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Critical-Care Nurses Specialize in Saving Lives

Jennifer LeClaire | Monster Contributing Writer — Mon, 12 Oct 2009 14:39:00 -0700

With an ability to think quickly, act decisively and stay calm when lives are at stake, critical-care nurses are among the in-demand healthcare professionals who make life-or-death decisions about patient care every day.

Critical-care nurses treat patients at high risk for actual or potential life-threatening health problems and also tend to the emotional well-being of those patients' families. That's no small task, given the current current shortage of nurses in critical care -- a shortage that's expected to worsen as the level of patient acuity increases and the Baby Boomers age.

To help fill the current gap in this high-intensity specialty, hospitals are looking for temporary or traveling critical-care nurses, with requests up 45 percent in 2003, according to the American Association of Critical-Care Nurses (AACN).

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Critical-Care Nurses on the Front Lines

Critical-care nurses draw on good communication skills, endless compassion and the ability to concentrate amid a patient crisis to succeed in their roles.

"Critical-care nurses are usually type-A personalities," says Michele Mazurek, RN, director of the surgical intensive-care and surgical open-heart units at Mount Sinai Hospital in Chicago. "You need to be extremely organized and methodical in your work. You need to be able to handle stress. You can't be easily swayed by the circumstances."

And since "critical-care nurses have a level of autonomy that most other nurses don't, you need to have confidence in your skills and be able to make quick decisions about patient care," says Jeanette Hermann, a nurse recruiter at Phoenix-based St. Joseph's Hospital and Medical Center, which is building a new wing that will add 144 new beds for critical and acute-care patients.

Critical-Care Settings, Certification

Critical-care nurses account for nearly 323,000 of the 1.36 million nurses working in hospitals, according to a 2004 Department of Health and Human Services study of the registered nurse population. Hospital settings in which critical-care nurses work include intensive-care, cardiac-care and transitional-care units; emergency rooms; and postoperative recovery units.

Outside hospitals, critical-care nurses are increasingly in demand in home healthcare, outpatient surgery centers and clinics. They can also become nurse educators, nurse researchers and nurse practitioners. Median critical-care nurse salaries are in line with the national median salary for nurses.

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Critical-care nurses must be RNs. Training occurs on the job, because an intensive-care unit cannot be replicated in a training environment. Experience in this setting carries considerable weight in the job market. A nurse can demonstrate that experience by becoming a Certified Critical Care Nurse (CCRN). To earn this optional AACN designation, nurses must practice at least two years in critical care and pass a rigorous, valid, job-related examination that demonstrates strong critical-thinking abilities.

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Beyond certification, critical-care nurses must make a lifelong commitment to learning, says Cathy Cooper, RN, MSN, a per-diem critical-care nurse and assistant professor in the department of nursing systems at the University of Wisconsin at Eau Claire. "It's challenging, because you have to stay abreast of new medications and technologies that save people's lives," she says.

Patient Ratios on the Rise?

Even though they deal with the challenges inherent in treating higher-acuity patients, critical-care nurses say a big plus is working with just one or two patients per shift vs. the six that's typical in medical/surgical units.

"In critical care, I feel like I can do a lot to help an individual patient," says Cooper, who practiced as a critical-care nurse for 15 years before pursuing a professorship.

However, the nursing shortage may mean critical-care nurses will be caring for more patients in the near future, a potentially troubling development given that increasingly ill patients demand more individual attention.

Critical-care nurses say that helping to save a life balances out the pain of losing one. However, Mazurek estimates that about 50 percent of the critical-care nurse's job is helping a patient die with dignity and helping his family enter into the grieving process.

To relieve stress, "critical-care nurses do silly things for one another," she says. "You find the nurses that you work with form very tight relationships. You go through more with strangers and team members than you do with your family and friends."

This article originally appeared on Monster Career Advice.

Neonatal Nursing: An In-Depth Look

Renee Berg / Monster Contributing Writer — Mon, 12 Oct 2009 14:33:00 -0700

With an increase in the number of premature babies requiring acute hospital care, new and experienced nurses are finding more career opportunities in neonatal nursing.

Neonatal nurses work in general maternity wards and in neonatal intensive-care units (NICUs). Those caring for premature and critically ill babies spend their shifts diapering and feeding the infants, checking vital signs, administering medications and tests, and teaching families how to care for their children properly.

"For parents, having a baby is one of the best times of their life," says Lori Loan, PhD, a former NICU charge nurse. "To share that with so many people every week is really exciting. And even when you have really sick babies, there's personal reward from taking care of them as if they were your own."

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Training and Growth Paths

Neonatal nurses are typically RNs, though some hospitals prefer to hire those who also have a BSN or an associate's degree. In addition, some facilities require continuing-education credits. Others provide on-site classes or send nurses to workshops, such as those offered by the National Association of Neonatal Nurses (NANN).

Neonatal nurses can work in hospitals as floor nurses, transport nurses or case managers. Experienced neonatal nurses can move up to management roles or, with advanced education, become neonatal nurse practitioners.

Research is another career option, as Loan discovered when, after several years as a NICU charge nurse, she was asked to serve as project director of a National Institutes of Health study on neonates. She is now chief of the nursing research service at Madigan Army Medical Center in Tacoma, Washington, where she continues to conduct research on neonatal nursing.

Special Appeal for Younger Nurses

Nurses with a maternal instinct, meticulous nature and an interest in education are drawn to neonatal nursing. But the specialty also holds appeal for young nurses seeking to work with technology. NICUs are usually stocked with the latest high tech equipment, giving preemies and ill newborns who may not have survived a generation or two ago a chance at life.

Cathy Quinn, RN, landed a position as a neonatal nurse at Tucson Medical Center in Arizona 10 years ago as a new graduate -- uncommon for a new nurse at the time, but more common now.

Quinn views her job as being a liaison between the medical staff and patients' families. It's especially important for neonatal nurses to foster strong ties with physicians, while helping the families cope with the trying experience of having an ill child.

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"[Neonatal nurses] have to care about the babies and realize the families aren't just people," Quinn says. "The people who stay NICU nurses are people who care about the family as a whole."

Nurturing Long-Term Relationships

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Typically, neonatal nurses work 12-hour shifts, caring for as many as three babies. Patients born slightly premature but otherwise healthy may stay in the NICU for just a few days, whereas those born with more complicated health problems may stay several months.

Developing long-term relationships with their patients is common for neonatal nurses, who often receive cards and photos of their former patients' birthdays and holidays and even college-graduation announcements. It's those relationships that make neonatal nursing so fulfilling, Quinn says, and the specialty one that engenders loyalty. In fact, some Tucson Medical Center nurses spend their entire careers in the NICU.

A patient's death and seeing families in distress are the job's biggest challenges, she says, but those experiences are rare. When a baby goes home, it's a bright day on the NICU floor.

"You never know what the outcome will be, [but] most of us think it will be a good outcome, because that's what we've seen," Quinn says.

This article originally appeared on Monster Career Advice.

OTs Find Niche Consulting to Assisted-Living Facilities

Cindy Mehallow | Monster Contributing Writer — Thu, 08 Oct 2009 14:16:00 -0700

Entrepreneurial occupational therapists (OTs) are finding rich rewards by providing both rehabilitation and consulting services to assisted-living facilities and their residents.

Assisted-living facilities occupy a niche between independent-living facilities and more-expensive skilled nursing homes, catering to people who are fairly independent but who need some assistance with activities of daily living (ADLs) or who suffer dementia or incontinence.

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As society ages -- and as assisted living becomes a more popular long-term-care choice -- millions of people are expected to need help with ADLs in these settings. Of the more than 1 million current assisted-living residents, 81 percent need help with at least one ADL.

In a competitive marketplace, facilities are eager to meet residents' needs, maintain a high level of satisfaction and, of course, attract new residents. OTs are well-suited to help facilities achieve these goals through programming, staff training and expert consultation. For those reasons, the American Occupational Therapy Association (AOTA) calls consulting to assisted-living facilities a "wide-open opportunity" and an emerging trend in OT practice.

Applying the OT's Skills

"Occupational therapy helps people deal with ADLs, and people move to assisted-living facilities because they have problems with ADLs," says Mary Kay Buysse, director of patient-care solutions for Hinsdale, Illinois-based Life Services Network. The typical assisted-living facility resident is an 86-year-old woman who needs assistance with approximately two ADLs.

OTs can serve assisted-living facilities by:

• Designing and overseeing group wellness programs for residents.

• Advising architects, contractors and facilities managers on environmental modifications and universal design.

• Assessing and screening residents for proper placement.

• Establishing and running on-site adult day-care programs.

• Training staff therapists and nursing aides.

• Develop fitness and water aerobics programs.

Blazing the Trail

In the mid-1960s, OT Nancy Richman struck out on her own instead of accepting the then-traditional 9-to-5 job. Her business grew, and in the mid-1980s, she joined forces with fellow OT Corky Glantz. Today, Glantz Richman Rehabilitation Associates employs nearly 80 OTs, physical therapists, speech and recreational therapists and social workers, who offer a range of services to care facilities in the Chicago area.

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On the West Coast, Mary Foto, OT, FAOTA, CCM, a former assisted-living facilities consultant, has carved out a thriving consulting practice. Through The Foto Group, she and others consult with Blue Cross of California, providing catastrophic case management, policy development, utilization review and retrospective medical reviews. She also provides individual rehabilitation services through her San Bernardino, California-based company, Rehabilitation Technology Works.

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Lisa Fagan, a licensed registered OT (OTR/L) and licensed assisted-living facility administrator, consults with facilities in New Jersey and Pennsylvania on quality-of-care issues, regulation compliance, program development, environmental modifications and staff training.

OT Consulting Success Factors

Based on their experiences, these established consultants identify factors for consulting success:

• A Track Record: Consulting is not for recent grads or beginners, emphasizes Foto. Richman concurs. "Consulting calls for a very thorough knowledge of geriatrics, especially dementia, and an advanced level of skills gained through direct therapy work and continuing education," she says.

• Business Skills: "Very few OTs are good businesspeople," says Foto, a past president of the AOTA and a board member at the University of Southern California's School of Occupational Science and Occupational Therapy. "They need practice-management skills. Many OTs may not fail as consultants, but they aren't nearly as successful as they could be, because they don't understand business issues." The solution: Attend practice-management workshops at conferences and get sound legal and accounting help.

• Salesmanship: OT consultants must generate their own business by showing facilities how their services can benefit the bottom line. As part of that effort, they must communicate why an OT can do a better job than other potential providers, such as recreational therapists, exercise trainers and certified gerontologists. "You've got to make people realize they need you," Richman says.

• Income: Building a business takes time, so have supplemental income sources until your consulting practice is established. While Medicare and private insurance reimburse for direct rehab services, OT consulting fees are generally borne by the facilities.

• Visibility: "Becoming active with the Assisted Living Federation of America and speaking at industry conferences and meetings has helped build my credibility," Fagan says.

Disaster Relief: Boost Your Skills — and Karma!

Kayla Baxter | AllHealthcare — Thu, 01 Oct 2009 10:18:00 -0700

Helping a little can go a long way.

On September 26, 2009, Typhoon Ondoy (also internationally known as Typhoon Ketsana) dropped an entire month’s worth of rainfall on the Philippines in a matter of hours.

Typhoon Ketsana has already claimed hundreds of lives and destroyed thousands of Philippine residents’ homes and crops vital to the area’s livelihood. It has claimed 92 lives in Vietnam, and is the worst storm to hit Vietnam in decades.

Additionally, an 8.3 magnitude earthquake struck September 29, 2009 near the American Samoa islands, triggering a deadly tsunami for the Samoan islands, killing 150 in the South Pacific and ravaging the area.

And of course, no one has forgotten about Hurricane Katrina.

In the midst of all these natural disasters, a health care worker might wonder – how can I help?

Here’s What You Can Do ->

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1. Donate funds.

Help people affected by disasters like the current floods by donating to the American Red Cross Disaster Relief Fund. On those rare occasions when donations exceed Red Cross expenses for a specific disaster, contributions are used to prepare for and serve victims of other disasters. Your gift enables the Red Cross to prepare for disasters and provide shelter, food, emotional support and other assistance to victims of all disasters.

Call 1-800-REDCROSS (1-800-733-2767) or 1-800-257-7575 (Spanish). Contributions to the Disaster Relief Fund may be sent to your local American Red Cross chapter or to the American Red Cross, P.O. Box 37243, Washington, DC 20013. Internet users can make a secure online contribution by visiting redcross.org.

You can donate specifically to the Philippines by going here: Philippines Red Cross

2. Donate your time ->

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2. Donate your time.

Search volunteer activities powered by VolunteerMatch.com, Doctors without Borders, Hands On Disaster Response and more - read about volunteering and disaster relief volunteering resources here.

It may seem impossible to live for a year volunteering without any income, but many factors apply — for instance, the country in which you volunteer might be drastically cheaper than your current living situation, and you could get by with much, much less. In some cases, you might be able to volunteer for a year on savings of a few hundred dollars. Some programs will give you room and board, some programs will pay a salary for your expertise, and others won't do anything but give you a place to help. It's up to you to choose a program that fits your specific needs. Keep in mind that if you ask, many volunteer programs will help with student loans, give excellent letters of recommendation, and help with job placement among many other things that might help you financially, or in the future. It never hurts to ask!

3. Donate your blood, canned food, old clothes, shoes... ->

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3. Donate your blood, canned food, old clothes, shoes...

Depending on the locale, you can donate just about anything to benefit disaster victims.

You can also be a catalyst for other people to donate by raising funds through the Red Cross and other services. You could organize a local drop-off spot where people could donate their unwanted canned food, clothes and shoes.

For Philippines disaster, Google has created a list of all the drop-offs currently in the country, among other disaster resources. We highly recommend you check it out if you're interested in helping the disaster victims of Typhoon Ondoy.

More Disaster Relief Resources

• Disaster Relief: Boost Your Skills — and Karma!

• Live Your Dreams: Volunteering Abroad

• Resources for Flood Victims

• Donate to the Philippine Red Cross or the Red Cross Disaster Relief

• Volunteer with the Red Cross

• Donate Blood in Your Area

• Join Up! Disaster Relief Group

• Quiz: What’s Your Disaster IQ?

Could You Succeed as an Independent Pharmacist?

Heather Stringer | Monster Contributing Writer — Thu, 24 Sep 2009 14:37:00 -0700

Finding personalized service is increasingly difficult today, but independent pharmacists are among the few remaining business owners determined to greet customers by name. If you enjoy people, creativity and pharmaceutical science and have a knack for running a business, you've got the potential to become a successful independent community pharmacist.

The nation's more than 24,000 independent pharmacies, which include some franchises and chains, represent an $84 billion marketplace, dispensing 42 percent of the nation's retail prescription medicines, according to the National Community Pharmacists Association (NCPA).

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If you're trying to decide whether to open your own pharmacy or buy out a retiring pharmacist, consider these insights from successful industry veterans:

Know Your Customers

"The main thing you have to do to be successful as an independent pharmacist is that you have to like people," says Marlin Weekley, RPh, president of the Illinois Pharmacists Association. "If that is your attitude, you will succeed, and you will enjoy it. Every time customers walk in the store, I make friends with them. I give them outstanding service, and I take a very personal interest in them."

Weekley, who owns four pharmacies in rural Illinois, tries to give his customers an in-depth understanding of their health issues. While they're waiting for prescriptions, he may suggest having their blood sugar or blood pressure tested. Such tests have helped some customers discover for the first time that they had diabetes. This kind of personalized service is one reason his drugstores have not struggled even as chains opened nearby, Weekley says.

Seize the Opportunity

Weekly also attributes his success to the creative approach he takes to the pharmacy business. Earlier in his career, for example, he started providing equipment and training caregivers when he noticed that many of his customers with lung disease needed oxygen at home.

More recently, Weekley has been tapping into the business opportunities associated with diabetes care. His pharmacy is in the process of becoming a certified diabetic training facility, which will allow him to teach diabetics how to use needles and medication.

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"I enjoy being my own boss so much," Weekley says. "It's like being an author. Authors come up with their own ideas and write their own books. I can see a customer need and can choose to address it in my own time frame."

Entrepreneurial Endeavor

Weekley opened his own pharmacy in 1978 but says starting out that way now is much more difficult. It's more common today for established pharmacists to sell their businesses to budding pharmacists.

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That's how John Tilley, RPh, president of the NCPA, began his career as an independent druggist in Downey, California. Tilley worked for a seasoned pharmacist for six years. When the owner decided to retire, Tilley bought the owner's three pharmacies. During the next two decades, Tilley opened 17 new pharmacies in a southern California grocery chain.

As a new business owner, Tilley worked long hours and assumed a certain amount of risk. To pay off the original owner, he took a lower salary than what he paid his staff pharmacists. After eight years, he was finally debt-free, and his salary doubled. His compensation continued to increase as his pharmacies thrived.

Independent pharmacy owners earned average annual pretax compensation of about $136,000 in 2004, says Douglas Hoey, RPh, the NCPA's chief operating officer. By comparison, staff pharmacists posted median cash compensation of $108,700 nationwide, according to the "2008 US Pharmacy Compensation Survey" from Mercer Human Resource Consulting.

High Risk, High Reward

Tilley's days of long hours are long gone. He now works just two to three days a week as he oversees his business.

"If I had it to do over again, I'd do it the same," Tilley says. "There is more risk as an independent, but there is more reward. You get to be your own boss and run the business the way you want to. You also learn through your mistakes, and you can't do those things if you are working for someone else."

Pharmacy Associations Offer Customized Benefits

Jennifer LeClaire | Monster Contributing Writer — Tue, 22 Sep 2009 17:41:00 -0700

Thinking about joining a professional pharmacy association? Beyond free publications, networking and leadership opportunities -- all standard benefits of association membership -- these groups can offer valuable, career-specific

No matter what your specialty, there's likely an association for it. Consider the following organizations in your quest for career resources:

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Academy of Managed Care Pharmacy (AMCP)

This professional society is for pharmacists working in managed healthcare environments.

Member benefits include: Continuing education, conference discounts, residency programs and access to an online career center.

Fees: Professional annual membership fees are from $240 to $440. Resident and student fees range from $35 to $85 annually.

American Association of Colleges of Pharmacy (AACP)

This organization represents the interests of pharmacy education and educators.

Member benefits include: Educational opportunities and eligibility for prestigious industry awards.

Fees: Annual dues are $100. Students, residents and fellows can join for $15.

American College of Clinical Pharmacy (ACCP)

This professional and scientific society is for practitioners, scientists, educators, administrators, students, residents, fellows and others committed to excellence in clinical pharmacy and patient pharmacotherapy.

Member benefits include: The ability to tap into research forums and home and online educational opportunities.

Fees: Annual membership dues are $215 for practitioners and $35 for students and $75 for residents or fellows.

American College of Veterinary Pharmacists (ACVP)

This organization supports independent pharmacists who serve veterinarians.

Member benefits include: Access to the Research & Education Resource Center, which is home to the ACVP National Training Center. The Center provides technical and professional information to help pharmacists develop and strengthen their practices.

Fees: $1,395 to join; annual dues are $500 thereafter.

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American Pharmacists Association (APhA)

The APhA is the largest professional pharmacists' association in the US. Its more than 50,000 members include pharmacists, pharmaceutical scientists, pharmacy students, pharmacy technicians and others interested in advancing the profession.

Member benefits include: Drug information resources, continuing education and other educational programs, professional and career development, employment resources, and financial and insurance products.

Fees: Annual dues range from $79 for residents and pharmacy technicians to $235 for pharmacists.

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American Society of Consultant Pharmacists (ASCP)

The ASCP is the international professional association for pharmacists who treat mainly older patients.

Member benefits include: Special credentialing opportunities, online conference rooms, legislative updates, videotapes, software and other specialized tools.

Fees: Professional annual membership dues range from $105 to $245. Students can join for free.

American Society of Health-System Pharmacists (ASHP)

This group represents pharmacists who practice in hospitals, HMOs, long-term-care facilities, home care and elsewhere in the healthcare system.

Member benefits include: Online continuing education, access to an email news service and the ability to join ASHP practice-niche subsections.

Fees: Annual membership dues range from $38 for students to $240 for practitioners.

Association of Natural Medicine Pharmacists (ANMP)

This professional organization serves pharmacists and those interested in the field of natural medicine.

Member benefits include: Online continuing-education programs and an online newsletter. Corporate members can submit one product for approval in the Virtual Natural Medicine Trade Show.

Fees: Corporate membership costs $1,000 annually. Students can join for $20.

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International Pharmaceutical Federation (FIP)

This international federation of national pharmaceutical associations represents pharmaceutical practitioners and scientists.

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Member benefits include: Access to continuing education, working groups, discussion groups and regional forums. Part of the FIP, the Young Pharmacists Group gives provides opportunities for pharmacy graduates to make an impact on the global pharmaceutical scene.

Fees: Individual membership fees are based on country of residence.

National Community Pharmacists Association (NCPA)

Billing itself as "the voice of the community pharmacist," the NCPA advances the interests of community pharmacists and their patients on Capitol Hill.

Member benefits include: Access to an Internet portal for educational, business and patient-care resources. To expand and strengthen their businesses, members can access the tools, training and professional services offered through the group's Management Institute.

Fees: Annual membership dues are $295 for practicing pharmacists, $75 for pharmacy technicians and $25 for students.

Society of Infectious Diseases Pharmacists (SIDP)

The SIDP is an association of pharmacists and other healthcare professionals dedicated to promoting the appropriate use of antimicrobials.

Member benefits include: The chance to work with government agencies on decision-making committees and collaborate with other healthcare organizations, such as the American Society for Microbiology. The SIDP also awards research grants.

Fees: Annual dues are $100 for professionals and $25 for students.

Diverse Opportunities Await Pharmacists in Industry

John Rossheim | Monster Senior Contributing Writer — Tue, 22 Sep 2009 16:20:00 -0700

Hospitals, retail, long-term-care facilities -- are those all the options available for pharmacists considering the full range of career settings? Absolutely not. One important sector employs PharmDs in a range of functional areas: Pharmaceuticals.

"Pharma loves PharmDs, because they're trained with pharmaceuticals, and they know how to apply them to human health," says William Sietsema, vice president of clinical and regulatory strategic planning at Kendle International, a Cincinnati-based company that provides clinical research and development services on a contract basis to the biopharmaceutical industry.

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Niches for PharmDs

What industry niches can PharmDs enter, either right from school or with just a few years' work experience or postgraduate training? Each year, pharma hires or promotes PharmDs to work in clinical research, drug safety, medical affairs, medical writing, regulatory affairs, education and even traditional business disciplines such as marketing, sales, finance and legal.

"Quite a few grads go directly into industry, especially if they've already done some relevant research," Sietsema says. A clinical research associate position, for example, might await a newly minted PharmD savvy enough to win an academic-corporate fellowship or an industry internship or residency.

Pharmacists interested in a corporate career do need to keep in mind the milieu they're entering. "Employers want low- or no-maintenance staff and team players," says one California pharmacist recruiter. Although pharmacists in industry may avoid night shifts, they usually work long hours and some weekends. Substantial travel also may be involved.

For their efforts, industry pharmacists are well-compensated. "The pharmaceutical industry pays a real premium to get good people," Sietsema says. "They're almost certain to get a higher salary than in retail or academia.

Still, it's hard to make a broad comparison of pay in industry versus other settings. "Pay in the industry is all over [the] place -- it varies a lot by company," says Rachel Bongiorno, a professor of pharmacology at the University of Maryland School of Pharmacy in Baltimore.

Here's a brief survey of some of the most promising career areas for pharmacists in the industry:

Clinical Research

Senior scientists in clinical research and drug discovery typically are PhDs. But associate positions and some management roles are open to PharmDs, typically with some research experience.

Clinical research associates help conduct the investigational studies required for a drug to gain FDA approval, design and process case report forms, and write and process study protocols.

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Drug Safety

"Entry-level positions in industry are often in drug safety," Bongiorno says. With their intensive safety training, PharmDs are well-suited to many roles within this critical function.

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Pharmacists may be called on to review adverse effects revealed in clinical studies, work with databases of study results and communicate safety information to a pharmaceutical firm's R&D department.

Regulatory Affairs

"People move into regulatory affairs from postgrad training programs like residencies or fellowships," Bongiorno says. Putting in a year or two at relatively low wages can pay big dividends later in terms of career growth and compensation.

Regulatory affairs specialists help ensure that drugs under development meet the complex web of federal and state regulations that protect the public. Pharmacists in this role work with safety data and produce communications such as product labels for patients and healthcare providers.

Marketing and Sales Support

Pharmaceuticals makers can't sell their products without incorporating technical information into their pitch. Enter PharmD medical marketing and sales specialists.

"PharmD reps are the ones who go to hospitals and make sales at conventions," says the California pharmacist recruiter. "They're the pharmacists who go in to see the pharmacists."

Education and Training

Offering a complex array of products, drug companies face a daunting task when it comes to educating their own staffs, the healthcare community at large and the public.

"I help meet the needs of our customers who are healthcare providers," says Catherine Cooke, a Baltimore-based education consultant for Pfizer and an adjunct professor of pharmacology at the University of Maryland School of Pharmacy. "I do formulary reviews, assist with drug and medical information, and give lectures on disease states and appropriate management at hospitals and in doctors' offices."

Pharmacy Specialties

Jennifer LeClaire | Monster Contributing Writer — Tue, 22 Sep 2009 13:40:00 -0700

Pharmacists seeking career opportunities beyond traditional pill-dispensing roles at the local drugstore or hospital have many options available to them. From education and research to pharmaceutical production and consulting, the pharmacy field encompasses many disciplines, all of which relate to knowledge of drug therapies.

Here's a look at some of these pharmacy specialties:

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Academic Pharmacists

These specialists work in colleges of pharmacy as teachers, researchers and consultants for industry organizations.

Ambulatory Pharmacists

An ambulatory pharmacist's responsibility is to manage patients at risk for drug-related problems, such as adverse reactions. They also supervise patients with chronic diseases, including diabetes and asthma, and those unlikely to take their medication or to take it as prescribed. Ambulatory pharmacists work in outpatient clinics, psychiatric wards and in specialties such as HIV or renal transplantation.

Compounding Pharmacists

Compounding pharmacists prepare customized prescription medications to meet individual patient needs. They also prepare, mix, assemble, package and label drugs and devices.

Consultant Pharmacists

Also known as long-term-care pharmacists, these professionals make sure residents of extended-care facilities get the correct dose of medication at the right frequency. Consultant pharmacists also work in subacute care, psychiatric hospitals, hospice programs, and in home- and community-based care.

Critical-Care Pharmacists

These pharmacists play a major role in hospital intensive-care units, working with lifesaving drugs. They optimize each patient's drug therapy and go on rounds with doctors to ensure patients don't experience adverse reactions. They also help doctors choose the most beneficial, cost-effective medication.

Drug Information Pharmacists

These pharmacists help hospitals answer queries about the best use of drug therapies. They also write and compile articles for scientific journals and continuing-education materials.

Home-Care Pharmacists

Home-care pharmacists are similar to their hospital counterparts in that they prepare medications and educate patients on medication use and storage at home.

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Hospice Pharmacists

This specialty works with medications that include controlled substances prescribed for terminally ill patients. Hospice pharmacists work at hospice agencies or at pharmacies serving hospice patients.

Industrial Pharmacists

Pharmacists in this specialty oversee all aspects of drug production for pharmaceutical companies. They can specialize in the production of a certain type of drug, such as aerosol or topical medications, tablets or capsules.

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Infectious Disease Pharmacists

These professionals work in hospitals to implement decisions regarding use of therapeutic antibiotics, monitor patients and enforce formulary restrictions on antibiotics. A formulary is a list of insurance-approved drugs and their proper dosages.

Managed-Care Pharmacists

Within managed-care environments, such as HMOs or pharmacy-benefit management companies, these pharmacists review drug use and are involved in outcomes research, disease management, cost-analysis programs and pharmacy benefit design.

Nuclear Pharmacists

This specialization involves the procurement, compounding, quality assurance, dispensing, distribution and development of radiopharmaceuticals. These pharmacists also monitor patient outcomes and provide information and consultation regarding health and safety issues.

Nutrition Support Pharmacists

These pharmacists design and modify use of nutritional supplements to treat cancer patients, diabetics, pregnant women and others needing special nutrition support.

Oncology Pharmacists

Oncology pharmacists analyze pharmaceutical aspects of cancer-care programs to ensure optimal results. They also help improve the quality and safety of chemotherapy mixtures by monitoring dosing and administration.

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Pediatric Pharmacists

This pharmacy subset specializes in medications used to treat or prevent conditions in children. Pediatric pharmacists often compound medications for specific ages and weights.

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Pharmaceutical Detailers

These professionals inform physicians about new drugs and promote ethical drug use for pharmaceutical manufacturers.

Pharmacist Attorneys

These pharmacists possess law degrees and deal with issues pertaining to pharmacists' rights and duties. They work in various settings, including hospitals, pharmaceutical companies and corporations.

Pharmacy Benefit Managers

These pharmacists administer prescription drug programs for insurance companies, develop and maintain formularies, contract with pharmacies and negotiate discounts and rebates with drug manufacturers.

Poison-Control Pharmacists

Found at poison-control centers, hospitals, universities and consulting firms, these pharmacists answer emergency questions and suggest action plans regarding poisonous chemicals, hazardous toxins or harmful drug interactions.

Psychiatric Pharmacists

These pharmacists help optimize drug treatment and care for patients with psychiatric disorders by dispensing medication, conducting patient assessments, recommending treatment plans, monitoring patient response and recognizing adverse drug reactions.

Regulatory Pharmacists

These specialists work at state boards of pharmacy, state education departments and state departments of health.

The US military and US Public Health Service offer additional public-sector career avenues for pharmacists.

Fight Cancer as a Radiation Therapist

Wendy J. Meyeroff | Monster Contributing Writer — Tue, 22 Sep 2009 12:11:00 -0700

Medical advances have made radiation therapists among the most sought-after specialists in the field of radiologic technology.

"Improvements in cancer treatment have enhanced survival rates, so there are more patients requiring therapy," according to a study by Allied Consulting, a national healthcare staffing firm in Austin. Indeed, the US Bureau of Labor Statistics projects much faster-than–average job growth for radiation therapists through 2016.

Practicing radiation therapists say two aspects of their work make it an especially attractive career. First, there's the opportunity to play an integral role in patients' recovery. Second, they enjoy the challenges that arise from the medical and scientific advances associated with cancer treatment.

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Pinpointing Cancer

Working as part of a team supervised by radiation oncologists, radiation therapists deliver ionizing radiation to a precise point in the body. Radiation therapy can be used alone or in conjunction with the other two methods used to treat cancer -- surgery and chemotherapy.

Leila Bussman-Yeakel, RT(R)(T), program director of radiation therapy at the Mayo Clinic in Rochester, Minnesota, says radiation therapists must be sticklers for details. "It's not like an X-ray, where if you slightly misposition the patient, you can do it over," she explains. "You must precisely hit that cancer without damaging healthy tissue nearby."

Maureen Larkin, RT(R)(T), technical director of radiation oncology at Memorial Sloan-Kettering Cancer Center (MSKCC), says that one-on-one patient interaction is a critical part of this job. "You're not just pushing a button," she says. "You work with that patient every day," usually for several weeks.

That's why compassion and empathy are critical. "You see people every day who are not only trying to cope with cancer, but wondering about things like, ‘Will I get to my daughter's graduation?'" Bussman-Yeakel says.

Training Notes

In most states, radiation therapists must pass a two-year training course and then become certified. The American Registry of Radiologic Technologists administers the national certification exam. In addition, some states require radiation therapists to be licensed.

While a degree is not yet required, experts recommend that aspiring radiation therapists earn a bachelor's degree, since, by the time they finish both the training and certification, they're only about 30 credits shy of a bachelor's anyway.

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Radiation therapists are posting mean salaries of about $71,500 a year, according to the American Society of Radiologic Technologists' 2007 Wage and Salary Survey.

Michael Shanahan, RT(R)(T), technical manager in radiation oncology at NewYork-Presbyterian Hospital/Columbia, funded his education through a union he'd joined. A former electrician, Shanahan completed a two-year training program at New York City's Montefiore Medical Center and then got his license. In his 10 years at NewYork-Presbyterian, Shanahan has been regularly promoted, most recently to his current position after only three years as a senior supervisor.

"I saw the radiation therapists being challenged on a daily basis," he says of his decision to pursue radiation therapy over other radiologic specialties, which he thought might turn out to be more "cookie cutter."

Diverse Challenges, Personal Rewards

Danielle Gencarelli, RT(R)(T), a radiation therapist at MSKCC, says specialty hospitals such as MSKCC are great for radiation therapists. "Here you have so many diverse treatments," she says. "Straight out of school, it's a great way to see as many techniques as possible."

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A good example is Intensity Modulated Radiation Therapy (IMRT), she explains. IMRT uses sophisticated computer calculations and other advances to deliver very precise radiation doses. "A lot of places now say, ‘We have IMRT,' but I learned on that," says Gencarelli, who holds an associate's degree and trained at MSKCC for two years before being hired in August 2003.

Beyond technological advances, Larkin is grateful for improvements in medications that control patients' pain and nausea better.

The ultimate rewards of the job, though, are often intensely personal. "You see the relief in your patients' eyes when they know you're there again to take care of them," Larkin says. "Eleven years of doing this, and I haven't lost the feeling of satisfaction."

Cardiovascular Technologist Careers

Megan Malugani | Monster Contributing Writer — Tue, 22 Sep 2009 11:54:00 -0700

Getting to the heart of what's ailing patients is the lifeblood of cardiovascular technologists, a highly skilled and in-demand group of imaging professionals who help diagnose and treat cardiac and vascular disorders.

Given the needs of an aging population and technological advances that have reduced reliance on heart surgery for treatment, employment of cardiovascular technologists, who earn roughly $20 to $40 an hour, is expected to grow 26 percent through 2016, according to the Bureau of Labor Statistics.

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In particular demand are cardiovascular technologists who specialize in either cardiac sonography, vascular sonography or cardiac catheterization, says Rick Rigling, clinical manager of cardiology at the Regional Heart and Vascular Center at Danbury Hospital in Connecticut. Here's a closer look at these specialties:

Cardiac and Vascular Sonography

Cardiovascular technologists who use ultrasound to examine the heart and create images called echocardiograms are referred to as cardiac sonographers, or echocardiographers. About half of all cardiac sonographers work in hospitals, and the other half work in physicians' offices.

Cardiac sonographers, whose work is diagnostic and noninvasive, generally perform about eight to 10 echocardiograms a day, says Rigling, incoming chair of the sonography council for the American Society of Echocardiography. Each case begins when the sonographer reviews a patient's chart. Then the sonographer spends about 45 minutes performing the ultrasound scan, saving the images digitally or on videotape. Finally, the sonographer creates a preliminary report for a physician to interpret. "You get to put advanced technology to work and see how the heart relates to a patient's total health," Rigling says. "But the best part is the one-on-one interaction you have with patients. A good sonographer will let a patient watch and will explain as they work."

Vascular sonographers, whose focus is broader than that of cardiovascular technologists, scan blood vessels in the neck, legs and arms and record blood flow, blood pressure and other measurements. Some sonographers are getting credentialed to perform both cardiac and vascular ultrasounds, and Rigling predicts the dual-credential movement will gain momentum.

Cardiac and vascular sonographers must be personable, detail-oriented and willing to deal with repetition, Rigling says. "You see different patients and different situations, but essentially you're doing the same exam over and over."

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Cardiac Catheterization

Cardiovascular technology professionals who work in hospital cardiac-catheterization laboratories (cath labs) help diagnose and treat heart patients. These cath-lab professionals, known as cardiology technologists, assist physicians with cardiac catheterization, an invasive procedure in which a small tube is wound through a blood vessel into the heart to determine whether a blockage exists. Part of the procedure may involve angioplasty, which can be used to treat blockages without heart surgery.

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Cardiology technologists use electrocardiograph equipment to monitor patients' blood pressure and heart rate during these procedures. "It's a job that provides instant gratification," says Georgann Bruski, director of invasive cardiology for Beth Israel Deaconess Medical Center in Boston. "You get to see a patient come in having a heart attack, and you get to see it fixed. You're not just part of the diagnosis but part of the cure."

Another fulfilling aspect of working in the cath lab is the teamwork among cardiology technologists, physicians, nurses and X-ray technicians, says Bruski, president-elect of the Alliance of Cardiovascular Professionals. The fast-paced action in cath labs dictates that the professionals who work there have strong, decisive personalities, she says.

Cath-lab workers spend a considerable amount of time on their feet and are "tied to a beeper" for scheduled on-call hours every few weeks, Bruski says.

Reimbursement Spurs Certification

Most cardiovascular technologists in any of the three specialties -- cardiac sonography, vascular sonography or cardiac catheterization -- hold an associate's or bachelor's degree in ultrasound or cardiovascular technology. Some technologists enter the field after working as nursing aides or X-ray technicians, usually after completing additional education.

Certification is not mandatory for cardiovascular technologists, Rigling says. However, many insurers won't reimburse hospitals and clinics for cardiovascular technology services unless credentialed technologists perform them, he says. That stipulation is forcing more technologists to become certified through a credentialing agency such as the American Registry for Diagnostic Medical Sonography or Cardiovascular Credentialing International.

Video Games Meet Surgical Training in Las Vegas

Camille Schenkel | Editor - Healthyspacesrx.com — Tue, 07 Jul 2009 17:54:00 -0700

A lot of negative news is coming out of Las Vegas these days. Suffering from one of the highest foreclosure rates in the country, the financial impact on the state has been severe. With state revenues down, one of the areas that suffered cuts is healthcare services. A high profile budget cut involved the closure of the University Medical Center (UMC) outpatient cancer center due to state Medicaid cuts.

With all the bad news, it is easy to miss a healthcare bright spot at UMC. The Virtual Skills Laboratory, currently the largest facility of its kind in the Western U.S., has been a part of training future surgeons from the University of Nevada's School of Medicine since December 2008. Sixty-five third year residents are currently training at the facility. The simulators allow residents to get hands-on training before operating on humans.

Much of surgical training has been through textbook and observation training. Occasionally, students were able to practice on cadavers and animals. Virtual training allows students to train in an environment with realistic graphics and feedback through haptics technology.

Dr. Adnan Mohsin, the Surgical Skills Lab Coordinator at UMC's Virtual Skills Lab, explained that virtual skills training is becoming more important with the Accreditation Council for Graduate Medical Education (ACGME) limiting residents to 80-hour weeks. With typical surgical residents previously spending up to 110 hours a week training, the Lab provides an important function. "It provides a safe, controlled environment for residents to practice procedures such as chest tube insertions."

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"There is a lot of art involved," says Dr. James N. Lau, who is a Minimally Invasive Surgery Assistant Professor as well as the Chief of Bariatric Surgery. He believes in the role of technology in training future surgeons. "We are a skills-based field, so surgeons need to be trained in a skills lab."

Along with virtual training on surgical procedures, the lab also conducts communication training for residents, including how to communicate bad news to patients.

Virtual training of surgeons is still relatively new. The American College of Surgeons has had a voluntary accreditation program for virtual training labs since 2005. There are currently 33 facilities participating in the program in the U.S. Dr. Mohsin, who is training to be a surgeon himself, said the University of Nevada School of Medicine currently does not mandate a minimum number of virtual training for residents. That may change once the ACS introduces a recommended curriculum and training modules.

With this generation of residents being weaned on video games, it's not surprising that advanced simulators is finally making its way into medical training programs. "There are numerous studies that indicate increased hand-eye coordination with gamers. This translates to better laparoscopic skills," says Dr. Lau.

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Despite UMC's embrace of virtual training, the school currently does not train surgeons via the web through Twitter or Second Life. Dr. Lau cites patient privacy concerns, although he concedes that there is some value to these types of training because it exposes the general public to the intricacies of surgery in general.

Given the remote training needs and the number of smaller medical schools in the country that are experiencing budgetary constraints, it may be a good idea for medical simulation companies to consider delivering web-based simulation training. The experience may not be as high fidelity as as the full simulators offered by UMC (the haptic feedback is helpful) but the higher engagement for students and the lack of any training facilities at all in some areas may be worth the trade-off.

Despite recent funding setbacks, UMC is scheduled to open a 37,000 square foot simulation center, the University of Nevada School of Medicine Simulation Center, September 1, 2009. The larger facility will also provide training opportunities for non-surgical students, such as nurses and anesthesiologists.

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Nursing Careers Beyond the Hospital

By Cindy Mehallow | Monster Contributing Writer — Mon, 01 Jun 2009 18:44:00 -0700

Mid-career nurses who want to reinvent themselves without starting over can apply their clinical skills and experience outside of the hospital. Take a look at these career possibilities. Perhaps one of them is the key to helping you rediscover your passion for nursing.

Consultant

Want to strike out on your own? Many nurses carve out lucrative niches as consultants, offering data analysis, strategic planning, project management or architectural services.

Gwen Uman, PhD, RN, is one of them. As the cofounder of Vital Research, a Los Angeles data-analysis firm, Uman began by analyzing dissertation data for fellow graduate students. Her business grew as her clients moved up the career ladder. Today, her company designs research studies, develops custom surveys, and provides qualitative and quantitative data analysis and results interpretation. Clients include clinicians, healthcare providers, trade associations, professional organizations, government entities, consumer groups, and such non-healthcare groups as school districts, universities and credit unions.

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"Beyond health and methodology expertise, consultants must have the ability to communicate in a language the client understands -- basic English, not research jargon," Uman explains. "You need a feel for the client's content area and must be able to market and sell your services. That includes closing a deal, estimating jobs accurately and figuring out market-rate pricing."

Medical Office Manager

Nurses are well-suited to running a physician's office, a hectic job requiring a wide range of skills and constant multitasking. "With HIPAA, OSHA and compliance laws at every turn, this position is much more complex today," says J. Roger Landers, executive director of the Professional Association of Health Care Office Management (PAHCOM). Landers suggests that nurses break in as a billing supervisor or coding supervisor at a group practice and then work their way up to office manager.

PAHCOM, the Practice Management Institute and the Association of Registered Health Care Professionals all offer certification programs. While most older office managers learned on the job, some schools now offer associate's degrees in healthcare office management.

But be forewarned: According to PAHCOM's 2004 salary survey, medical office managers earned just under $61,000 in salary and benefits. This may not be competitive with the compensation nurses can earn in hospitals, Landers says.

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Research Nurse

Research nurses are the eyes, ears and hands that conduct much of today's clinical research. Working with the principal investigator and research coordinators, staff research nurses participate in clinical trials that evaluate new drugs and medical devices. They evaluate potential studies, screen and schedule patients, conduct patient visits according to protocols, review patient progress and help report study results.

These nurses typically work in academic medical centers, educational institutions, pharmaceutical companies and private research foundations, but private-practice physicians are now also hiring research nurses.

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Research nurses generally enjoy positive, long-term relationships with patients and garner the appreciation of physicians, says Kristine Brindak, BSN, RN, patient service manager for the clinical research unit at the Institute for Human Performance at The State University of New York Upstate Medical University in Syracuse, New York.

Plus, the work is exciting. "We know we are contributing to the future of medicine," Brindak says. "We're on the cutting edge."

More Paths to Explore

Other nurses successfully launch second careers as:

* Case Managers: Distinct from hospital case managers who coordinate patient care, these professionals work for managed-care companies, home-care agencies, nursing agencies and management-services organizations to minimize duplication of care and services and maximize clinical and financial outcomes. These employers value nurses who understand Medicare/Medicaid regulations, managed-care guidelines and the care guidelines issued by the Joint Commission on Accreditation of Healthcare Organizations. Case managers also must be proficient in criteria issued by InterQual and Millman & Robertson, two leading developers of level-of-care guidelines.

*Pharmaceutical, Medical Equipment and Supply Educators: These nurses educate the hospital staff members who will be using the endless stream of new medical equipment, supplies and pharmaceuticals.

*Telemedicine Nurses: Interacting with patients via phone or Internet, these nurses advise managed-care subscribers based on physician-developed protocols. Academic medical centers often employ nurses as research assistants to perform telephone consultations with patients participating in clinical trials.

*Nurse Educators: Nurses are in great demand to join the ranks of nursing-school faculty and to teach in community-college diploma programs.

Expressive Arts Therapy for Elderly Patients

Brandon Thomas / ArticlesBase.com — Thu, 21 May 2009 09:36:00 -0700

"I just got all around the music and let it get all around me.” This is the way Lorna Smith, a resident at Hazel I. Findlay Country Manor in Saint Johns, Michigan, described her experience during one of the regular music therapy sessions offered by music therapist and gerontologist Dr. Stephen Hale.

The program facilitates long-term care for residents who suffer from Alzheimer’s and other severe dementia-causing disorders. Like Smith, many of these residents, who daily battle against decreasing levels of cognitive functioning, perk up immediately as soon as Dr. Hale starts to strum his guitar. Suddenly animated, many of them begin to laugh and smile, clapping and nodding their heads in time to the rhythm. While many residents typically have trouble maintaining focus and remaining alert, as soon as Dr. Hale begins a music therapy session they make eye contact with him easily. When the music starts, their former listlessness and agitation quickly disappears.

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"Music therapy in a long-term care setting has a particular value for residents who become isolated, withdrawn and depressed," says Vicki Ritz, the program’s director of nursing.

Alzheimer’s patients are not the only ones whose lives have been significantly improved by music, art, and dance therapy. The treatment has been shown to benefit people suffering from a wide range of disorders, including schizophrenia, aphasia, autism, Tourette Syndrome, and Parkinson’s disease.

Elaine Hall, who adopted her autistic son, Neal, from a Russian orphanage when he was 2-years-old, has made it her mission to bring art therapy to children who have difficulty expressing themselves.

“I wanted to teach theater and dance to kids with autism, cerebral palsy,” attention-deficit disorder, obsessive-compulsive disorder and Tourette syndrome, she said, “anything that gets somebody kicked out of everywhere else.”

Hall, who has been dubbed “the child whisperer” because of her knack for engaging children in performance, founded the Miracle Project as a way to carry out her mission. Formerly an acting coach for Hollywood film and television stars, Hall now prefers to focus her attention on the very young. The Mircale Project, “a musical theater and video arts program for children of all abilities celebrating music, dance, story and culture,” produced a documentary called “Autism: The Musical” that HBO released in 2008. The film chronicles the struggles of a group of autistic children and their families as they get ready to put on a show.

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“The first 11 weeks were so chaotic, kids were literally hiding under tables and spinning around in circles,” Hall recalls, then whispers: “Then all of a sudden they start coming together as a group. We wrote a play. We learned songs. We wore costumes. We no longer talked about Steven hiding under tables. We we’re saying, ‘O.K., what role do you think Steven should play?’ ”

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Today, as many as seventy universities across the country offer arts therapy programs. Once considered a dubious science at best, expressive arts therapy is now understood to be an important tool in the therapeutic process. Many researchers believe that this is due in large part to the neurological effects of music and dance. Rhythm stimulates activity in parts of the brain that control cognitive function. By promoting communication and facilitating the development of motor skills and synaptic reorganization, music and dance therapy can foster rehabilitation after a stroke or severe brain injury.

Music therapy is also proven to produce calming effects on the body and mind, slowing blood pressure and decreasing heart rate, blood pressure, depression, and anxiety. Because emotional wellbeing plays an important part in overall healing, expressive arts therapy is likewise an important part of the healing process. Dancing and making art and music also have a social impact that helps individuals to feel confident to express themselves and connect with others around them. Music therapists call this the “ripple effect,” a term coined by Mercedes Pavlicevic and Gary Ansdell to describe music’s ability to naturally attract people and create larger social contexts.

Dr. Mike Crawford, professor of Psychological Medicine at Imperial College, who studies the medical effects of creative therapies, says that at times when patients are struggling with illness they “may find it difficult to express themselves using words, but through the skill of the therapist it may be possible to help people interact…in a way that is constructive, creative and enjoyable.”

Whether battling illness or not, just about anyone can benefit from the transformative power of art.

Mending the Heart--Calming the Mind With Art Therapy

Victoria Van Zandt, MA — Tue, 19 May 2009 11:23:00 -0700

When asked to explain art therapy, I usually begin by saying that art, as therapy, goes way back. I say that before there were anti-depressants there was poetry and, before there was language, there were cave drawings. A person with the blues was given a poem to read to help lift their spirit. Using art to express yourself has its roots in the theories of Freud and Jung, who both believed in the power of imagery to tap into the thoughts, memories and feelings of a person. They used the symbolism in dreams to help clients uncover their unconscious thoughts and feelings. In the early 1900s, Margaret Naumburg, an educator, and one who believed that the symbolic communication of art would access feelings quicker than language and she helped move art therapy into a recognized profession. As an educator, she believed in the power of creative expression to aid in the emotional development of children. Both she and her sister, Florence Cane, played a significant role in the development of art therapy and helped form the profession that it is today. Many more clinicians followed in their footsteps to continue to establish the field of art therapy and to bring it into the public eye and, in 1969, the American Association of Art Therapy was formed.

There continues to be a dialogue about art being therapy and art in therapy. I believe it is a little of both. Whether the art-making acts as a bridge to discuss one’s thoughts and feelings and reactions to the art or as a means to get feelings out and provide a release when words are difficult to find, the practice of art therapy is proven to be healing. Art therapy is not concerned with how artistic or how well a person can draw, paint or work with clay. It is about the process of self-expression, not the product. It is about getting feelings out in a creative manner without the filter of words. Art therapy provides a safe place to explore feelings such as anger, fear, sadness that in the past might have been viewed as not ok to talk about or feel. When working with imagery, the client is tapping into their right brain, the part of the brain where emotions reside--not the analytical left brain. Though clients are welcome and encouraged to talk about the art and any reactions they experience, as an art therapist, I do not assume to know what a client’s art means nor do I interpret their work. I do maintain a sense of curiosity about their art and might ask a question such as, “Tell me about this drawing?,” or “What might this image be feeling?” I leave interpretation up to the client.

Art therapy is used in hospitals, clinics, rehab facilitites, schools, private practice and in senior centers. It is used
with children, teens and adults, older adults and with families and couples. It is used to promote and enhance physical, emotional and mental health by using creative expression as a tool to communicate feelings. Taking part in art-making helps decrease anxiety, stress and depression and increase self-awareness, self-esteem and promote insight into one’s life. Clients will may times tell me that they experience a calming effect while taking part in the art-making process and that the images they create are less worrisome than the actual thought attached to them. I explain that art therapy is not an art class though the process might inspire a person to pick up pastels and draw on their own.

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Children gravitate towards the use of art and approach creativity with imagination and freedom and play without judgment or self-criticism. They enjoy experimenting with new art materials and soon discover creative tools to handle difficult emotions such as anger. As we age, we begin to seek perfection in ourselves and, through creative expression, clients can learn to silence the voice of the internal critic and become more self-aware of their negative thoughts and irrational beliefs. I invite clients to let the page hold the feeling(s) where we can explore them together. I suggest to clients that, instead of letting the feeling fester inside of them, why not allow the art to be the container. If a client has a reaction to an art piece, I provide a safe place to explore the feelings that surface. Many adults are surprised how art can facilitate the expression of feelings and emotions easier and quicker than traditional talk therapy. I explain that when we look at an image of a loved one or a visual image of a place that we have strong feelings for, we many times experience a physical response. It is the same when we engage in expressive art. In the last few years, scientific research has discovered how fear-based emotions, negative thoughts and suppressed feelings can trigger physiological stress on the body in turn directly affecting the immune system. As we begin to heal emotional wounds, the body begins to heal also. One of the goals I have when working with a client is for them to find balance between the right and the left brain where they are not residing completely in their emotional brain or living stictly in the analytical brain.

Art therapy is a master’s level profession with training in psychology and visual arts. When seeking an art therapist, it is important to work with someone who is trained in the field of art therapy or expressive arts. Many therapists introduce art into sessions, though they may not be trained specifically in art therapy. It is important to know how to introduce the art and how to process the client’s experience of the artmaking.

When asked how I work, I explain that I invite clients to take part in an art directive. For instance, I might ask, “What might that anger look like if you put it down on paper?” “What color, shape, or size might it be?” I might suggest that they use their nondominant hand to draw or that they create an image out of clay that represents how they feel that day. Even the simple act of doodling can provide a relaxing and contemplative experience. For people that suffer from anxiety and an over active right brain, I recommend they keep a doodle journal with them. This way, when they begin to experience worry or anxiousness, they can learn to calm themselves with the act of doodling. If a client feels uncomfortable drawing, I offer alternative art forms, such as collage using magazine cutouts. During the artmaking process, I recommend to the client that they work without talking in this way the nonverbal right brain is dominant allowing easier access to emotions. I leave time to discuss the artmaking and time for any other reflection the client might have. I keep the art in a safe place or, if the client wishes, they can bring their art home with them. I provide all of the art materials including pastels, markers, crayons, colored pencils, paint, collage materials, clay and paper. Where the imagination is concerned, the items we can work with is endless. Children love working with pipe clearners popsicle sticks and “Model Magic” as these objects provide a tactile experience for them. For both the young and the old, the practice of art therapy is a safe place where feelings and imagination can meet.

More information about art therapy can also be found on the website of the American Associations of Art Therapy (arttherapy.org).

Chiropractor: Mark J. Blessley, NTS., DC

Cathy Sivak, ChiropracticSchools.com Contributing Writer — Mon, 09 Mar 2009 17:04:00 -0700

_Mark Blessley is good with his hands. He dove into auto mechanic training as a high school student and received GM-certification as a "doctor of motors" and he spent time in the Alaska construction trade remodeling homes and building solariums. A decision to get a massage in the late 80s led to his discovery of the $40 per hour charge and two-week waiting list. "That's a business opportunity," he said to himself._

_After extensive research, he chose the New Mexico School of Natural Therapeutics in Albuquerque, New Mexico and received Natural Therapeutics Specialist (NTS) certification in 1989. He set up a massage therapy practice, and eventually joined forces with a chiropractic care center to expand his ability to care for patients. "It was not my intention to become a chiropractor when I decided to become a massage therapist. That was very far from my mind," he says._

_As a natural therapeutics practitioner, he often utilized harp music in the background of massage therapy sessions. His wedding featured harp music, and his musician wife soon rented a harp. It wasn't long before his woodworking background led him to build a custom harp._

_Meanwhile, encouragement from chiropractors in the practice along with his assessment of the dual benefits of massage combined with chiropractic care led to a new goal. He decided to seek chiropractic training, and to help fund his tuition, the future chiropractor built and sold custom harps. He earned a bachelor's of science in human biology (1995) and his Doctor of Chiropractic (1997) from Western States Chiropractic College in Portland, Ore._

_Dr. Blessley's board certifications include: the National Board of Chiropractic Examiners (NBCE), Parts I, II, III, IV, and Physiotherapy; Washington and Oregon State Chiropractic Boards (currently licensed in Washington and Oregon); and through the North American Association of Impairment Rating Physicians (NAAIRP). In addition to fulfilling his continuing education requirements, he is enrolled in an internet-based master's program in holistic nutrition through Clayton College of Natural Health._

_He is a member of professional organizations including the Clark County Chiropractic Society; the Washington State Chiropractic Association; the American Chiropractic Association (ACE); the North American Association of Impairment Rating Physicians; the American Academy of Spine Physicians (AASP); and the American Holistic Health Association (AHHA)._

_With extensive experience in a sports medicine-related chiropractic care clinic on top of his previous experience in other chiropractic and massage therapy patient care settings, Dr. Blessley is about to launch a new, wellness-focused partnership practice. "Chiropractors work from a holistic point of view; you're not just a bunch of parts, you are the sum of your parts," he says. The new venture, Good Health, Naturally, is expected to open its doors this fall and will aim to treat patients with a wellness-oriented, massage therapy and chiropractic focus._

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h4. His Career

*What initially led you to pursue a career in the natural therapeutic field?*

I was up in Fairbanks, Alaska, in 1988 and I was doing construction and home remodeling. I was noticing a lot of tension in my upper back and shoulders, and I thought it would be a beneficial thing to get a massage. I was also thinking about what the next step would be to get out of construction and help people in a different way. I called around for massage therapists, and I found out that they were charging $40 an hour, and that I had to wait two weeks for an appointment. So I said to myself, "$40 an hour and they are booked two weeks in advance, that's a business opportunity. There is obviously a need for more massage therapists."

After completing my training, and spending time in private practice massage therapy, I decided to pursue an affiliation with a medical provider. I searched for doctors that work directly with the body, and decided to try to work with the chiropractic field. I started work at Chiropractic Arts Clinic in New Mexico. I worked there for a couple of years, all of the while taking course in clinical interests like neuromuscular therapy and craniosacral therapy, and I got involved in sports medicine. I became a nationally certified sports massage therapist with the American Massage Therapy Association (AMTA) National Sports Massage Team. I don't think the team exists anymore, but at the time (the early '90s), it was a big deal. I was also the first massage therapist asked to work with the University of New Mexico Women's Track & Field team, and I was the only massage therapist asked to go to the Olympics.

*How did your natural therapeutics career lead you to the chiropractic field?*

All along, my chiropractic mentors were telling me I could help people more efficiently and at a higher level as a chiropractor. I had been watching how we treated patients, and what the most effective care was; it boiled down that the combination of chiropractic and massage together is quite a bit more effective than either treatment alone.

It was not my intention to become a chiropractor when I decided to become a massage therapist. That was very far from my mind. But it turned out that being a massage therapist first was a really helpful to me as I went into chiropractic school, because I already had studied physiology and learned palpitation skills. It was a huge advantage over other students coming from other professions or schooling backgrounds. The third year of chiropractic school, you go into student clinic and work with instructors at first; they know what to feel for when you're checking them. I had instructors tell me I had a "feel" like a doctor already, that my touch was really good. It developed a confidence. The other students were not used to placing their hands on people and were trembling; I just went right in there. If you wanted to do a part-time business while you are in chiropractor school, with massage therapy you can take appointments that fit your schedule; it's a good way to make additional income as you are going to school.

*How is your chiropractic career unfolding?*

I went to work with a sports medicine group in Washington. I started with Kim Christenson. He was a sports medicine chiropractor with a very good reputation in the local area, and a rehab specialist. He was especially good at using sports medicine techniques, which is an excellent way to address injury. In sports, when have an injury on the field, they are not interested in doing something that takes a long time. You want something that makes the injury heal as quickly as possible, because these are millions-of-dollars-a-year athletes. You don't mess around; you find out what works, and that's what you do. If you think about it, everyone can be treated like an athlete when they have an injury, to get better faster, a better healing environment. It works out well to use a sports better approach. Even if you are an older person, or somewhat limited due to other health conditions, you can still tailor a sports medicine approach to the person's condition. That's what I was doing for years and years.

What I'm doing now is I'm coming back around and thinking that prevention is often the most practical. You can't prevent a car accident or a slip or a fall. But you can do sports medicine and prevention, to help a person heal after they've had an accident. All of the prevention is becoming a big issue with the congenitive (developed) diseases. Many of them are inflammatory and dietary in nature, basically life choices in nature. What I learned at the New Mexico School of Natural Therapeutics on a basic, preliminary level is now being supported by a much deeper understanding of that part of human physiology.

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*What differences do the chiropractic and natural therapeutic care disciplines share?*

The difference is the intent and the goal of the treatment. The chiropractor works from a holistic standpoint and analyzes the structure to make changes in the nervous system and the physiology. If a person has pronations syndrome, known as flat feet, their knees internally rotate, that puts pressure on the hips, which turns their whole body toward the side. People don't notice right away, but over time, it creates an imbalance which adds up. You have a bucket, and it is filling up and filling up. When the bucket is full, you don't have anymore reserve capacity, that's when something is going to happen: your body is going to say "I can't take it any more. I'm going to get sick so that you will stop and pay attention to me." So the body gets sick, or you have an accident. This may occur over months, weeks or years. We strive to look at the whole person, find out where the problems are way ahead of time; it's like relieving pressure in a pressure cooker. It can be quick or slow, but that's the focus.

A lot of other disciplines are symptom chasers: "You hurt here, so I'll rub that for you." In a way, that does have the effect to lessen the pressure, but the source of the pain is often not where the person thought it was. Numbness in the wrist could be coming from the cervical spine; you may be able to get the symptoms to go away because of referral relief, or you may be able to get referral release in acupuncture. But it may be temporary relief that is going to come back. We work from a holistic point of view; you're not just a bunch of parts, you are the sum of your parts. If all the parts aren't working correctly, there's friction and pressure coming down that's unevenly distributed, and that's what chiropractors address. In natural therapeutics, we're doing that, but we didn't have the same tools and knowledge and training, so chiropractics is kind of like moving up a couple of levels.

*What are some of your personal and/or professional goals for the future?*

My focus has been getting less and less on the sports medicine. We treat a lot of athletes, and they are great to treat, but they are relatively healthy people. My goal right now is to establish a new clinic, Good Health, Naturally, this fall. The focus will be on wellness and health, combining chiropractic and other health modalities, probably acupuncture, with massage therapy. I'm working with a massage therapist who has seven massage therapists working with him already.

There's a definite need in society right now in the area of wellness. Parker Chiropractic in Dallas, one of the earliest established chiropractic schools, has recently revised its mission statement to be a wellness-oriented school. That's a huge public statement when a college that has been around since the early 1900s revises its mission to train doctors specifically for wellness-oriented methods.

*What are some common myths about the chiropractic and natural therapeutic professions?*

The myths on chiropractic are that it hurts and that it just involves the back. You say chiropractic, and many people think popping bones. In reality, it's useful for many different types of problems, including internal organ problems, PMS, hearing problems.

Chiropractic care is not just for adults, it's also for children and older people. There has been considerable research on the effectiveness of chiropractic treatment in treating conditions such as babies' earaches.

On natural therapeutics, a myth in general is that health comes from the outside in. In reality, the body has mechanisms that are genetically programmed for health, and they get misdirected or become overwhelmed by toxic substances in the environment, toxic thoughts or restrictions due to injuries or illnesses. So the two basic premises of natural therapeutics are to find and remove toxicities and to create nutritional adequacies.

*How does nutrition factor into your patient care offerings?*

I plan to work with people who have weight problems as part of my nutritional treatment goals; obesity in our culture is one of my clinical interests. There's an interesting concept related to obesity that many people don't think about; our foods are not as nutritious as they used to be 20 years ago or longer. If the body doesn't get the nutrition that it needs, the vitamins and minerals, the body says to the brain, "eat." Unfortunately, the brain can't say, "You need beta carotene, go have a carrot." It says, "You need beta carotene, go eat more." If the closest thing is a donut, you're going to eat it. Your brain says eat more, and if the food doesn't have the nutrition you need, you eat more, and you gain weight and you still don't have the vitamins and minerals. We have to increase our healthy choices and make sure we're getting the right intake of enough foods.

*Do you feel that is important for someone to be passionate about the chiropractic and/or the natural therapeutic field in order to be successful?*

You could never make it through the training unless you were passionate. It's a long row to hoe. You have to be passionate to get to the point of getting into practice, and you have to take care of yourself along the way to make sure you have adequate energy. You need to have the willingness and the desire to help people in general; otherwise you couldn't make it through. You have to have a dream or a goal or a destination.

The beautiful thing about studying the body is that no matter how long or hard you study, you can never know even know a fraction about it. New things are being discovered all the time. For instance, energy medicine has been practiced for thousands of years, but no one really ever pinned down why it works. Now the beneficial healing energy of people's hands is becoming more measurable. Researchers are finding healers have the ability to promote certain frequencies, or up-regulate or down-regulate the body's energy field. They're finding that people with the innate ability to heal have intuitively figured out how to up-regulate or down-regulate energy fields.

The spark of learning is an important aspect to have if you are getting into the healing professions, because there's always more to learn. I guess I'm a junkie.

*What contributions do you feel the chiropractic and natural therapeutic fields have made in society?*

From a microscopic viewpoint, a more balanced person and a healthier person tends to interact with society much more harmoniously. A person who is balanced doesn't create problems for other people, and is much more productive. Balanced people tend to raise the level of consciousness of community and global progress rather than tear it down. So on a small level, if you add up all the people who feel better and operate more efficiently, it has a global effect. It's a small thing and a big thing, it all adds up.

The only person you really have influence on is yourself. Work on yourself, and as you become balanced, you will overflow with benefit to others. If everything is working well, the energy effects others, and they become infected and infect others, all in a good way.

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h4. Education Information and Advice

*How did you choose the Natural Therapeutics Specialist program at the New Mexico School of Natural Therapeutics?*

I wrote to 21 schools, I personally visited seven schools, and I picked the New Mexico School of Natural Therapeutics. I moved from Alaska to Albuquerque, took the 1,000 hour course in natural therapeutics and also massage therapy and polarity, which was similar to an associate's degree. I finished in January of 1989 and went into private practice.

*You went on to earn a Bachelor's of Science in Human Biology and your Doctor of Chiropractic degree from Western States Chiropractic College. What led you there?*

I met and married my wife in Albuquerque, and along the way we decided it would be a good goal for me to become a chiropractor. So I started the pre-requisites to get into chiropractic school, which are the same as a medical school course. It's basically pre-med; you have to take the physics, the chemistry, the organic chemistry, the biology. I did all of that in Albuquerque.

We checked chiropractic schools, decided we'd like to live in the Northwest and chose Western State in Portland. I like trees, and the Northwest is really good for trees. We moved up to Washington State, and I started school. I graduated with Bachelor's of Science in human biology in December 1995, and got my doctorate in chiropractic in June 1997.

*How did you finance your chiropractic schooling?*

Similar to medical school, it's not cheap to go to chiropractic school. Part of what I did to pay for chiropractic school was to use my woodworking abilities. My wife Valerie and I build (and play) harps, and I actually paid for some of my tuition in cash with "harp money" from Blessley Instruments. I paid for several quarters by making them count out $100 bills; it was $4,000 a quarter; that's a lot of money. Not too many students pay in cash. Most students end up borrowing money and signing checks, a lot of chiropractors end up $100,000 or more in debt by the time they are done. I got out with about half of that amount of debt. I was written up in the local newspaper, The Oregonian, in an article called something like "Local Chiropractic Student is Good With His Hands."

*As a chiropractor, you are required to take continuing education classes. What are your current interests?*

Right now I'm taking a 100-hour certification course in chiropractic wellness through the International Chiropractic Association; the instructor is Dr. James Chestnut. His philosophy is very simple, and well put: "Move well, eat well, think well." Essentially, it means that you will help yourself by doing those three things: get your body moving correctly, maximize all of the joints and keep everything moving; eat right to decrease toxicity; think right, avoid negative thoughts, strive toward the positive, and laugh.

I was recently privileged to take a class with Dr. Jeffrey Spencer, the private personal physician to sports icons including Tiger Woods and Lance Armstrong. The course was "The Winning protocol, the Tour de France." It explored the preventative treatment, the conditioning and the acute injuries treatment leading to Armstrong's winning the Tour de France seven times in a row.

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*What advice do you have for students hoping to pursue chiropractic or natural therapeutics educations and careers?*

Keep up on your math. Don't let the math slide, even if it seems boring and doesn't seem useful for the future. Get good at math. Erasers are really useful too. In my woodworking, when young kids are in my shop looking at the woodworking tools, I ask them, "What the most important tool here?" They usually point to something big, like the band saw. I show them the pencil eraser and tell them the eraser is best, most important thing. You plan, you write stuff out, but you find you want to change it, and erasers are really helpful.

I was not that good of a high school student, I couldn't see the value. While I was in high school I actually went to auto mechanic school nights. I got certificated as a doctor of motors, which was a General Motors certification that you got in auto mechanic school that has since been replaced with Mr. Goodwrench certification. The way I look at this from a retrospective view is that I started out with mechanical things, figured out how they worked, electrical systems, pressure, hydraulics. Then I went on to building very technical solariums, and sun spaces and things with glass, aluminum and wood in challenging environments. It kept bringing me closer to the most exquisite mechanical thing in the world, the human body. I kept graduating.

*What did you like and dislike about your education?*

I wish I knew how critical math was going to be. I had to go through a lot of extra work, because I didn't take the classes when I should have. I didn't see the importance and value of algebra as a student. When I realized I had to take physics class, calculus and have a certain math level before I could start school. I got a tutor, I rented math videos. Have you ever watched a math video? Instead of sleeping pills, go rent a math video, and I guarantee you'll be asleep before you know it. I caught up pretty fast; I got a C in my first class, than an A in the next one. It was something like six quarters in sequence I had to take. So, make sure you have math training.

*In retrospect, what do you know now, that you wish you knew before you pursued your education?*

I did a lot of traveling and looking at the world before I started, and I don't regret that. You start when you're ready. Get some of the stuff out of the way; travel and get a broad perspective of the world. Before you settle down, make sure you know what you want to do, create goals for yourself, and get good at accomplishing your goals. It's a big goal to become a doctor, and a big responsibility afterwards, so you want to make sure you're ready for that.

Doing massage therapy is not quite as large of a schooling commitment, but there is a high burnout rate in massage therapy. If you want to get into massage therapy, that's something you should make sure you get an education in, how to avoid burnout. They teach that well at the best schools.

*What factors should prospective students consider when choosing a school?*

Choose the place where you would like to live, make sure you visit more than one school. It oftentimes boils down to being in a place you like to live. That's for your practice, too; look for a place you want to live, and when you have your practice, you'll be happier and the practice will flow better.

I would visit several schools, as they all have a different feel. They have the same requirements, taking much of the same classes, but each has a different feel and a different philosophy. It's hard to know what your philosophy is, but if you find a place where you know you want to live, that your intuition tells you is a good place, it's probably the right school for you.

*Does school choice make a difference in being prepared to treat patients? In landing a job or launching a practice?*

There are differences in philosophies of the schools; they all have fairly similar curricula to be certified. I would get with a mentor or a chiropractor; go out to lunch with someone who does what you'd think you'd like to do. Interview them a bit. Ask them how they like what they are doing. There are differences in chiropractic treatment philosophies, but you don't get some of that info from the schools' web sites and brochures and literature. If you want to focus on wellness, a school that has changed their mission statement to focus on wellness may be a draw. Find out what extra-curricular clubs are at the school, what the students are into. How many people are involved in the wellness clubs, sports clubs, motion palpation club, nutrition circles? Find out the extra stuff at the school. If you're married, find out if there are things going on in the area to interest your spouse.

*What can students do to increase their chances of being accepted to chiropractic and natural therapeutic programs?*

You have to do your prerequisites, get good grades in the pre-reqs and have good goals. The schools look at what your goals are, and why you want to be a chiropractor, how well you express yourself. Some states require a bachelor's degree before starting chiropractic college.

*What other advice can you give to prospective students thinking about an education and career in the chiropractic and natural therapeutic field?*

I would go and check out what chiropractors do, shadow one and watch what they do. If you have a goal of how you would like to help people in practice, and try to pick a chiropractor who is doing that kind of procedure.

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h4. The Actual Work

*Describe a typical day of work for you.*

I treat around 18 to 20 patients a day. I greet them in the waiting room, I watch them move, how they get up from their seating position and how they walk. That's a big advantage to me over a doctor who might come in when they are already in the examining room. I do a bit of an exam every time, measure certain points and tenderness or muscle spasms. Then I do adjusting. I use a percusser, which is an impact tool, it percusses rather than vibrates; it puts a wave directly into the tissue that directly reaches the tissue; it doesn't oscillate, it's like a piston coming in and out that loosens the tissues. Then I do chiropractic adjusting depending on what they person needs. For an older person, I do it gently, while for a young athlete or a vibrant person, I might use a more assertive touch. Sometimes I use an ortheostem, a device that creates an impulse of 12 times a second into the nervous system. It helps to balance the muscles in the area, turns off the pain receptors and increases the feedback from receptors that cause pain to go down. I talk patients about stretching and nutrition. Then I'll check to see how they are doing, watch them walk. Treatments usually last between 10 and 15 minutes. It takes much longer with a new patient or an acute patient.

Each visit, I try to do something a little bit different the patient. One time I might check feet and knees, another time their shoulders. I want to check their whole movement system, but I can't do it all in one visit. If was to do everything I could do, it would last hours. So I have to break it into different aspects each time. I have a medical assistant who works with me for checking blood pressure and conducting range of motion tests. It's beneficial to work with other professionals that can do some of the work, that way you can plan your patient encounter by knowing what other person can assist you with future patient care plans.

*On a basic level, what skills does your career demand?*

It demands empathy for people. It demands having an ability to recognize patterns; you need to have the ability to palpate, assist tissues changes and different motions of joints. There are many different ways we assess joints - sometimes the end feel when you move a joint will be squishy, sometimes it will be hard, sometimes it comes to the end point slowly, but appropriately, and sometimes it comes too quickly and you can't move a joint. You need the ability to analyze different kinds of movement.

*Is "squishy" the technical term?*

The actually terms we use can be kind of funny. There's a term "boggy"; swelling makes tissue feel boggy, like pushing down on a swampy area of ground. It's funny how we use different terms; we can use squishy. I try to make my feedback to the patient appropriate to whatever level they can understand. I've worked with nurses and people who have had anatomical training, and I'll go right in to naming muscles and talking about origins and range of motions. Other people don't have training, and they might not understand. You can explain it and it is going right over their heads, but they may still nod as if they understand. Terms like squishy work for everyone.

*What do you enjoy most about your patient encounters?*

What I like is when they get up and say "Wow, that doesn't hurt any more" or "I can feel my headache going away" or "The veil has been lifted, and my consciousness is upgraded" or "I feel so much better now." I could almost do my work without getting paid. I like helping people, and I like it that I get that feedback every day. That's what keeps me going.

*What unique challenges and rewards come from being on the chiropractic and natural therapeutic side of a multidisciplinary healthcare facility?*

There are challenges in explaining what you are doing and how it is helping, especially when a person has a chronic problem that has existed for years. It's like the difference in working with concrete. If a person waits and doesn't come in until the illness or disability has settled in, it's like working with solid concrete, its very difficult to work with. If the person comes in with a new injury, or something that has just started up, its more like working with liquid concrete, you can still smooth and form it. One of the challenges is how to explain why it might take months to get better than they are now, and that they should get little changes for the better, but that at some points they might feel like they are getting worse. People have ups and downs. I try to relate treatment programs and progress in common terms. So that's a challenge, but its fun to do that and to find new ways to express things.

*How can the reality of being a practicing chiropractor and natural therapeutic provider differ from typical expectations?*

Since I was doing patient care already, it was pretty much as I imagine it. I can remember when I was first hired by Dr. Christenson; we were in a meeting discussing patients and I asked about red flags for disc problems. He looked at me and smiled, and said "We treat those people every day." I was being over-cautious because I was new.

There are times you have to refer for a neurological consult; a student has a lower threshold for determining if it's a case you can treat or if you need to refer. What people don't know is that chiropractic students treat the student population for a year. The last year you are in chiropractic college, you treat the general public. At Western State, students work at the free clinic in downtown Portland. By the time you are done with school, you develop pretty good confidence.

*How has the popularity of the Internet affected your profession?*

The Internet is becoming a larger and larger impact; we have all of our pre-treatment forms on the Internet. People are checking out doctors before they go see them. And of course, there's a degree of marketing that the Internet makes available.

*Best patient care tip for a novice?*

Look them in the eyes, watch their movements and find out what their primary complaint is. And always address the primary presenting complaint first. They could have a foot problem that is causing a lower back problem, but if they complain of back pain, don't go for the foot first. Check the lower back first, and then let them know the treatment will explore other potential causes.

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h4. Information, Trends, and Advice

*What are some of the trends that you see in the chiropractic and natural therapeutic field which could help students plan for the future?*

The interconnectedness of the disciplines and the medical community is a trend. All of the disciplines are starting to talk to one another more flexibly. The Internet is bringing people together, and more information can be disseminated. Research is getting better and better. Staying in contact with other doctors and would be a way to promote yourself and as a means to keep the art alive.

Wellness is up and coming as a concept. It's been around for a long time, but is being looked into more as prevention rather than cure, the old phrase an ounce of prevention is worth a pound of cure. A lot of research is pointing to problems that develop over time rather than problems that just show up that could be preventable, conditions like arthritis and diabetes potentially being caused by inflammatory conditions, food allergies, toxicities in the environment and other forces that are preventable. Preventative medicine is getting a big push; food as well as wellness care.

*What is the impact of managed care in the chiropractic profession?*

Insurance is going up and up and up in price, and to keep the price down, they are decreasing the types of providers that are able to be on the panels and lowering the amount of reimbursement. Something else that occurs is that the managed care companies will say "we cover chiropractic," and they'll even advertise that they cover 10 visits a year. But the reality is that they may only cover a certain amount of visits for a certain condition. That's almost like they are practicing medicine without a license. Insurers are dictating the care people are getting. That's wrong.

*How available are internships and other hands-on learning experiences? Are there formal internships beyond in-school clinical experience?*

Some schools allow or encourage, instead of the last quarter, they encourage a student to go out into the local community to work in a practice. We've had several interns work at our clinics, and it's a good thing. Although, right after you get them trained, then they leave. It's a good experience for the students; they get a real world experience. The colleges have protocols, but it's a good idea to check out different protocols; there is more than one way to treat a patient.

*How is the job market now in the chiropractic and natural therapeutic field? How do you think it will develop over the next five years?*

As baby boomers reach their peak, and more and more people are getting older and living longer, I think it's pretty positive for job outlets. There are opportunities in many areas; for instance, hospitals are starting to incorporate some chiropractic care in rehabilitation and elsewhere, adding chiropractors to the hospital staff.

*What is the average salary/compensation package for a chiropractor? What can recent chiropractic school graduates expect as a salary range starting out? Once they get to the top of the profession?*

It's a rapidly accelerating amount you get paid. As an associate you get paid less than if you are in private practice. If you go into private practice out of school, you're going to make less the first year or two. I know that the American Chiropractor Association says the average salary $80,000 to 100,000 after a couple of years of practice. Some will make more, some less; for a new doc, you have to figure its going to be less to start with. It all depends on your skill level. It's probably good for a new person to make an agreement with their employer that as their patient numbers increase, that they would get appropriate levels of increased compensation. It's also a good idea for a new employee to have a risk-free trial period, of say three to six months. and essentially say "lets try this out and see we work well together, and if not, let's part agreeably." Make sure philosophies are congruent and then go from there.

*Is there anything else you can tell us about yourself, your career, or the profession that would be interesting or helpful to others aspiring to succeed in the fields of chiropractic or natural therapeutics care?*

Chiropractic treatment is not just back cracking. What we mostly do is remove interference so the body can work more efficiently. Most people don't realize that chiropractors have considerable training in nutrition and other aspects of holistic wellness.

Career Profile: Medical Assistant - Jill Vroegindewey, CMA

MedicalSchools.com — Mon, 09 Mar 2009 17:04:00 -0700

Michigan healthcare management professional Jill Vroegindewey started her three-decade healthcare career as a medical insurance coder in the billing department of a radiology group. She considered it just a job while she was attending Western Michigan University with an eye on a bachelor's degree in business. Jill earned her Certified Medical Assistant certification along the way.

When the group's office manager unexpectedly left the practice for another job, Jill was promoted. One opportunity led to another within the practice. For a time, she scaled back her schedule to work two days a week to accommodate her growing family. The position grew with her availability, and a series of streamlining moves between hospitals and practices led to a marketing/human resources role for the same radiology practice, then to her current role as the diagnostic marketing liaison for Bronson Methodist Hospital/Dept. of Radiology in Kalamazoo, Mich._

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Jill's CMA certification requires 60 continuing medical education credits every five years for re-certification eligibility; she was first certified in 1987. Her business studies plus her CMA status served to pave the way in her healthcare management career in what she describes as a series of opportunities. "I've been very open to new experiences and career paths," she tells MedicalSchools.com.

h4. Her Career

*Tell us about your career. How did you break into the medical field? How did your career unfold to allow you to advance to where you are today?*

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I went from a job in the billing office of a radiology group to deciding to attain my CMA certification. At that time, certification did not translate into additional benefits or pay, but it brought great personal satisfaction. My boss had been there 20 years, and unexpectedly left to go to another job. So I became the business office manager, which at that time also included the role of controller, and continued to attend Western Michigan University a few classes at a time. It was an interesting time, right at the beginning of computerization of files; before that we used the punch hole data cards.

When I started my family, I was able to cut back to part time; working two days a week calling on referring physicians in support of our radiology services, and basically catering to their needs. For nine years, eventually stretching the two day a week schedule to a four day a week schedule, I called on the physicians. This is where my medical assisting certification really paid off as I was able to speak intelligently with referring providers with regard to every aspect of our services.

When the controller retired, my educational background in business made me a natural. I guess you have to have a willingness to have opportunities presented to you for consideration, something that I have done throughout my career. Classes and certifications in human resources as well as the CMA opened all kinds of doors for me. I became HR/Benefits manager and served in that role for seven years.

In 2003 my radiology practice merged with another group - more than tripling the size of our practice. This merger eventually led to a joint venture between one of the hospitals we served and our radiology practice. When this change occurred, I wasn't sure if they would need me around. A new position was created for me, the first year, jointly paid by the practice and the hospital. It has resulted in more business for both the Joint Venture and the hospital radiology department. Once again, I am calling on referring providers to talk to them about the exciting things happening in diagnostics, including how to order our services and access testing results through the internet. Although my role is marketing radiology services, my knowledge base is broadening to include lab services. There is a learning curve, but less of a curve for a medical assistant than there would be for a straight marketing background person. The CMA has given me the opportunity to do cross-training.

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*How do you tap into your CMA training on the job?*

Knowing both administrative and clinical aspects has become very important in healthcare management. For instance, malpractice companies are seeking credentialed personnel. When you are working with insurance billing, understanding diagnostic coding and terminology is critical. We can't market to people who can't come to our hospital, so I work with insurers all the time to understand what we have to do to work within their system to help their insured get our tests covered.

The psychology aspects of a CMA background are also important, as you are always striving to produce exceptional patient care. It helps you understand situations you find yourself in with the referrals. Sometimes a patient feels they've had a horrible experience, and it's important to remember that their perception is their reality. It's your job to find out how you can turn the experience into an opportunity to improve patient care for all patients.

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*What do you enjoy most about your career? Your current position?*

I treasure the relationships I have been able to create with my referring providers, constantly searching to tools to give them to better care for our mutual patient. Being employed by the hospital, having the availability to tap into their resources, has been great for us.

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Now we're film-less, with access to images over the internet or produced on a CD. Even the most "Podunk" office is now getting internet. In radiology, we sell one product, it's a report. All our lab results and radiology reports are now available through the internet as soon as they are transcribed. The turnaround time on that report is the most critical thing we do so, because it allows referrers to diagnose their patients. Whatever we can do to cut that reporting time is great thing. It's been really satisfying.

Another aspect I enjoy is improving our access to providers. While we previously had limited the access to providers that were credentialed with our hospital, we've determined it is good patient care to open access to our reporting to other practices such as podiatrists, chiropractors, as well as interfacing with the other hospitals. It's all about patient care; it's the reason we're here.

*What are the rewards and challenges in your current position?*

One of the best things I've done over the 30 years is develop strong relationships with all different types of people in the medical offices, across state lines even. Networking is a great thing, in several cases I've been able to draw on my contacts to save valuable research time searching for new vendors or system upgrades.

One challenge is customer service. The thing to know is that if there is an issue, follow the 3-A rule: acknowledge, apologize and amend.

*What ranks among the favorite projects that you've completed in your career and why?*

The transition from punch card records to microfiche to computers for billing information. Today, film-less imaging is very exciting. If a patient needs their images to take to another provider we can produce them on a CD or in many cases are able to give the provider access to the images through our internet based reporting tools. I helped develop the radiology web site, as well as numerous brochures on diagnostic imaging.

*What has been your personal key to success?*

I love meeting new people in the field, and helping them to help their patients. If I can get them to mention what their biggest pet peeves are, and I can solve their problems, that makes me feel so good.

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*What are some of your personal and/or professional goals for the future?*

I have no huge aspirations of getting to the next level. I feel it's been a wonderful ride. I'm happy being in a new position, developing that role. I only intend to work another five to eight years at the most. I don't intend to slack off, but I don't have my eye set on another career move. I'm very open. My faith plays a strong role in my professional life - I go where He leads.

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*Do you feel that is important for someone to be passionate about the healthcare field in order to be successful? Do you think that it's important to truly enjoy the field in order to be happy in life?*

I don't know how you could do this job without having a heart for people. It would make no sense. It's what drives me to perform to the very best of my abilities.

h4. The Actual Work

*Describe a typical week of work for you. What exactly do you do? What are your key responsibilities? On a basic level, what skills does your job demand?*

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I make between 15 and 20 calls a week on referring physicians. I'm always working on a publication, such as our quarterly newsletter, or developing a presentation. I get involved with service issues, marketing materials and communications. Identify new referral sources, payers and insurance groups.

I facilitate our Imaging Update luncheons, where we invite referring provider staff and exchange information regarding new radiology procedures and how we can better serve their practice. This event is co-sponsored by our local chapter of medical assistants so we are able to offer continuing education credits toward certification requirements. Usually we have a radiologist speak on a new topic, and then tell them how to schedule for that procedure. The luncheons are becoming quite evolved. The first one we hosted had 15 attendees, and these days, we're averaging 75 people at each event.

I also work closely with central scheduling at the hospital; I review the "bad orders" with the referrers. Since the scheduling department will not schedule someone for an exam without a "good order," I call on the physicians offices, meeting with the office managers and physicians to make sure the order is turned into a "good" order; it's part of the education process to help them help their patients. Whenever possible we want insured patients to receive all the benefits their coverage allows, and submitting clean orders with appropriate coding and documentation substantiating medical necessity of the procedure ordered is the first step in this process.

*What are the tools of the trade that you use the most or favorite gadget?*

My PDA. I would be lost without it; all of my contact info. And my radiologists' schedules are in there. Another tool I use is a quarterly report that tracks referring providers by procedure, by month. I use this as research to help make decisions on new equipment, and to call on physicians whose referral patterns have changed - for the better or worse - as well as those who are new referrals.

*Has the popularity of the Internet affected your profession?*

Web-based film viewing is the biggest impact. We're also moving to a direction where patients will be able to schedule their own exams, on-line.

*What challenges will be addressed by your industry in the next five years?*

HIPAA (Health Insurance Portability and Accountability Act) frustration. I think we're killing a lot of trees with the paperwork. It has actually changed the way some people practice. The patients sometimes feel the doctors are losing touch with them - HIPPA takes away one more level of personal attention to the patient.

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*Is it important to collaborate with your colleagues? How have your professional collaborations benefited your career?*

Getting involved in the American Association of Medical Assistants has proved to be very rewarding. My activities there, including site surveys, opened my eyes to ways others practice medicine across the country. It gave me examples along the lines of "who is doing what, and where." I got to meet with them, talk to them about their successes; these relationships have become part of my network.

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*What are some common myths about your CMA licensing?*

A myth is that CMAs are nursing assistants of some sort. People don't understand the credential, the scope of practice of a CMA. As a CMA, you're only as limited as the employer that employs you. You can do everything a nurse can do in the ambulatory setting. If you are seeking a job and are a new CMA, make sure the employers know what your credential is, and your scope of practice. The pay follows the understanding.

*Can you share an interesting patient care or marketing anecdote?*

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Patients do take you very literally, sometimes. Once I was helping out with admissions in the radiology department, and I asked an elderly patient to put on her gown. The typical line to patients is "Take everything off; the gown goes over your head, when you're ready have a seat in the waiting room." When the technologist went to get her for her exam she the patient was sitting in the waiting room, stark naked, with the gown wrapped around her head. Luckily she was the only one there.

*What contributions do you feel CMAs make to the healthcare field, and to society as a whole?*

They're the right people to have in physicians' offices, as well as certain departments of the hospital. I think sometimes we think too narrow mindedly. More fields should specify medical training such as a CMA. We can add more than people understand, in all types of settings. It's our job to promote the credential, the scope of practice CMA's offer.

h4. Job Information and Advice

*What are the best ways to land a CMA job?*

Through other CMAs. Get involved in local, state and national organizations, use that network!

*How available are externships?*

Readily available. Before you graduate from an accredited program, you must serve 160 hours; unpaid and under the supervision of a licensed MD, DO or PA to receive your certification. It's a great opportunity for employers, particularly with the nursing shortage. If it works out, you've landed a job!

*How is the job market now? How do you think it will emerge over the next five years?*

It's very good right now. The nursing shortage is having a great effect for CMAs. However, it's still at lesser pay than nurses. Many CMAs later go on into nursing, as it is a very natural transition.

*How can the reality of being a CMA differ from typical expectations?*

Some of the things they teach in the medical assisting programs vs. real world expectations. I'm kind of disappointed that the CMA programs are slow to change the curriculum and planning; the curriculum doesn't seem to keep pace with the field and technology.

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*What career advice can you give to future CMAs?*

They really need to understand the link between the clinical side and the administrative side. They come out wanting to do one or the other. But some fields tap into both, and I'm an example. The expertise in the medical jargon can open up all sorts of doors, from hospital administration to pharmaceutical sales to medical equipment vendors to occupational health.

*What are your pet peeves as a CMA?*

The lack of recognition for the credential, challenging of the CMA's right to practice, the low pay, and people who fail to see the link between administrate and clinical. People with the "that doesn't fall within my job category" attitude. I certainly would not have gone as far as I have with that attitude.

*What are some of the trends that you see in the healthcare field which could help CMA students plan for the future*?

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You need to be more educated these days to be successful. Look for a program that at the very least, offers a certificate that allows you to easily move into an associate's degree program if later on you decide to do so. If you decide as you get into it that you'd like more training, and you are enrolled in a restricted program design that won't transfer, you're wasting time.

Keep pushing toward a program that can be built onto for further degrees and certification. Look at the ability to later transfer to bachelor's program. Don't limit your options.

h4. Education Information and Advice

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*In retrospect, what do you know now that you wish you knew before you pursued your education in the field?*

My education pursued me! I wish I had the bachelor's right now, for personal satisfaction - I'm 11 credits away.

*What factors should prospective students consider when choosing a school?*

Make sure it's an accredited medical assisting program.

*Based on what you hear in the industry, what do you think are the most respected and prestigious schools, departments or programs? Does school choice make a difference in landing a good job?*

Having the credential from an accredited school is the big thing. But, having the degree with the credential makes a difference. Our community college switched to a certificate program that can go into an associate's program as a way to get students in allied health fields with a shorter education time commitment to get them employable.

*What other advice can you give to prospective CMA students?*

Do your research. You are not going to get rich in this job, but if you love caring for people, and get great satisfaction from helping people, being a CMA is something you should look into.

Mental Health Practitioner: Tyler Woods, Ph.D

Cathy Sivak, NaturopathicSchools.com Contributing Writer — Mon, 09 Mar 2009 17:03:00 -0700

_Frustration with her work in social services was the impetus that led to Tyler Woods to return to college at age 34. She structured her curriculum at Prescott College in Prescott, Ariz., to design a bachelor's of arts program in holistic psychology. She then went on to earn a master's in counseling psychology, again with a holistic emphasis, and then to complete her Ph.D. in holistic health. "I knew that traditional psychology and drugging people for depression was not the answer people neither needed nor wanted," Dr. Woods says._

_Dr. Woods is a member of and board certified with The American Alternative Medicine Association as well as a member of Association of Comprehensive Energy Psychology and the American Holistic Health Association. "These groups offer a great deal of support, information, research and networking," she notes._

_With her freshly-minted Ph.D. in hand, Dr. Woods began to work as a psychotherapist for clinics as well as in a private practice. "I realized that clinics' treat and street approach pushed one thing, drugs! Traditional counseling did not explore alternatives for mental health issues. It refused to believe that mental health is about not just the mind, but the body and soul," she says. "Holistic health is about listening to the clients' needs, asking questions and allowing them to participate in their healing."_

_As a result of the collision of her beliefs with the traditional medical establishment, in 2004, Dr. Woods retired as a psychotherapist to focus on holistic mental health. Her practice, Mindhance Wellness, aims to help people heal from mental health issues like depression, anxiety and insomnia while learning how to change their lives through positive healthy living habits. In addition, Dr. Woods uses her holistic approach to facilitate the Southern Arizona Survivors of Suicide group. Her practice focuses on examination of the physical, mental, emotional, spiritual and energetic dimensions of individuals to help them work towards an optimum balance of health and wellness._

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h4. Her Career

*What factors in your social services career drove you to return to school to pursue mental healthcare opportunities outside of traditional western medicine?*

I discovered that social services think mono-dimensionally. They do not encompass the mind-body-spirit connection, and humans are multi-dimensional by nature. I burned out after realizing that nothing really changes in social services.

*Tell us about your experiences during your career shifts from social services to psychotherapist to holistic mental health practitioner. What led you to give up your clinic work to concentrate on your private practice, the Mindhance Wellness Clinic?*

So many people in the field seemed more concerned about malpractice suits than client care. Therapists were talking about how to protect themselves rather than how to help their clients. They were stressing about how to please the behavioral health board and working with clients as if they were very fragile because of the fear of getting sued.

I once worked at a clinic with a client who was depressed and felt lost spiritually and who did not want to go on drug therapy. I suggested Omega fatty 3, and we talked about ways in which the client could get in touch with the spiritual self. The client called the clinic to thank me, and my boss called me to say, "You cannot suggest alternatives to our clients." I knew at that point that I had to leave the field. I retired as a psychotherapist and put my Ph.D. to use.

*Who (or what) are the biggest inspirations for your career?*

I facilitate the Survivors of Suicide group. It is a group for people who have lost a loved one to suicide. Several people told stories of their loved ones' depression, and how traditional drugs made things worse. One survivor said to the group, "if only they would have talked to him instead of drugging him." That story had such an impact on me.

But my biggest inspiration came from a friend of mine who was bi-polar. Her psychiatrist had her on nineteen different medications. She had tarda dyskinesia, her speech was impaired and the quality of her life was horrible. Each time we talked, her psychiatrist had changed her medications. One day she called and said she was feeling a little better; once again her medications had been changed. A few days later, I received a call that my friend had committed suicide. She had used her newest medication to accomplish this action. She remains my biggest inspiration.

*What do you enjoy most about your holistic role in patient care?*

This is simple. Watching them get better and heal.

*What unique challenges and rewards come from working with your patients in an independent holistic care setting? With your facilitation of the Southern Arizona Survivors of Suicide group?*

There is a great deal of challenge working in an independent setting because it is just that, independent. With that said, the rewards are wonderful. I can pick and choose the modalities that best suit the people I work with. I do not have to follow the guidelines of some clinical director. I can allow and encourage the client help direct their own care and listen to their feedback. Many times, the client just needs to be heard.

With Survivors of Suicide, well, mainly the rewards are sharing with these people that grief and loss is holistic period. It encompasses the mind body and spirit and that the journey is about looking for the possibilities through tragedy. Many Survivors of Suicide have post traumatic stress disorder (PTSD) because they found their loved one's body. Medication is often used to treat PTSD. Approaching PTSD holistically helps the survivors realize they have a variety of options available to treat their PTSD symptoms such as meditation, guided imagery, certain herbs for sleep, and amino acids for anxiety and stress. Survivors like knowing they have a choice because when it comes to losing a loved one to suicide, their choice in the matter had been taken from them.

*What are some of your personal and/or professional goals for the future?*

A goal I am currently working on is starting a general wellness program and incorporating it into the mental health system. If people only realized that what we eat impacts depression, that exercise aids in anxiety and depression, and that self-confidence and self-esteem decrease mental health issues. In our current mental health system, we treat and street. We drug people. The government gives them money to live on, and the psychiatrist instructs them to come back every three months for a med check. No one teaches these people proper diet. No one tells these people that exercise is simple and helpful. No one allows people in the mental health system the chance to achieve overall wellness. So my current goal is to finish writing the wellness program and then try to incorporate it into existing mental health programs. Funding seems to be the real issue, so who knows what will happen, but it is a goal.

I also want to write a book. I am in the middle of a book now, but it has nothing to do with holistic health. It is actually a comedy about being born deaf and then getting my hearing back and learning how to be a real person in a hearing world. It�s actually quite funny. Eventually, I want to write a book about holistic mental health. I believe holistic mental health is all about choice.

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h4. The Actual Work

*Describe a typical day of work for you. On a basic level, what skills does your job demand?*

What I love about my work is it changes on a daily basis. One of the first things I do upon meeting a new client is get a medical and mental health history. Then I give the client an eating journal and ask them to track their food intake. I remind them that I will not be looking at it, that I just want them to begin to notice how food influences their moods. I am a huge advocate that what we put in our mouth affects our biology and our moods.

I pay attention. That is where being a retired psychotherapist comes in handy. I watch my clients and I can tell if they are uneasy, if they have anxiety or if they have depression. The body carries a great deal of information. I listen carefully to their health symptoms. I believe if there is an issue, it is in the tissue. Normally if a client comes to me with depression or anxiety issues, they leave with a regiment of alternatives to help them with their symptoms.

The skills that I really use are compassion along with an understanding of mental health issues, and the knowledge needed to develop a program combining supplements and a diet designed to meet a client's needs.

*Can you describe a patient care anecdote that exemplifies your holistic practice?*

I had a female client in her 40s. She had been on a variety of medications for over half her life for depression and anxiety. She had been in traditional therapy for years. Still, she was unable to function with her depression. Medications would work for a brief period of time, but she said the effects "wore off" eventually or side effects such as weight gain and digestive problems became too much for her, so she would take herself off the medications. She also experienced insomnia and was afraid to take medication for this condition because of the fear of becoming addicted to the sleep aid.

I suggested a regiment of high doses of Omega 3 and GABA for the anxiety and Calms Forte for her insomnia. We also made several changes in her diet. Within a few weeks she was sleeping better and her anxiety was much better, but the depression was still paralyzing her. We added folic acid to the supplement mix and began to explore her spiritual path. We slowly added swimming to her regiment. Now we are working on her spiritual self, her mental self, and her physical self. She realized that she always worked on either her mental health or physical health, but rarely worked on them both. Once she added a spiritual component to it, she stated she felt her treatment was very well rounded. Five months later, she started working and is now married and doing well.

*What are the tools of the trade that you use the most? Favorite gadget?*

Hope is the best tool of this trade. I can't say I use a gadget. I've used vitamins, herbs, education, love, spirituality, insight and ritual. Ritual is a great "gadget."Giving a client an item to hold onto is a wonderful tool as well. A rock, a healing stone, a crystal, something with positive energy that they can hold onto, goes a very long way.

*What contributions do you feel the naturopathic profession has made in society?*

Again, choice. It gives people a choice in their health care. Medicine has become an assembly line for the HMO companies. Doctors are allowed to spend something like 7. 5 minutes with each patient, and then bring out the prescription pad and write prescriptions. They no longer spend time asking important questions or suggesting alternatives. Holistic health is about listening to the clients' needs, asking questions and allowing them to participate in their healing. The other huge contribution is holistic medicine doesn't just mask symptoms, it heals!

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h4. Education Information and Advice

*How did you decide to study holistic psychology, counseling and holistic health? How did you find your schools?*

By accident! I was going to go to school to be this great psychotherapist and heal the world. In my first semester I took an anatomy class. Because I had taken nursing before, I asked the school why I needed anatomy, the advisor said just take it. So I did. I told the instructor I already knew anatomy. She said, "Really, then which chakra is the kidneys in?" I had no clue what she was saying. What was a chakra? The instructor was a healer who embraced me and worked with me for over four years. It was through my apprenticeship with her that I discovered holistic psychology and healing. The school I went to is an alternative learning school. I did not go to a degree factory. The school challenged me to think outside the traditional box. So I did.

*What did you like and dislike about your holistic/naturopathic education? How did it build on your previous educational experiences in the field of social work? How did it differ?*

I did not dislike anything. Nor did it differ from my other education because as I said I went to an alternative school for both my BA and MA. The college wanted you to take a chance and take risks to reach out and learn beyond what traditional learning would have asked.

I used to work at a clinic at which I supervised psych interns. Again, the social service field is really cut and dry. There is no room for a holistic point of view as much as follow the directions whether the client likes it or not. So for me, the big difference is about choice versus no choice.

*What do you know now, that you wish you knew before you pursued your education in the mental healthcare field?*

Great question! I wished I would have known several things. First, I wish I had known that being in the mental health field means pleasing a board and not the client.

*What factors should prospective students consider when choosing a school? What should students expect from a holistic mental health curriculum? How available are hands-on learning experiences?*

Here is the main thing to remember: pick a school that has accreditation! Expect a well rounded curriculum. Make sure there is an internship involved. Make sure there is a great deal of homework. Make sure there are days and weeks, even months, when you say, "This is the hardest thing I have ever done."

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h4. Industry Trends, Information, and Advice

*How do you feel that the naturopathic, holistic and overall medical system could be changed to better serve society?*

I wish there was more malpractice insurance for us. It is difficult to find an insurance carrier specifically suited toward holistic mental health. It makes it more valued in our society.

I think holistic mental health should be explored more thoroughly in the media. Medical shows, and news shows about medicine, but it is not often we focus on the positive aspects of alternative health in prime time.

What I really wish, though, is that more medical doctors would refer their patients to holistic health providers. It is rare to hear a doctor say, "Yeah, go see Dr. Tyler Woods, she will suggest that you incorporate some Omega fatty three, GABA and follow a good diet to improve your general well-being. All I can offer you is a prescription for Zoloft."

*What are some common myths about the naturopathic/holistic healthcare profession?*

Just today someone said to me, "Did you hear someone died from mixing vitamins?" I smiled and said, hmmm one person died today from taking vitamins huh, well 250,000 people die each year from adverse side effects of their medication, which means 684 people will die today from their medication. So tell me, why is it so important that we pay attention to the one person that died from a supplement?

That is the myth. We are told we are quacks; that we are undereducated, that we are witches, or as someone once called it "voodoo."

My favorite myth is "supplements and vitamins just give you expensive urine."

*Has the popularity of the Internet affected your profession?*

Oh yes, it has increased my services. Yeah for the Internet! It is a great and affordable way to advertise as well.

*How is the job market now in the naturopathic field? How do you think it will develop over the next five years?*

I live in Arizona. So of course I think it isn't that great here. We are getting better. Since I specialize in mental health, and not just health, it is different for me because most people have such a taboo around mental health issues, now mix that taboo with holistic health..need I say more? That won't stop me though, because I believe holistic mental health works and so do my clients.

*What other career advice can you offer future naturopathic and holistic healthcare specialists?*

Be patient, excuse the pun! It is not like you go to school and come out and find the perfect job in this field. It in fact is a competitive field. There is not an alternative clinic on each street corner like there are doctors' offices.

The other important thing is to specialize. You can't know everything and be good at it, so know some things and be the best at it. Again, it takes time to establish a name, allow yourself the time it takes be become good at what you do. If you are good at what you do, then you will succeed.

*Is there anything else you can tell us about yourself, your career, or the profession that would be interesting or helpful to others aspiring to succeed in the field of naturopathic and holistic mental healthcare?*

It's a new field. It is cutting edge. The pharmaceutical companies will be going out of their way to make this difficult for us. What if proper diet prevents ADHD, or if acupuncture relieves stress, or if massage helps with insomnia, or if amino acids help with depression and fibromyalgia? The pharmaceutical companies do not want that to happen because they stand to lose billions and billions of dollars. There will be a fight ahead of us because the FDA wants to prohibit the sale of certain supplements. It could be that one day we will require a prescription for vitamin C.

So the best thing we can do is be sincere to our practice, and be exceptionally informed about and good at what we do, because in a way "the whole world is watching."

Dental Hygienist: Tammi Byrd, RDH

Cathy Sivak, DentalSchools.com Contributing Writer — Mon, 09 Mar 2009 17:03:00 -0700

_Tammi Byrd, RDH (Registered Dental Hygienist) has some valuable advice for those seeking to embark on training and a career in dental hygiene: Don't ever settle for average. Anyone can reach that goal. Ms. Byrd has certainly followed her own wisdom. She has extensive clinical experience with dental hygienist experience in periodontics, family practice and pediatric dentistry, and is currently the CEO/clinical director of Health Promotion Specialists Inc., a group that administers school-based oral health programs. In addition, Byrd is an adjunct clinical course instructor at Midland Technical College in Columbia, S.C., where she previously received an associate of science degree in dental hygiene._

_Ms. Byrd, an active member of the Chicago-based American Dental Hygienists' Association (ADHA) since 1977, has served nationally as president, vice president and district trustee, and has held numerous positions as council, committee chair and member._

_She was president of the South Carolina Dental Hygienists' Association (SCDHA), as well as an ADHA delegate and the chair of numerous committees. At the local level she has served as both president and vice president of the Greater Columbia Dental Hygiene Association. "I truly believe that upon graduation, each individual has a choice of pursuing a job or a profession. If you want to be a professional you must be involved with your professional association," she notes._

_Byrd is likewise actively involved with the South Carolina Healthy Schools Oral Health Coalition, the South Carolina Tobacco Free Coalition, the South Carolina, Robert Wood Johnson, Smiling Faces Grant Steering Committee and the Maternal Child Health Education Task Force. "When I am no longer in this world, I want to know that I made a difference in the lives of others through improved quality of life. I believe involvement in these initiatives creates change for the better," Ms. Byrd says._

_Her professional efforts have not gone unnoticed. She is the recipient of the ADHA Distinguished Service Award, a two-time recipient of the SC Dental Hygienist of the Year Award and recipient of the SC American Association of University Women, Women of Distinction Award._

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h4. Her Career

*Tell us about your dental hygiene career. What led you to shift from a clinical care focus to become the CEO/clinical director of a school-based oral care program organization?*

I worked in pediatric dentistry for the first year of my practice and then moved to a family practice closer to my home. I worked there for 8.5 years and moved to a periodontal practice for the next 12.5 years. During this time, I was always involved with my professional association and worked with our Council on Regulation and Practice. I had seen the inequities of oral health status of different populations and knew that dental hygienists were not utilized to their full potential and that some of the neediest populations did not have access to preventive services and not aware of the value of good oral health.

The South Carolina General Assembly passed legislation in 2000 to allow registered dental hygienists (RDHs) to work in schools, nursing homes, etc. without the presence of a dentist. At that time, I met with the policy advisor for our state department of health and environmental control. The state had utilized RDHs in the early 1980s to provide preventive services in schools and had a very successful Newberry Sealant Project. The purpose of the meeting was to discuss the reinstatement of this program with the statute change to allow the services again. I was informed that the state did not want to directly provide the services but would prefer to oversee them. I was quite surprised and disappointed because I knew of the great needs in our state schools. It was at that time that God laid it on my heart that no one would provide the much-needed services unless I did. It was a leap of faith and has been a character-enhancing opportunity.

*You have extensive clinical experience as a dental hygienist in periodontics, family practice and pediatric dentistry. What differences and similarities are found in these clinical settings?*

All settings utilize the dental hygiene education but the personalities, age differences, and presence of disease determine the treatment plan, how you present your dental hygiene treatment plan, teach patient education, and utilize different home care products.

*Describe a typical day (or week) of work for you. What are your key responsibilities?*

As CEO/Clinical Director of a statewide school-based program, my day is quite different from when I was practicing clinically. I spend a lot of time involved with public relations - networking, marketing, and working with the clinical RDHs to assure that our relationships on the local levels are maintained at the highest levels. I keep close tabs on the legislative arena through tracking systems of our state legislature to monitor any changes that could affect how our services are delivered. I visit RDHs onsite, review new products, and work diligently to stay abreast of current literature and research and assure that it is disseminated to the staff. I also arrange to have speakers annually on cultural awareness, infection control, child abuse recognition and prevention, oral pathology, medical emergencies, CPR recertification, etc. to ensure continuing competency of our staff.

*You have served nationally in leadership positions including president of the American Dental Hygienists' Association, and have likewise served the South Carolina Dental Hygienists' Association and the Greater Columbia Dental Hygiene Association. How has your involvement benefited your career? What can emerging dental hygiene professionals expect from membership to national, regional and local professional organizations?*

My involvement with my professional association has been the lifeline of my career. It has kept me informed, involved and energized. I truly believe that upon graduation, each individual has a choice of pursuing a job or a profession. If you want to be a professional you must be involved with your professional association. They speak for the profession and I want to make sure my voice is heard. Involvement moves an individual from average to excellence.

*In addition to serving in numerous capacities for the professional organizations, you are involved with numerous public health initiatives. What drives you to be so professionally active?*

When I am no longer in this world, I want to know that I made a difference in the lives of others through improved quality of life. I believe involvement in these initiatives creates change for the better.

*You have received numerous awards and honors for your service, performance and involvement in the field. What do these honors mean to you on a personal and professional level?*

Personally, it is an honor that me that my colleagues consider me worthy. I have done nothing more than many of them have and have enjoyed the camaraderie on the journey. Professionally, I hope that it will instill a passion in other individuals to get involved and make a difference.

*What are some favorite projects that you've been involved with in your career? What makes them stand out?*

The current school-based sealant program I am working with now is extremely rewarding. The hugs, hand-made cards, and letters of appreciation from the children, parents and school administrators stating the impact our services have had on the lives we touch daily makes it all worth while. We have been enormously challenged by private practitioners and organized dentistry that sealants are not safe and should not be placed by dental hygienists without a personal exam by a dentist. The opposition was so great that the Federal Trade Commission brought formal charges against the South Carolina Board of Dentistry and the Association of State and Territorial Dental Directors (ASTDD) requested that the Centers for Disease Control convene an Expert Panel on School-Based Sealant Programs to again review the evidence. The evidence is clear that sealants are effective and safe and the CDC has committed to disseminate this message to dental practitioners. They are scheduled to release new guidelines for these programs late summer 2006 along with the evidence documenting the findings. Barriers to access and preventive services are being broken down. This is the ultimate goal to improving oral health. No disease has been eliminated through a treatment program. We must capitalize on prevention.

Another great project was the tobacco cessation program implanted by ADHA the "Ask, Advise and Refer" program. Living in a tobacco state, I have seen the firsthand effects of this horribly addictive drug.

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h4. Education Advice

*You earned a dental hygiene associate's degree from a technical college. Would you change anything about your education if you could? If so, what?*

An associate degree in dental hygiene is much more than a two-year degree. It is just shy of a bachelor's degree. If I could change something, I would have gone straight into a bachelors program and completed it. I would eventually like to have my master's degree and/or a certificate in public health.

*What factors should students consider when choosing a dental hygiene school or program?*

Look for a bachelor's program or assure that the school has a matriculation process in place to attain the bachelor's degree. You spend far too much time on your education to settle for an associate degree.

*How can students considering an education and career in dental hygiene assess their aptitude for the field?*

I think caring for others should be first and foremost. After that, good manual dexterity and a desire for life-long learning.

*What can students applying to dental hygiene programs expect during the admissions process?*

Students should expect several interviews, testing for manual dexterity, and an aptitude test.

*How should students expect the curriculum to prepare them meet the trends and challenges the field of dental hygiene faces over the next decade?*

There will increased emphasis on public health. Many programs are implementing different career tracks for dental hygienists - public health, periodontics, pediatric dentistry, etc.

*Based on your experience as an adjunct clinical course professor, can you offer any tips to students starting dental hygiene training?*

Don't ever settle for average. Anyone can reach that goal.

*How could the dental post secondary educational system be changed to better serve students and society as a whole?*

Increased public health knowledge, understanding and experience.

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h4. Dental Hygiene Industry Trends, Information & Advice

*How can the reality of a career as a dental hygienist differ from typical expectations?*

I think that depends on whether you enter the field looking for a job or a profession. Anyone will get "burned-out" with a job. Additionally, individuals need to realize the long term wear on the body in a job that predominantly utilizes usually one side of the body. Get involved in yoga or some type of exercise on a regular that strengthens and stretches the body on both sides to maintain your personal health and well-being.

*What are the best ways to land a job as a dental hygienist?*

Know that you haven't settled for average and project this confidence when interviewing.

*How available are internships or other hands-on learning experiences?*

All accredited dental hygiene programs have many hours of "hands-on" learning experiences and most programs have rotations in settings outside of the schools in nursing homes, elementary schools, etc.

*How is the job market now in the industry? How do you think it will develop over the next five years?*

Dependent on where you live, the job market is usually very good. Dental hygiene is one of the fastest growing professions. The market will continue to drive this as consumers become more aware of the education and services dental hygienists provide. The barriers restricting direct access to dental hygiene care will continue to be removed over the next several years. You will also see advanced levels of dental hygienists develop that will increase opportunities for those pursuing a higher degree and increased responsibilities.

*What can recent dental hygiene school graduates expect as a salary range starting out?*

This is directly affected by the region of the country you live in and is usually proportionate with the cost of living. Alabama is the only real exception, as dental hygienists in the state are not required to have a formal education and the salaries are directly affected by this.

*What topics are emerging as hot issues in the overall field of dentistry that will impact the dental hygiene profession?*

The need for increased access to care is one. There will be the development of a mid-level practitioner to provide additional restorative services. The ADHA is in the process of finalizing the curriculum development for an Advance Dental Hygiene Practitioner. The U.S. Budget was ratified by the President this year with language that HRSA pursue this practitioner development.

*Do you feel that is important to be passionate about the field of dental hygiene in order to be successful?*

I believe that success is being passionate about anything you do.

*What other career advice can you offer future dental hygienists?

Stay involved and on the cutting edge of emerging technology.

*Is there anything else you can tell us about yourself, your career, or the field of dental hygiene that would be interesting or helpful to dental hygiene students?*

Find a mentor and ask them for direction when you are unsure.

How Speech Pathologists, Audiologists Work with Aging Patients

Megan Malugani, Monster Contributing Writer — Tue, 10 Feb 2009 17:12:00 -0800

Of the many types of healthcare practitioners who care for the elderly, speech-language pathologists (SLPs) and audiologists may have the greatest potential to actually improve the quality of life for older Americans. SLPs, who evaluate and treat speech, language and swallowing disorders, and audiologists, who identify and treat hearing and balance disorders, can help restore a person's fundamental ability to communicate.

"We can give elderly clients hope," says Donna Geffner, PhD, who is licensed and certified in both audiology and speech-language pathology and is director of the graduate programs and the Speech and Hearing Center at St. John's University in Jamaica, New York.

Many age-related conditions, like Alzheimer's disease, strokes and hearing loss, are expected to become more prevalent as the country's population ages. Indeed, the government projects the number of people 65 and older will nearly double between 2005 and 2030, to 71.5 million. The speech-language pathology and audiology professions are taking steps to prepare for this great gray wave.

In their graduate programs, most SLPs, who are required to have a master's degree, complete several geriatric-themed courses, including counseling and adult neurological disorders, Geffner says. Audiologists, who also must hold a master's degree but will be required to have a doctorate by 2012, are also trained to counsel older adults and their families about hearing loss.

SLPs and audiologists must have a strong understanding of the aging process and recognize the adjustments, such as speaking slower, that may be needed to work effectively with elderly clients, Geffner says.

h4. Keeping Up with Advancing Techniques, Technologies

Both audiology and speech-language pathology are dynamic, evolving professions, Geffner says. SLPs must continually adopt new techniques and technologies to address the communication and swallowing disorders of elderly clients who've had strokes, for example, or to train the families of Alzheimer's patients to communicate effectively with relatives suffering from dementia and impaired memories.

Audiologists must constantly stay abreast of the latest and greatest amplification devices available for fitting and dispensing. "Hearing aids as we know them today won't look the same in five or 10 years," says audiologist Richard Gans, PhD, president of the American Academy of Audiology. "We're going to see big technological breakthroughs."

Combining the scientific and interpersonal aspects of audiology is rewarding, Gans says, especially in working with older Americans. "People look at hearing loss as a sign of weakness or of getting older," he says. "Some clients will be 90 years old and tell you they're not old enough for a hearing aid, or that they don't want to spend the money they were planning on leaving their kids. But what if they can't communicate with their kids for the last 10 years of their life?" The stigma attached to wearing hearing aids has lessened in recent decades and may diminish further as the devices become smaller and less obtrusive, Gans adds.

Besides fitting, dispensing and providing follow-up care for hearing-aid users, audiologists also help diagnose and treat balance disorders. About 50 percent of all accidental deaths in people older than 65 are due to balance-related falls, and most balance disorders are related to an inner-ear dysfunction, says Gans, who is also founder and executive director of the American Institute of Balance, a balance-disorders treatment center in Seminole, Florida.

h4. Bettering Patients' Outlook on Life

Audiologists and SLPs work with clients of all ages, but it's the expected needs of aging Americans that should fuel steady growth in both professions through 2014, according to the Bureau of Labor Statistics.

For professionals interested in helping older Americans communicate effectively despite obstacles, speech-language pathology and audiology are fulfilling career choices. "We can help improve not only a client's quality of life, but their whole outlook on life as well," Geffner says.

Careers in Naturopathic Medicine

ArticlesBase.com — Tue, 10 Feb 2009 17:00:00 -0800

There are two careers in naturopathic medicine: Naturopathic Doctors (ND) and Naturopathic Medical Doctors (NMD). The primary difference between these two professions is that Naturopathic Medical Doctors must have completed additional training in clinical sciences.

Prerequisites for entry into most naturopathy colleges or schools includes an equivalent of a four-year degree in basic sciences; including biology, chemistry, physics, math, and humanities.

Once you've completed all course prerequisites, you must complete a minimum of a four- to six-year course of study in naturopathy to earn one of the careers in naturopathic medicine. The four-year curriculum entails comprehensive studies in biochemistry, human physiology, histology, embryology, traditional Chinese medicine (TCM) principles, hydrotherapy, botanical medicine, macronutrients, homeopathy, and more.

Upon completion of clinical education and practical training, graduates need to take board exams to meet the standards, which are required by individual States and/or Nationally. Depending in which State you reside, you may require licensure - as is the case in Canadian Provinces, and in 13 US States. In addition, careers in naturopathic medicine must be maintained by keeping certification and/or licensure updated through continuing education programs.

Careers in naturopathic medicine are perfect for candidates who have good communication skills, and who can effectively use observation capabilities to "read" patients, and treat individual healthcare needs. As a holistic profession, careers in naturopathic medicine adhere to quality care principles including the Hippocratic Oath, which includes treating the "whole person," and to "first do no harm," among others.

If you (or someone you know) are interested in learning more about these or other wellness occupations, let professional training within fast-growing industries like massage therapy, naturopathy, acupuncture, Chinese medicine, Reiki, and others get you started! Explore careers in naturopathic medicine near you.