0
Histologic technician 4.7 7. 5 0.0 13.3 Medical laboratory technician 6.3 1.
7 7.5 8. 5

Note: Data exclude individuals at the supervisory or managerial level.
Source: ASCP, 2000 Wage and Vacancy Survey of Medical Laboratories. Staffing
Challenges Reported for Some Workers

Difficulties in hiring and rising vacancy rates for laboratory and
radiologic technologists and technicians are being reported by some
professional and industry groups. According to a recent AHA survey, 43
percent of hospitals reported experiencing more difficulty recruiting
laboratory technologists compared with the previous year, and 63 percent
reported more difficulty recruiting radiologic technologists. According to a
2000 American Healthcare Radiology Administrators? (AHRA) survey, 42 percent
of hospitals and 66 percent of nonhospital facilities reported sufficient
staffing for diagnostic radiography. This represents a decrease since AHRA?s
last survey in 1995, when 74 percent of both hospital and nonhospital
facilities reported sufficient staffing. AHA reported that vacancy rates for
hospital laboratory and radiologic technologists in 2001 were 12 percent and
18 percent, respectively. 12 According to representatives from both AHA and
ASRT, rising vacancy rates for laboratory and radiology workers appear to be
a new phenomenon, occurring only within the last 2 years.

According to the ASCP, vacancy rates for laboratory workers have fluctuated
since it conducted its first wage and vacancy survey in 1988, and no
specialty has experienced a persistent trend in one direction or the other.
However, across all of the surveys, the range of vacancy rates reported for
the various specialties rose from 5.0 to 13.6 percent in 1988 to 10.0 to
22.2 percent in 2000. The most significant recent

11 American Society of Radiologic Technologists (ASRT), 2001 Wage and Salary
Survey. 12 ?The Hospital Workforce Shortage: Immediate and Future,? 2001.

GAO- 02- 137R Supply of Selected Health Workers 11 increases in job vacancy
rates were for cytotechnologists and histotechnologists,

with vacancy rates for these specialties doubling from 1998 to 2000. In
addition, in 2000, laboratory managers reported higher turnover and
increased difficulty in filling all positions compared with the previous
year.

Supply of New Laboratory and Radiology Workers Appears to Have Declined

Comprehensive data on new laboratory and radiology workers are not
available. However, data that are available from a range of organizations
and educational programs, while not representative of all new entrants to
these occupations, suggest that the numbers of new entrants to the
laboratory and radiologic fields have declined in recent years. 13 While
laboratory and radiologic technology education programs appear to have
sufficient capacity, the numbers of enrollees and graduates declined from
the 1995- 96 school year to the 1999- 2000 school year, the last year for
which data are available. These declines may affect the overall supply of
workers in coming years, and, while little is known about recent trends in
the utilization of radiology and laboratory services, demand is expected to
rise as the U. S. population ages.

The numbers of enrollees in both laboratory and radiologic technologist and
technician programs have declined in most occupational specialties in recent
years, although some specialties have experienced an increase. Declines in
laboratory enrollments from 1995 to 1999 ranged from about 16 percent for
specialists in blood banking technology to 33 percent for
histotechnologists. Declines in radiologic program enrollments ranged from
about 15 percent for radiographers to about 38 percent for radiation
therapists. In addition, the number of graduates of laboratory and
radiologic programs and the number of graduates taking certification exams
have declined. Although education programs for several laboratory and
radiologic specialties experienced increased graduations in the 1999- 2000
school year, since 1995, the majority of education programs in these fields
experienced declines in graduates, from about 14 percent to about 38
percent. Since 1994, the number of newly certified medical technologists
declined by 33 percent, and the number of radiographers taking certification
exams for the first time also declined by 33 percent.

Representatives of industry and professional organizations believe the
decrease in enrollments is more the result of a loss of interest in these
professions than a lack of capacity in the current education system.
Although the number of education programs for laboratory and radiologic
specialties has declined in recent years, the decline in student enrollment
cannot be attributed solely to a loss of capacity in the education system.
For example, officials from the Joint Review Committee on

13 These data generally do not include information on technologists who are
employed in the field but do not seek certification, nor do they include any
data on technicians and professionals who receive on- the- job training or
training from sources other than formal education programs.

GAO- 02- 137R Supply of Selected Health Workers 12 Education in Radiologic
Technology told us that most radiologic technology

programs are currently operating at only about 50 to 60 percent of their
capacity. One factor that may explain declining interest in these
occupations is that other business fields can offer higher salaries to
technology- minded workers. For example, representatives from professional
and industry organizations cite competition from the information technology
and medical equipment manufacturing fields.

FUTURE SUPPLY AND DEMAND FOR WORKERS DIFFICULT TO PREDICT

Demographic changes can be expected to exert pressure on both the demand for
pharmacy, laboratory, and radiology services and the supply of workers
available to provide them. However, the impact of current and future
scientific and technologic advances and management decisions about staff
utilization are difficult to predict. Improvements in some technologies may
raise the productivity of the existing workforce, but other advances in
science may increase the volume and complexity of health care services and
create a need for workers with specialized or advanced skills.

Demographic Changes Will Exert Pressure on Supply and Demand

The future demand for health care services is expected to increase
dramatically once the baby boom generation reaches age 60 and beyond. The
population aged 65 and older will double from 2000 to 2030. Moreover, the
population aged 85 and older is the fastest growing age group in the United
States. The growing number of elderly persons will have a significant effect
on the demand for health care in the future. Older age groups tend to use a
greater volume of health care services. For example, in 1996, the average
annual number of prescriptions for women aged 40 through 44 was about 9,
compared with about 18 for those aged 60 through 64 and about 24 for those
aged 80 through 84. 14

With the aging of the population comes the potential for a mismatch between
the future supply and demand for health care workers. From 2000 to 2030, the
total working- aged population- people aged 18 to 64- is expected to grow by
only 16 percent. The ratio of the working- aged population to the population
over age 85- those likely to require the most services- will decline from
39.5 workers for each person 85 and older in 2000 to 22.1 in 2030 and 14.8
in 2040. In addition, the current workforce in the laboratory and radiology
fields is aging, similar to the trends in the nursing field. In 2000, over
half of the certified laboratory technologist and technician workforce was
over age 45, similar to the registered nurse workforce, and almost a third
were over age 50. The median age for laboratory technologists and
technicians and radiologic technicians increased from about 34 in 1989 to
about 38 in 1999.

14 1996 Medical Expenditure Panel Survey (MEPS). Data on the number of
prescriptions are for persons with health insurance.

GAO- 02- 137R Supply of Selected Health Workers 13 Impact of Technology

and Staffing Patterns Unclear Projecting future employment trends for these
occupations requires an understanding of the forces that will likely
influence supply, demand, and utilization as well as sufficient data to
estimate their potential impact. Technological advances that facilitate
increased automation may enhance productivity by substituting for some
workers even as the demand for the particular service, test, or procedure
continues to rise. But other advances, such as new, more sophisticated tests
and procedures, may increase demand for workers with more advanced or
specialized qualifications.

For radiology services, one analysis predicts that the demand for medical
imaging will increase by 140 percent over the next 20 years, while other
studies suggest that advances in the use of digital filming equipment and
procedures may significantly increase the productivity of the existing
workforce. With regard to pharmaceutical care, some health care systems-
VA?s in particular- have made extensive use of robotics and bar code reader
systems to fill mail- order, outpatient, and inpatient prescriptions. These
systems have not only increased the productivity of VA pharmacists by
relieving them of many routine, time- consuming tasks but also reduced
medication errors in the inpatient setting.

Management decisions about how to use productivity- enhancing technology as
well as staff with differing skill mixes and qualifications may affect
demand for workers. For example, substitution of lower- skilled pharmacy
technicians for some pharmacist tasks may increase a pharmacist?s
productivity. The number of pharmacy technicians has risen in recent years:
according to BLS, the number of employed pharmacy technicians increased from
approximately 83,000 in 1996 to 109,000 in 1998. VA, for example, uses
pharmacy technicians widely. Although VA still has a pharmacist shortage,
the expanded use of pharmacy technicians and new technologies has limited
the degree to which VA pharmacies have needed to restrict operations. While
the duties of laboratory technologists and technicians may overlap, there is
little evidence of systematic substitution of one type of worker for the
other. However, the simplification of some routine tests may enable people
other than laboratory personnel to complete tests that are now performed in
laboratories.

- - - - As agreed with your office, unless you publicly announce its
contents earlier, we plan no further distribution of this letter until 30
days from its date. At that time, we will send copies to interested parties.
This letter will also be available on GAO?s home page at http:// www. gao.
gov.

GAO- 02- 137R Supply of Selected Health Workers 14 If you or your staff have
any questions, please call me on (202) 512- 7119 or Helene

Toiv on (202) 512- 7162. Other contributors were Eric Anderson, Beth Cameron
Feldpush, and Patricia Jones.

Sincerely yours, Janet Heinrich Director, Health Care- Public Health Issues

Enclosure

Enclosure Enclosure 15 GAO- 02- 137 Supply of Selected Health Workers

RELATED GAO PRODUCTS Health Workforce: Ensuring Adequate Supply and
Distribution Remains Challenging (GAO- 01- 1042T, Aug. 1, 2001).

Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors (GAO-
01- 944, July 10, 2001).

Nursing Workforce: Multiple Factors Create Nurse Recruitment and Retention
Problems (GAO- 01- 912T, June 27, 2001).

Nursing Workforce: Recruitment and Retention of Nurses and Nurse Aides Is a
Growing Concern (GA0- 01- 750T, May 17, 2001).

VA Patient Safety: Initiatives Promising But Continued Progress Requires
Culture Change (GAO/ T- HEHS- 00- 167, July 27, 2000).

DOD and VA Health Care: Jointly Buying and Mailing Out Pharmaceuticals Could
Save Millions of Dollars (GAO/ T- HEHS- 00- 121, May 25, 2000).

(290122)
*** End of document. ***