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NOVA contracted with BW Research Partnership, Inc. (BW Research) to
complete this project, the results of which will enable NOVA to provide relevant
labor market information to job seekers for career guidance.

BW Research is a full-service consulting and research firm specializing in
workforce and economic development for public entities, including workforce
investment boards, economic development agencies, cities, colleges,
universities, and other educational institutions. BW Research specializes in
conducting comprehensive labor market research studies that incorporate both
qualitative and quantitative research techniques to assess the current and
projected workforce needs of a given geographic area, industries, or employer
groups.

BW Research worked with partners Green LMI and Community Colleges'
Northern California Region Center of Excellence to conduct secondary research
of the healthcare industry: gather and analyze occupational and industry trend
data; review the economic and workforce data specifically relevant to traditional
IT workforce applications in healthcare; and determine the size, growth, and skill
demands for workers who will design, build, deploy, and maintain new hardware,
software, and networking products and services for the healthcare sector.

This report was authored by:

Josh Williams and Jaime Barrah, BW Research Partnership, Inc.

Theresa Milan, Center of Excellence Hosted at Los Rios Community
College District

Phillip Jordan, Green LMI Consulting

.
           "#$%"%&%'!()*!%+'!(&%&*'!
           !

           !
The “Future Forces of Change” section of this report was provided by the
Institute for the Future to examine trends shaping the healthcare workforce.


                                                                                     2
                                                                                     2
TABLE OF CONTENTS
List of Figures ................................................................................................................... ii	
  
List of Tables ................................................................................................................... ii	
  
Introduction …………………………………………………………………………………… 1	
  
Industry Definition ............................................................................................................ 1	
  
Industry Composition and Growth Trends ....................................................................... 2	
  
Key Issues Impacting the Industry ................................................................................... 6	
  
  Population Growth ........................................................................................................ 6	
  
  Aging Population .......................................................................................................... 7	
  
  Regulatory Impacts....................................................................................................... 8	
  
  Technological Advances............................................................................................... 9	
  
Health Information Technology ...................................................................................... 10	
  
Workforce and Recruitment Needs................................................................................ 13	
  
  Recruiting, Retraining, and Replacing Workers.......................................................... 13	
  
  Communication and Language Challenges................................................................ 14	
  
  Recruitment Practices ................................................................................................ 15	
  
Occupational Analysis.................................................................................................... 16	
  
  Occupational Projections ............................................................................................ 17	
  
  Difficulty Hiring............................................................................................................ 19	
  
  Supply and Demand Gap Estimates .......................................................................... 21	
  
  Employer Hiring Preferences...................................................................................... 23
Conclusion .................................................................................................................... 25

Appendix A:          Healthcare Industry Definition by NAICS .................................................A-1	
  
Appendix B:          Healthcare Career Lattices ......................................................................B-1	
  
Appendix C:          Healthcare Occupation Profiles............................................................... C-1	
  
Appendix D:          HIT Occupations ..................................................................................... D-1	
  
Appendix E:          Healthcare Growth Maps .........................................................................E-1	
  
Appendix F:          Summary of Healthcare Reform Act ........................................................F-1	
  
Appendix G:          Employer Survey Toplines ...................................................................... G-1	
  
Appendix H:          Methodology............................................................................................ H-1
Appendix I:          Future Forces of Change: Companion Memo to IFTF Map ...................... I-1




                                                                                                                                             i
LIST OF FIGURES
Figure 1:    Healthcare Organizations by Industry Segment.......................................... 2	
  
Figure 2:    2005-2015 Job Growth in the Healthcare Sector by Segment ................... 3	
  
Figure 3:    Employer Expectations for Employment 12 Months from Now .................. 4	
  
Figure 4:    Map 2009 Healthcare Jobs by Zip Code in the Silicon Valley .................... 5	
  
Figure 5:    2010-2015 Change in Population by Age Cohort in the Silicon Valley ....... 7	
  
Figure 6:    Use of New Healthcare Technologies within the Last Three Years ......... 10	
  
Figure 7:    Workforce Challenges for Healthcare Employers .................................... 13	
  
Figure 8:    Skill Deficiencies among Recent Hires ..................................................... 14	
  
Figure 9:    Recruitment Practices .............................................................................. 15	
  
Figure 10:   Estimated Growth and Replacement Needs by Occupation:
             Next 12 Months ........................................................................................ 17	
  
Figure 11:   Difficulty Finding Applicants who Meet Hiring Standards ......................... 19	
  
Figure 12:   Number Employed, Occupational Need, and Difficulty Hiring .................. 20	
  
Figure 13:   Typical Education Requirements: At Least Some College by
             Occupation ............................................................................................... 23	
  
Figure 14:   Typical Work Experience Requirements: At Least Some Experience
             by Occupation .......................................................................................... 24	
  


LIST OF TABLES
Table 1:     2010–40 Population Projections ................................................................. 6	
  
Table 2:     Percentage of Firms Employing Each Occupation ................................... 16	
  
Table 3:     Occupational Employment Estimates and Projections ............................. 18	
  
Table 4:     Healthcare Degrees Conferred by Occupation in Silicon Valley .............. 21	
  
Table 5:     Supply and Demand Gap Estimate Table ................................................ 22	
  
Table 6      Overview of Project Methodology ........................................................... H-1	
  




                                                                                                                                 ii
INTRODUCTION
Healthcare is a critical sector in Silicon Valley, providing quality care to residents,
supporting good paying jobs, and stimulating economic activity in the region. The NOVA
Workforce Board commissioned the Healthcare Workforce Study to estimate the short-
and long-term training needs of the healthcare sector in the Silicon Valley, which
includes Santa Clara, San Mateo, and southern Alameda counties.1 This information will
enable NOVA to provide relevant labor market information to job seekers in search of
career guidance.

Data compiled for this report were drawn from both primary and secondary data sources.
Two phases of primary research were conducted as part of this project—qualitative
executive interviews with 10 industry leaders, prominent employers, human resource
directors, and technology managers within the healthcare and information technology
sectors in the Silicon Valley that are implementers, developers, or super users of
healthcare information technology, and a quantitative telephone survey of 200
healthcare employers. External secondary data sources utilized in this report include
information from Economic Modeling Specialists Inc. (EMSI), InfoUSA, US Bureau of
Labor Statistics (Occupational Outlook Handbook), U.S. Department of Labor (O*NET
Online), and specific occupational and industry association resources.2

INDUSTRY DEFINITION
The healthcare sector is composed of four major segments: acute care, offices and
clinics, outpatient care and medical labs, and long-term and residential care. Each
segment specializes in a method of delivery and/or treatment techniques.

    •   Acute care is the branch of healthcare that provides treatment of severe
        diseases, including general medical, surgical, psychiatric and substance abuse
        hospitals, as well as ambulance services and blood and organ banks.
    •   Healthcare offices and clinics provide primary and specialty care services,
        and include offices of physicians, chiropractors, mental health practitioners, and all
        other health practitioners.3
    •   Outpatient care and m edical labs focus on two areas: the treatment of
        conditions that can be delivered on an outpatient basis and the testing and
        diagnoses of disease. This industry group includes outpatient mental health and
        substance abuse centers, family planning centers, HMO medical centers and other
        specialized outpatient care facilities, as well as medical and diagnostic
        laboratories.
    •   Long-term and residential care is the branch of healthcare that provides
        treatment to people with a chronic illness or disability. This industry group includes
        nursing care facilities, residential mental-health/substance-abuse facilities, and
        continuing care retirement communities.

1
  Southern Alameda County includes the following zip codes: 94536 Fremont, 94537 Fremont,
        94538 Fremont, 94539 Fremont, 94555 Fremont, 94560 Newark, and 94587 Union City.
2
  Please refer to the Methodology Section in Appendix H for a more detailed list.
3
  Offices of dentists were excluded from the definition of the healthcare sector for this study.




                                                                                                   1
INDUSTRY COMPOSITION AND GROWTH TRENDS
As shown in Figure 1, there are approximately 4,107 healthcare establishments in the
               4
Silicon Valley, with the majority in the office and clinics industry segment (68%),
followed by long-term and residential care (21%), outpatient care/medical labs (7%) and
                 5
acute care (4%).
Figure 1: Healthcare Organizations by Industry Segment


                     Long-Term
                                              Acute Care
                        and
                                                 4%
                     Residential
                       Care
                        21%


          Outpatient
          Care and
         Medical Labs
             7%



                                                                Offices and
                                                                  Clinics
                                                                    68%


Eighty percent of healthcare establishments employ 10 or fewer workers, 15 percent
employ 11 to 50 workers and the remaining five percent employ more than 50 workers.
However, the larger organizations, namely hospital systems, dominate the market
employing the majority of healthcare workers. Seventy percent of all healthcare workers
are employed by establishments with more than 50 employees.6




4
  EMSI Complete Employment - 3rd Quarter 2010 for Santa Clara and San Mateo counties. The number of
       establishments in southern Alameda County was estimated from InfoUSA data. Offices of dentists
       were excluded from the definition of the healthcare sector for this study.
5
  EMSI Complete Employment - 3rd Quarter 2010 for Santa Clara and San Mateo counties. The data in
       Figure 1 excludes southern Alameda County because establishment data by type was not available
       at the zip code level.
6
  InfoUSA Employer Database, January 2010.




                                                                                                        2
In 2009, there were 101,134 workers employed by the healthcare sector in the Silicon
Valley, comprising six percent of the 1,744,661 workers across the total economy in the
region. Current data from the 200 healthcare employers surveyed during the primary
research component of this study revealed that 29 percent of permanent employees
work part-time.

Between 2005 and 2010, the healthcare sector grew by 13.1 percent, adding 11,801
new jobs in Silicon Valley. This is significantly higher than the region’s overall job growth
which remained nearly flat during the same time period. By 2015, EMSI projects that the
healthcare sector will grow by 10.7 percent, expanding by 10,888 new jobs.7

Figure 2 displays historic and projected growth of the healthcare sector by industry
segment. As shown, all four segments of the healthcare sector are growing.
                                                                       8
Figure 2: 2005-2015 Job Growth in the Healthcare Sector by Segment


       2015

       2014

       2013

       2012

        2011
Year




       2010

       2009

       2008

       2007

       2006

       2005

               0            20,000          40,000          60,000         80,000          100,000       120,000

                                                            Jobs
       Acute Care      Offices & Clinics     Outpatient Care & Medical Labs         Long-term & Residential Care




7
    Projected growth from 101,756 in 2010 to 112,644 in 2015.
8 EMSI Complete Employment - 3rd Quarter 2010.




                                                                                                                   3
Results of the employer survey reveal short-term growth expectations within the
healthcare sector. It should be noted that growth expectations reported by employers
only represent growth among current firms and do not account for growth from
relocations or new firms being established.

Survey respondents reported that 11 percent of their employees are temporary or
contract. As such, of the 101,134 employees in the healthcare sector, 90,470 are
estimated to be permanent with approximately 10,664 temporary or contract employees.

The majority of firms expect employment to remain the same over the next 12 months,
with 61 percent anticipating the same number of permanent employees and 79 percent
anticipating the same number of contract or temporary employees 12 months from now.

Twenty-seven percent of firms expect to have more permanent employees and 14
percent expect to have more temporary or contract employees 12 months from now.
Only three percent of firms anticipate job cuts to permanent employees and two percent
expect fewer contract or temporary employees within the year.

Overall, employers anticipate a 6.4 percent growth rate in permanent employment and a
20.7 percent increase in temporary or contract employment over the next 12 months.
Figure 3: Employer Expectations for Employment 12 Months from Now



                             27%
           More
                       14%


                                         61%
  Same number
                                               79%


                       3%
           Less
                       2%                                     Permanent Employees 12
                                                              Months from Now

                             9%                               Temporary or Contract
 Don't Know/NA                                                Employees 12 Months from
                        6%                                    Now


                  0%               20%         40%         60%          80%            100%




                                                                                              4
Of the 101,134 workers employed by the healthcare sector, 64 percent work in Santa
Clara County (64,247 workers), 26 percent in San Mateo County (26,537 workers), and
10 percent in southern Alameda County (10,350 workers).

The following map displays current healthcare employment by zip code across Silicon
Valley. As shown, there are several zip codes that have high levels of employment.
Appendix D provides a side by side map comparison of current and projected
employment by healthcare segment.
Figure 4: Map 2009 Healthcare Jobs by Zip Code in the Silicon Valley




                                                                                      5
KEY ISSUES IMPACTING THE INDUSTRY
Some of the key issues facing healthcare include: (1) population growth, (2) aging
population, (3) regulatory impacts, (4) technological advances, and (5) training supply of
healthcare professionals.

POPULATION GROWTH
The demand for healthcare services will steadily increase as the population grows. Over
the next 30 years (2010–2040), the California Department of Finance estimates that the
Silicon Valley population will grow by 25 percent. Although somewhat slower than the
state’s overall expected growth rate of 39 percent, the addition of more than 645,000
new residents over the next 30 years will significantly increase the demand for
healthcare services. To meet demand, the sector will need to expand its service capacity
by building new facilities and adding healthcare professionals to the payroll.
                                              9
Table 1: 2010–2040 Population Projections
                                                                        2010–2040
                                                                                            2010–2040
                                      2010               2040            Absolute
                                                                                            % Change
                                                                         Change
    Silicon Valley10               2,574,028           3,219,998           645,970                    25%
    California                    39,135,676          54,266,115        15,130,439                    39%




9
  State of California, Department of Finance, Population Projections for California and Its Counties 2000-
       2050, by Age, Gender and Race/Ethnicity, Sacramento, California, July 2007.
10
   Data includes Santa Clara and San Mateo Counties. Zip code level data is not available for southern
       Alameda county.




                                                                                                             6
AGING POPULATION
The population is also getting older. As shown in Figure 5, Silicon Valley will see the
largest population increase in the 60 to 79 age cohort over the next five years. This baby
boomer generation will have a significant impact on the healthcare sector for several
reasons. First, the majority of older adults suffer from at least one chronic illness and are
likely to visit a physician’s office twice as often as the average person. Second, the baby
boomer generation is expected to live longer than any previous generation, increasing
and shifting demand for certain types of care.11 Lastly, as the population ages, baby
boomers employed by healthcare will retire in larger numbers, increasing demand for
newly trained healthcare professionals.
                                                                                 12
Figure 5: 2010–2015 Change in Population by Age Cohort in the Silicon Valley

     50,000
                                                                        13%

     40,000


     30,000


     20,000


     10,000                                                                                6%
                   1%
                                                      0.2%
          0
                Under 20          20 to 39          40 to 59          60 to 79        80 and Over
     -10,000


     -20,000                        -2%

     -30,000




11
   Retooling for an Aging America: Building the Healthcare Workforce, Committee on the Future Healthcare
       Workforce for Older Americans, Institute of Medicine (2008).
12
   EMSI Complete Employment - 3rd Quarter 2010.




                                                                                                           7
REGULATORY IMPACTS
On March 23, 2010, President Barack Obama signed               The Healthcare Reform
into law the Patient Protection and Affordable Care Act
                                                               Act extends healthcare
(HR 3590), which was later amended by the Healthcare
and Education Reconciliation Act of 2010 (HR 4872).            coverage to 30 million
This law extends healthcare coverage to 30 million
uninsured Americans within four years, as well as              uninsured Americans
expands coverage for many others. It also improves             within four years as well
access for preventive services, provides incentives for
businesses to provide healthcare benefits, and                 as expands coverage for
establishes a workforce infrastructure, among other
provisions aimed at improving access and quality care.         many others.

Expanding coverage to 30 million Americans will
significantly increase the demand for healthcare
services, and in turn, will increase the demand for healthcare practitioners, such as
physicians, registered nurses, nurse practitioners, and physician assistants. The
Healthcare Reform Act includes several workforce provisions that will assist the
healthcare sector in meeting the anticipated increased demand for healthcare services.
Some of the key provisions include: (1) the establishment of a health workforce data,
analysis, and planning system; (2) grants to develop/expand primary care residency
programs; (3) the establishment of “Teacher Health Centers” to provide training to
primary care residents in community health centers; (4) revision of student loan
guidelines to increase accessibility of loans; and (5) mid-career scholarships to
professionals in allied health or public health. Appendix F provides a complete summary
of the workforce provisions in the Healthcare Reform Act.

In addition to federal regulations, the California state legislature enacts scope of practice
(SOP) laws that regulate the delivery of healthcare services. SOP laws establish the
scope of services that may be provided by specific professions, sometimes increasing or
decreasing the overall supply and demand of healthcare professionals. Recent and
planned legislative changes include:

 •   Effective December 19, 2007, Medical Laboratory Technicians (MLTs) may
     perform routine laboratory tests for diagnosis and treatment under the supervision
     of a clinical laboratory scientist (CLS). This new requirement created a new
     occupation that is considered the middle step in the clinical laboratory career
     ladder, between lower skilled occupations such as phlebotomist and lab assistant
     and the higher skilled CLS occupation.

 •   Effective October 11, 2009, California State Senate Bill 112 established new state
     licensing requirements for Hemodialysis Technicians. New and current certificate
     holders must comply with the revised training and testing requirements to practice
     in California.

 •   Effective January 1, 2015, Radiologic Technologists must hold an associate
     degree, baccalaureate degree, or graduate degree from an accredited institution.
     Current legislation only requires that Radiologic Technologists complete a formal




                                                                                                8
         training program related to radiologic technology, ranging in length from one to four
         years depending on the program. This new requirement may restrict the supply of
         Radiologic Technologists as non-degree programs phase out of the system by
         2015.

TECHNOLOGICAL ADVANCES
In the United States, healthcare is more than a $2 trillion industry. Operating
expenditures are expected to grow substantially over the next decade, reaching $4.4
trillion by 2018, more than double 2007 spending.13 Through technology, however, there
are abundant opportunities to make healthcare safer, more effective and less costly.

The Obama administration has invested millions of dollars to advance the adoption of
health information technology (HIT) among healthcare organizations. This technology
eliminates processing of paper documents and reduces medical recording errors, while
reducing basic operating costs. The former national coordinator for health information
technology estimated that the widespread implementation of electronic health records
could save the healthcare sector $300 billion every year.14 (For more on health
information technology, please refer to the section beginning on page 10.)

Telemedicine is another technological advancement that has the potential to streamline
the care-giving process while reducing operating expenses. Using high-speed data lines,
telemedicine visually connects the physician with a patient in a remote location.15 This
allows patients in remote areas to consult with a specialist that may not be available in
their region. In situations where time is of the essence, telemedicine offers an
inexpensive course for immediate consultation.

Additionally, there have been many advances in the development and manufacturing of
medical technologies, such as miniaturization, robotics, rapid prototyping, photonics,
advanced machining, nanotechnology, stem cells, and digital imaging. As these new
technologies become integrated into clinical settings and processes, the sophistication of
devices improves the quality of patient care. These technological advances may also
reduce healthcare expenditures by increasing the speed in which medical problems are
diagnosed and treated.




13 “Health Spending Projections through 2018: Recession Effects Add Uncertainty to the Outlook,” Health
         Affairs – The Policy Journal of Health Sphere, February 2009.
14 Kluger, Jeffrey, Electronic Health Records: What‘s Taking so Long? Time Magazine, November 25, 2009,
        online at www.time.com/time/health/article/0,8599,1887658,00.html.
15
     UC Davis Health System, Center for Health and Technology
        www.ucdmc.ucdavis.edu/cht/services/telemedicine/, ccessed September 27, 2010.




                                                                                                          9
HEALTH INFORMATION TECHNOLOGY
Health information technology (HIT) is a term used to encompass the collection,
transmission, analysis, and storage of medical information. This information includes
medical records, insurance and billing details, diagnostic test results, and many other
technical patient data. A properly designed and implemented HIT system allows for
faster and more efficient communication, which can lead to higher patient satisfaction
and a reduction in medical errors.

The potential benefits of HIT systems have not been lost on healthcare providers or the
government. HIT systems are being deployed at a rapid pace in large hospitals and
small medical offices all across the nation. In order to more fully understand the factors
driving HIT growth in the region, the project team conducted an extensive literature
review along with eight executive interviews of HIT experts in California. This section
provides a summary of the research.

HIT is essentially customized IT for the healthcare sector. Just like IT, the sector
represents a broad category of technologies, including hardware, software, and
networks. At its most basic level, HIT includes the computers, networks, and storage
devices for Electronic Health Records (EHR). At its most advanced, HIT encompasses
wireless device technology embedded in medical implants that transmit signals to
medical offices for diagnosis.

Among the 200 employers surveyed, 41 percent indicated that their organization has
begun to use new healthcare information technologies, like electronic health records,
within the last three years, and in addition, 27 percent indicated that they are not
currently using but will consider new healthcare information technologies in the future.
Figure 6: Use of New Healthcare Technologies within the Last Three Years
 100%
  80%
  60%            41%
  40%                                  27%                   29%
  20%                                                                          4%
   0%
          Yes, we are using      No, but we are     No, and we do not      Don't know
           new healthcare       considering new       expect to be
             information            healthcare      adopting any new
            technologies           information          healthcare
                               technologies in the     information
                                      future       technologies in the
                                                    immediate future




                                                                                             10
Among those firms either currently using or expecting to incorporate new technologies,
the majority (55%) expressed no difficulty finding new workers or developing current
workers who can effectively use the tools and applications associated with healthcare
information technology (6% expressed great difficulty and 37% some difficulty).

In the last twelve months, 13 percent of employers have outsourced work to vendors that
are supporting the development, installation or training of health information technology
applications. On average, the healthcare employers surveyed have one (1.14 mean)
permanent, temporary, or contract employee at their location who spends at least half of
his/her time on supporting or installing information technology applications. Close to
three percent (2.6%) of employees (permanent, temporary, or contract) spend at least
half their time supporting the development, installation, or training of health information
technology applications.

According to the experts interviewed for this report,16 the vast majority of HIT activity in
the region is for the implementation of EHR systems. Much of this activity can be linked
directly to the American Recovery and Reinvestment Act of 2009 (ARRA), which
established incentives and penalties connected to the adoption of EHR. Specifically, the
HITECH Act, part of the larger ARRA bill, established a grant program to defray the
investment of EHR systems which, until then, had been the responsibility of healthcare
providers.

The financial incentives provided by ARRA were reported as being critical to the growth
of EHR in the region,17 which makes sense given the results of a 2006 national survey
that cited the implementation costs of EHR as the single largest obstacle to adoption.18
In addition to the grant program, the HITECH Act includes Medicare and Medicaid
penalties for non-adopters of one to three percent of reimbursement costs. Notably, the
EHR penalties and incentives are linked to minimum standards that should lead to at
least some consistency across systems, reducing frustration of users, from patients to
providers. Beyond EHR, cost, particularly in the current economic situation, was the
most frequently cited barrier to adoption.

From a workforce perspective, employers (developers or super users of healthcare
information technology that participated in the executive interviews) provided several
consistent responses, including:

     1. Short-term HIT growth will not lead to new occupations, but will require new skill
        sets.

     2. Most providers are not facing difficulty in training existing staff on how to use
        technology.


16
   Ten executive interviews with industry leaders, prominent employers, human resource directors, and
        technology managers within the healthcare and information technology sectors that are either
        developers or super users of healthcare information technology were conducted as part of this study.
17
   There are other factors driving the growth of HIT adoption in the region. The most notable is patient
        demand.
18
   Millenium Research Group, July 2007, United Press International. Available at:
      www.ihealthbeat.org/articles/2007/7/18/Doctor-EHR-Adoption-Could-Reach-30-by-2011-Survey-Finds.aspx.




                                                                                                               11
   3. Medical records clerks, followed by nurses and doctors, will be the most affected
      by HIT because they are the most prolific users of the systems.

   4. More technical training is required as part of formal education; users need both
      technical and medical training to be successful.

   5. For technical workers (such as IT staff, etc.), more contextualized training in a
      healthcare setting is critical.

   6. Workforce demand is temporary and is related to IT staff building infrastructure;
      current IT staff needs more training in security.

These findings indicate that HIT adoption, at least in regards to Electronic Health
Records, will not dramatically affect net job growth. However, employers have noted a
need for more technical training of healthcare providers, in addition to their medical
training. This presents a particularly important opportunity for the public workforce
system to meet the current short-term need for adequately trained medical
professionals.




                                                                                          12
WORKFORCE AND RECRUITMENT NEEDS
RECRUITING, RETRAINING, AND REPLACING WORKERS
The survey of 200 healthcare employers provides current data on the level of difficulty
employers face with regard to a number of general workforce needs.
•      Close to one in two (48%) healthcare employers have difficulty replacing workers
       with qualified candidates from outside the organization.
•      Forty-three percent of employers expressed difficulty finding qualified applicants that
       can communicate with the different languages needed to effectively communicate
       with customers.
•      Forty-one percent of employers indicated difficulty recruiting employees that are
       trained and experienced with the latest healthcare information technology.
 •     Employers expressed comparatively low difficulty replacing workers with qualified
       employees within the organization (30%) and retraining and educating entry-level
       employees for advancement (28%).
 •     Overall, the percentage of employers that reported “great difficulty” addressing each
       workforce need was relatively low (3% to 12%).
Figure 7: Workforce Challenges for Healthcare Employers


     Replacing workers with qualified
         candidates from outside the         12%                   36%
                        organization

          Finding qualified applicants
      that can communicate with the
       different languages needed to 3%                     40%
        effectively communicate with
                             customers
       Recruiting employees that are
        trained and experienced with
                                        10%                      31%
                  the latest healthcare
              information technology

             Replacing workers with
          qualified employees within     5%           25%
                     the organization

            Retraining and educating
       entry-level employees so they
       can advance to a new position 4%              24%
              with greater pay and/or
                      responsibilities
                                        0%                 20%            40%              60%
                                              Great difficulty           Some difficulty




                                                                                                 13
COMMUNICATION AND LANGUAGE CHALLENGES
Eighteen percent of surveyed employers indicated they use or need certified healthcare
interpreters or medical translators. Among those, 57 percent use an outside company to
provide interpreters or translators and 34 percent have them on staff. The remaining
employers provided “Other” or “Don’t know/NA” responses.

No one skill surfaced as being the most deficient among recent hires. Approximately a
third of employers cited technical competence specific to the position (36%), the ability to
effectively communicate in English (34%), and the ability to speak more than one
language (32%) as skill deficiencies among recent hires. One in four employers
indicated that the ability to use the most current health information technology (24%)
was a deficiency.
Figure 8: Skill Deficiencies among Recent Hires

      Technical competence specific to the
                                                             36%
                                 position
      Ability to communicate effectively in
                                                             34%
                                  English

  Ability to speak more than one language                   32%
 Ability to use the most current healthcare
                                                        24%
                    information technology

                           Other: Work ethic            4%

   Other: Computer/ typing / clerical skills           2%

                Other: Organizational skills           1%

                      Other: Listening skills          1%

                    Depends on occupation              1%

                        No skill deficiencies          4%

                                  Don't know            22%

                                                  0%          20%   40%     60%        80%




                                                                                               14
RECRUITMENT PRACTICES
The majority of healthcare employers advertise on craigslist (58%) and in local
newspapers, in web or print (53%), to recruit applicants for hiring. Forty percent partner
with local and regional educational providers, 25 percent advertise on job-finder
websites, 22 percent participate in local and regional job fairs, and 13 percent use social
media tools for recruitment.
Figure 9: Recruitment Practices



                     Advertising on craigslist                 58%                 40%         3%


             Advertising in local newspapers
                                (web or print)               53%                   45%         3%


           Partnering with local and regional
                      educational providers              40%                     55%           6%


      Advertising on job-finder websites like
                                monster.com            25%                  70%                6%



  Participating at local and regional job fairs        22%                  76%                3%


           Using social media tools, such as
            Facebook, Twitter, and Linkedin        13%                     84%                 3%
                                   to recruit

                                                  0%     20%         40%    60%        80%   100%
                                                         Yes         No      Don't know/NA




                                                                                                    15
OCCUPATIONAL ANALYSIS
The survey research component of the study focused on 10 healthcare occupations. To
be selected for inclusion, an occupation had to meet at least one of the following criteria:
large employment in the region, anticipated above average growth, or be an occupation
easily served by local workforce investment board education and training programs.

The occupations chosen as the focus of the primary research were:

 •   Registered Nurses (RNs)                         •    Radiologic Technicians
 •   Surgical Technicians or                         •    Dietitians and Nutritionists
     Technologists
                                                     •    Physician Assistants
 •   Health Information Administrators
                                                     •    Dialysis Technicians
 •   Certified Coders
                                                     •    Respiratory Therapists
 •   Radiologic Technologists

The table below shows the percentage of healthcare firms employing individuals within
each occupational title. Of the 10 occupations, healthcare firms were the most likely to
employ Health Information Administrators (29%) and Registered Nurses (27%).

To keep the survey length averaging 15 minutes, employers were asked to provide data
for up to four occupations at their location with the number of firms providing survey data
on each occupation is shown. Due to the low incidence of healthcare firms employing
Respiratory Therapists (4%) and Dialysis Technicians (3%) and the small survey sample
size, survey data for those two occupations has not been presented in the report. It
should also be noted that three other occupations, Surgical Technicians or
Technologists (n=15), Radiologic Technologists (n=13), Radiologic Technicians (n=12)
have sample sizes less than 25 and caution should be exercised in generalizing results.
Table 2: Percentage of Firms Employing Each Occupation
                                                % of Firms                Number of Firms
                                              Employing Each              Providing Survey
                                                Occupation                      Data
 Health Information Administrators                 29%                           54
 Registered Nurses (RNs)                           27%                           51
 Dietitians and Nutritionists                      18%                           34
 Certified Coders                                  17%                           29
 Physician Assistants                              15%                           26
 Surgical Technicians or
                                                         9%                         15
 Technologists
 Radiologic Technologists                                8%                         13
 Radiologic Technicians                                  8%                         12
 Respiratory Therapists                                  4%                         7
 Dialysis Technicians                                    3%                         5



                                                                                               16
OCCUPATIONAL PROJECTIONS
Figure 10 shows employers’ anticipated growth and replacement needs over the next 12
months for each of the occupations.

Employers anticipate double-digit need, growth plus replacements, for six of the eight
occupations. Employers expect a 20 percent growth and replacement need for Physician
Assistants over the next 12 months (12% growth, 8% replacement), followed by Certified
Coders at 15 percent (15% growth, 0% replacement) – both of these percentages are
driven by high anticipated growth in the occupations.

Employers expect the highest turnover – from either replacements or retirements – in
Dietitians and Nutritionists (12% replacement rate) and Surgical Technicians or
Technologists (10% replacement rate).
Figure 10: Estimated Growth and Replacement Needs by Occupation: Next 12 Months


                   Physician Assistants          12%            8%

                       Certified Coders              15%         0%

 Surgical Technicians or Technologists      4%        10%

              Radiological Technicians           9%        5%

     Health Information Administrators          8%        5%
                                            0%
            Dieticians and Nutritionists         12%

            Radiological Technologists      4%       6%                    12-Month Growth Rate

                                            3%                             12-Month Retirement
               Registered Nurses (RNs)           5%                        or Replacement Rate


                                           0%                        20%                         40%




                                                                                                       17
         The table below shows estimated employment, growth, replacements, and the median
         wage for each occupation; it is sorted by the total anticipated openings. Note that the
         estimated occupational employment shown represents healthcare sector employment
         only, excluding employment in other industries, such as government or education.
         Table 3: Occupational Employment Estimates and Projections for Silicon Valley
                                  Estimated
                                     2010                    Replace- Openings Total
                                             Growth Openings                          Median
                                  Healthcare                  ments     from Openings
                                             Next 12 from                             Hourly
                                    Sector                   Next 12 Replace- Next 12
                                             Months Growth                            Wage20
                                   Employ-                   Months ments      Months
                                    ment19
Registered Nurses (RNs)              14,054         2.6%         371          5.0%          704          1,075         $53.22
Health Information
                                       628          8.3%          52          4.8%           30            82          $48.72
Administrators
Surgical Technicians or
                                       572          4.0%          23         10.1%           58            80          $26.55
Technologists
Physician Assistants                   309         12.2%      38     7.5%        23         61                         $50.62
Radiologic Technologists               582         4.2%       24     5.6%        32         57                         $36.46
Dietitians and Nutritionists           448         0.0%       0     12.2%        54         54                         $32.25
Radiologic Technicians                 361         9.1%       33     4.8%        17         50                         $28.64
Certified Coders                       240         15.2%      36     0.0%         0         36                         $22.19
Dialysis Technicians                   256          Small survey sample size, data not presented                       $24.11
Respiratory Therapists                 613           Small survey sample size, data not presented                      $37.89

         19
            EMSI Projected 2010 Occupational Employment used for all occupations with a clearly defined SOC code.
               Exceptions: Health Information Administrators, Certified Coders, Radiologic Technologists, Radiologic
               Technicians, and Dialysis Technicians. Certified Coders are classified under the larger Health
               Information Technicians occupation (BW Research surveyed both occupations for the San Francisco
               Bay COE’s 2009 Allied Health Study). The proportion of Certified Coders to Health Information
               Technicians found in that for Silicon Valley was applied to estimate the number of Certified Coders
               within the larger occupational category. As the SOC system groups Radiologic Technologists and
               Technicians, NOVA’s current study survey data was used to estimate the proportion of each
               occupation to the total. For both Health Information Administrators and Dialysis Technicians, survey
               data from the total number in each occupation represented by the survey to the total 2010 EMSI
               projections across the other occupations was used to estimate the number employed in each
               occupation due to respective classification (Health Information Administrators: Medical and Health
               Services Managers, Dialysis Technicians: Healthcare Technologists and Technicians, All Other).
         20
            EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
               Alameda County due to limitations related to combining county and zip region data. The median
               hourly wage for Health Information Administrators is from the larger Medical and Health Services
               Managers occupation and that of Certified Coders is from the larger Medical Records and Health
               Information Technicians occupation. The median hourly wage for Dialysis Technicians is from the
               larger Healthcare Technologists and Technicians, All Other occupation. As the SOC system groups
               Radiologic Technologists and Technicians, the median wage across the category is shown for
                                                     th
               Radiologic Technologists and the 25 percentile wage is shown for Radiologic Technicians.




                                                                                                                                18
DIFFICULTY HIRING
The majority of employers (54% to 77% depending on the occupation) did not report any
difficulty finding qualified applicants for the eight occupations.

Employers reported the most total difficulty finding qualified Health Information
Administrators (35%), Radiologic Technologists (33%), and Radiologic Technicians
(31%).

Employers were most likely to have “great difficulty” finding Radiologic Technicians
(15%) and Certified Coders (14%).
Figure 11 Difficulty Finding Applicants who Meet Hiring Standards


      Health Information Administrators          9%               26%


             Radiological Technologists          8%              25%


                Radiological Technicians           15%              15%


                Registered Nurses (RNs)          8%            22%


                         Certified Coders         14%            14%
                                              0%
 Surgical Technicians or Technologists                   27%
                                              0%
                    Physician Assistants               23%


             Dieticians and Nutritionists 3%          15%

                                            0%                   20%        40%             60%

                                                      Great difficulty    Some difficulty




                                                                                                  19
Number Employed, Occupational Need, and Difficulty Hiring

The size of each bubble in Figure 12 represents the number of employees in each
occupation within the healthcare sector. The horizontal axis plots difficulty hiring and the
vertical axis plots the 12-month anticipated need (growth plus replacement).

The total sum (14,054) of Registered Nurses employed in Santa Clara, San Mateo, and
southern Alameda counties is four and a half times larger than the sum of the other
seven occupations included in this report (total employment of 3,140). Therefore,
although the total growth and replacement need for this occupation was the lowest of the
eight, the below figure reflects that this occupation has the highest number openings as
related to the other eight due to its size.

Based on employers’ reported 12-month need and difficulty hiring, Physician Assistants
(bubble 8), Certified Coders (bubble 4), Radiologic Technicians (bubble 6) and Health
Information Administrators (bubble 3) emerge as the occupations with the most potential
to be undersupplied in the future.
Figure 12: Number Employed, Occupational Need, and Difficulty Hiring




                                                (8)
        20%
12-month Need




                                                                    (4)
                                                                                   (6)
                                                                                                 (3)
                           (7)                          (2)

                                                                                          (5)
        10%


                                                                           (1)




                0%
                 15%                                   25%                                      35%
                                                               Difficulty Hiring
                       (1) Registered Nurses (RNs)                        (2) Surgical Technicians or Technologists
                       (3) Health Information Administrators              (4) Certified Coders
                       (5) Radiological Technologists                     (6) Radiological Technicians
                       (7) Dieticians and Nutritionists                   (8) Physician Assistants




                                                                                                                      20
   SUPPLY AND DEMAND GAP ESTIMATES
   The supply and demand assessment of the healthcare occupations is based on the
   estimates of job openings and the region's ability to train and educate new qualified
   applicants for these positions.

   There are several data limitations to the analysis that should be considered, including:

    •     The dataset does not track the number of graduates that are moving in and out of
          the region. It is very difficult to obtain this type of data. Yet, it has a significant
          impact on the availability of a trained workforce.
    •     The replacement estimates include turnover within the industry, which may
          overstate the gap assessment.
    •     The dataset does not assess employer education and training preferences by
          occupation.
    •     The total number of degrees awarded may be inflated due to some students
          immediately advancing (such as enrolling in a masters program post bachelor’s).

   With that being said, over the next several years, if the overall demand for individual
   occupations (new job openings plus replacement job openings from retirement or people
   leaving the profession) is larger than the region's ability to train and educate individuals
   in these professions, employers will need to recruit qualified individuals from outside the
   region. This is an additional financial burden on regional healthcare employers and a
   missed opportunity for strengthening Silicon Valley's workforce.

   The table below provides an annual estimate of the number of individuals that have
   graduated from the specific occupational training programs within Silicon Valley.
                                                                           21
   Table 4: Healthcare Degrees Conferred by Occupation in Silicon Valley
                                                         A.S. &
                                                        Certifica      B.S. & M.S.            Total
                    Occupation
                                                           te           Degrees              Degrees
                                                        Degrees
Certified Coders                                           82                                  82
Dialysis Technicians                                       46                                  46
Dietitians and Nutritionists                                                    38             38
Health Information Administrators                           64                                 64
Physician Assistants                                                                        Unavailable
Radiologic Technologists                                   40                                  40
Registered Nurses                                          282                  282            564
Respiratory Therapists                                     59                                  59
Surgical Technicians or Technologists                      59                                  59

   21
        California Postsecondary Education Commission, Custom Data Report, September 2010. Augmented by
             COE phone survey conducted 8/15/2010 – 9/10/2010.




                                                                                                          21
The table below shows the total expected openings for the healthcare occupations and
the current expected capacity to train and prepare individuals for these occupations, on
an annualized basis.

The results of the supply and demand gap estimate show that there is a large difference
between the number of expected openings and the region's capacity to train new nurses.
This simplified analysis is overstating the size of the problem because of the issues
identified on the previous page. However, if the large percentage of replacement
openings for nurses and other occupations continues for several years and most of the
replacements are connected to retirements or other qualified individuals leaving the
healthcare workforce rather than turnover, then these gap estimates portend some
important challenges for the region's healthcare training and educational institutions.
Note that Dialysis Technicians and Respiratory Therapists were not included due to
limitations of survey sample size.
Table 5: Regional Supply and Demand Gap Estimate Table
                                        Openings   Total                          Annual
                          Openings                                  Annual
                                          from   Openings                        Training -
                            from                                   Regional
                                        Replace-  Next 12                          Total
                           Growth                                  Training
                                         ments    Months                         Openings
Registered Nurses
                              371           704          1,075         564          (511)
(RNs)
Surgical Technicians
                              23             58           80           59            (21)
or Technologists
Health Information            52             30           82         64              (18)
Administrators
Radiologic                    24             32           57         40              (17)
Technologists
Dietitians and                0              54           54         38              (16)
Nutritionists
Certified Coders              36             0            36         82               46
Physician Assistants          38             23           61      Unavailable




                                                                                              22
EMPLOYER HIRING PREFERENCES
Education and Training Requirements

Within the survey, employers were asked to detail the typical education requirements for
successful applicants within each occupation. In the figure below, shades of green were
used to display education at the community college level and shades of orange to show
a bachelor’s or master’s degree. The figure is sorted by the percentage of employers
that expect at least a certificate for each occupation. Over 60 percent of employers
expected a certificate or higher for each occupation.

A certificate or associate’s degree was the typical level of education expected among the
majority of firms with Radiologic Technicians (62%), Certified Coders (59%), and
Radiologic Technologists (58%). The majority of employers indicated that a bachelor’s or
master’s degree was expected for Dietitians and Nutritionists (59%) and Registered
Nurses (59%).
Figure 13: Typical Education Requirements: At Least Some College by Occupation

 100%

                 Certificate   Associates         Bachelors     Masters          2%
                                                                          17%
  80%
                                            6%         8%
                         3%                                    21%        17%
                                                       8%
  60%      12%           7%     27%                                              57%
                         3%                 30%        8%

           15%                                                            25%
                                 7%
  40%                                                          38%
            8%                              11%
                        55%                           54%
  20%                           40%                             6%               27%
           31%                              30%                           33%
                                                               15%
                                                                                 6%
   0%




                                                                                            23
On-the-Job Experience Requirements

Employers were next asked to detail the typical levels of on the job or related work
experience for successful applicants in each of the occupations. Three out of four
employers expect at least some work experience for each occupation, with the highest
expectations for Certified Coders (93%) and Radiologic Technicians (92%).

Specific experience in the position being applied for was the typical expectation among
the majority of firms with Surgical Technicians or Technologists (73%), Radiologic
Technologists (67%), and Radiologic Technicians (62%).
                                                                                                       22
Figure 14: Typical Work Experience Requirements: At Least Some Experience by Occupation
 100%



     80%                                                                                23%
                                                                23%
                                                                            31%                     38%
                                       24%          26%

     60%       33%         40%
                                                                27%         13%         38%
                                       22%          18%                                             14%
     40%


               33%         33%
     20%
                                                                            44%                     41%
                                       37%          38%         38%
                                                                                        31%

                8%          7%
      0%




                        3 months to 2 years in a related occupation
                        3 months to 2 years in the specific occupation being applied for
                        At least 2 years experience in the specific occupation being applied for



22
     Although Radiologic Technologists have the second highest specific work experience requirement (67%),
         they appear as the lowest total work experience requirement (i.e., left most on the chart) because of a
         higher than average percentage of don’t know/ declined to state/ not sure (i.e., DK/NA) responses to
         this question. Please see Appendix G for the full distribution of responses to the question.




                                                                                                                   24
\




CONCLUSION
SILICON VALLEY'S HEALTHCARE WORKFORCE
Over the last three years (September 2007 to September 2010) total employment23 in
Santa Clara County for the entire economy except for the healthcare industry has
declined by three and a half percent. This represents a significant decline in total
employment that mirrors the national and statewide employment environment. However,
over that same time period, total employment in the healthcare industry has climbed by
four and a half percent. Industry employment in San Mateo has shown a similar trend
over the same time period, with healthcare employment increasing by almost four
percent and non-healthcare employment declining by over five percent. The results of
the employer survey indicate that Silicon Valley's healthcare industry will continue to
increase total employment as well as continue to have at least some difficulty finding
qualified workers. In a time where uncertainty seems to describe much of the regional
and national economy, healthcare remains a safe bet for continued employment growth
and a critical industry for job seekers looking for strong career pathways.

Over the next five years (2010 to 2015), employment in the region's healthcare industry
is expected to grow by over 10 percent, accounting for approximately 11,000 new jobs in
Silicon Valley. A recent study of Bay Area allied health employers24 revealed that
employers expect to hire three replacement jobs for every new job that is created in the
healthcare industry. This finding indicates that there could potentially be 40,000 new job
openings (replacement jobs + new jobs) in Silicon Valley's healthcare industry over the
next five years. In a labor market with unemployment hovering around 10 percent, these
40,000 job openings will be a valuable commodity as the region works to educate, train,
and prepare the next generation of healthcare workers.

FORCES THAT WILL IMPACT THE HEALTHCARE WORKFORCE
This baseline scenario for healthcare employment in Silicon Valley that forecasts just
under 11,000 new jobs over the next five years is built on some relatively conservative
assumptions about the demand for healthcare which include:

     •   The graying of the population: With the projected increase in the median age
         of Silicon Valley residents over the next five years, the demand for healthcare
         services will increase since older residents require considerably more healthcare
         services. This will also impact the healthcare workforce as many of the baby
         boomers who are currently working in the industry look to retire in the near future.

     •   Increased access to healthcare services due to healthcare reform: The
         recently enacted federal legislation will have its biggest impact starting in 2014
         and with it comes considerable uncertainty. However, generally the forecast
         assumes that the legislation will increase access to healthcare services and will
         incrementally have a small impact upon total demand for healthcare services.


23
   Defined as Total Civilian Employment: Source California Employment Development Department,
       September 2010.
24
   Source: www.coeccc.net/Environmental_Scans/alliedhealth_scan_bay_10.pdf




                                                                                                25
\




The baseline scenario does not tell the entire story of how the demand for different skills
and occupations is changing within healthcare as well as some of the other changes in
healthcare that if adopted earlier than expected could have a significant impact upon our
expectations for the healthcare workforce. These issues to consider include:

1. Health Information Technology: The proliferation of health information technologies
such as electronic health records, electronic billing, and automated customer interfaces
could potentially have a significant impact on the healthcare workforce. Healthcare
occupations that have traditionally focused on clinical competence, like registered
nurses, are now finding that they must combine their clinical expertise with a
comprehensive understanding of technology and the technical prowess associated with
using these new computerized tools. Several healthcare human resource professionals,
interviewed for this study, discussed the need to find individuals who combined clinical
training with technical skills that would allow them to use and understand the new
technologies that are quickly moving into healthcare. As of now, must healthcare human
resource planners do not believe that the adoption of health information technologies will
change the overall demand for healthcare workers; however, they do believe it will likely
have a significant impact on the skill sets that are needed to be successful within the
healthcare industry.
2. The growing demand for remote monitoring and use of outpatient facilities: The
traditional extended hospital stay may not be endangered yet but according to several
healthcare experts we spoke with, it may be something that we continue to see less and
less of. From a workforce perspective, as more and more healthcare services are
provided at outpatient facilities and the demand for remote monitoring of these patients
increases, the overall composition of the healthcare workforce is likely to change. Fewer
jobs will be found in hospitals and more employment will be located in clinics at
outpatient facilities. Traditional healthcare positions like certified nursing assistants
(CNAs) may decline and be replaced by mobile nurses who can monitor patients
remotely and go directly to their homes if needed.


There are great changes afoot in healthcare due to some of the issues discussed here
and other convergent factors. Institute for the Future examines future disruptive forces of
change that will have a great impact on the healthcare workforce in the next 10 to 20
years (see Appendix I) as an addendum to this report.




                                                                                              26
APPENDIX A: HEALTHCARE INDUSTRY DEFINITION BY NAICS
SEGMENT # 1: ACUTE CARE
  NAICS 621910 - Ambulance Services
  NAICS 621991 - Blood and Organ Banks
  NAICS 621999 - All Other Miscellaneous Ambulatory Healthcare Services
  NAICS 622110 - General Medical and Surgical Hospitals
  NAICS 622210 - Psychiatric and Substance Abuse Hospitals
  NAICS 622310 - Specialty (except Psychiatric and Substance Abuse) Hospitals

SEGMENT # 2: OFFICES AND CLINICS
  NAICS 621111 - Offices of Physicians (except Mental Health Specialists)
  NAICS 621112 - Offices of Physicians, Mental Health Specialists
  NAICS 621310 - Offices of Chiropractors
  NAICS 621320 - Offices of Mental Health Practitioners (except Physicians)
  NAICS 621320 - Offices of Optometrists
  NAICS 621340 - Offices of Physical, Occupational and Speech Therapists, and
  Audiologists
  NAICS 621391 - Offices of Podiatrists
  NAICS 621399 - Offices of All Other Miscellaneous Health Practitioners

SEGMENT # 3: OUTPATIENT CARE AND MEDICAL LABS
  NAICS 621410 - Family Planning Centers
  NAICS 621420 - Outpatient Mental Health and Substance Abuse Centers
  NAICS 621491 - HMO Medical Centers
  NAICS 621492 - Kidney Dialysis Centers
  NAICS 621493 - Freestanding Ambulatory Surgical and Emergency Centers
  NAICS 621498 - All Other Outpatient Care Centers
  NAICS 621511 - Medical Laboratories
  NAICS 621512 - Diagnostic Imaging Centers

SEGMENT # 4: LONG-TERM AND RESIDENTIAL CARE
  NAICS 621610 - Home Healthcare Services
  NAICS 623110 - Nursing Care Facilities
  NAICS 623210 - Residential Mental Retardation Facilities
  NAICS 623220 - Residential Mental Health and Substance Abuse Facilities
  NAICS 623311 - Continuing Care Retirement Communities
  NAICS 623312 - Homes for the Elderly
  NAICS 623990 - Other Residential Care Facilities




                                                                                A-1
APPENDIX B: HEALTHCARE CAREER LATTICES
Transferability of occupational skills is critically important in rapidly changing and
complex work environments. For healthcare workers, the ability to move seamlessly
from one occupation to another provides more employment stability as well as increased
upward mobility. However, due to the highly technical nature of many healthcare
positions, the development of career lattices that demonstrate transferable skills can be
more difficult without a detailed workforce skills analysis. Workers will often need to
augment their skills or credentials in order to move from one job to another.

This section includes an analysis on the transferability of skills from occupations that
show a potential surplus to occupations that are in high demand.

Career Lattice #1 on the following page illustrates the ability of Registered Nurses to
transition to Clinical Laboratory Scientists, Physical Therapists, or Radiologic
Technicians. Though these higher demand occupations pay less on average than
nursing positions, given the potential short-term surplus of Registered Nurses -- and the
high number of shared skills among the occupations -- Registered Nurses are more
likely to achieve better employment outcomes by considering a transfer to one of the
three listed occupations.

Because the education and training requirements for nurses (AS or BS in nursing) and
those for Clinical Laboratory Scientists (BS), Physical Therapists (MS), and Radiologic
Technicians (AS) are slightly different, nurses (particularly those with an AS degree) will
require additional specialized training to be most competitive. Due to the similarities of
the programs, however, nurses will have already completed many of the course
requirements for their new credentials.




                                                                                              B-1
                                   Occupations in High Demand
Career Lattice #1

                                     Clinical	
       • Educa(on:	
  BS	
  in	
  Clinical	
  
  Possible	
  Surplus:	
  	
       Laboratory	
         Laboratory	
  Technology	
  	
  
  Registered	
  Nurse	
             Scien(st	
        • Median	
  Hourly	
  Wage:	
  $42	
  


                                                      • Educa(on:	
  	
  MS	
  in	
  Physical	
  
                                     Physical	
         Therapy	
  
                                    Therapist	
  
                                                      • Median	
  Hourly	
  Wage:	
  $35	
  
  Education:	
  	
  AS	
  or	
  
    BS	
  in	
  Nursing	
                             • Educa(on:	
  AS	
  in	
  
                                    Radiologic	
        Radiologic	
  Technology	
  
   Median	
  Hourly	
              Technologist	
  
    Wage:	
  $53	
                                    • Median	
  Hourly	
  Wage:	
  $36	
  



    Transferable Skills: social perceptiveness, active listening,
      monitoring, speaking, judgment & decision making, time
      management, complex problem solving, and instructing.




                                                                                                    B-2
Career Lattice #2 illustrates the potential for Medical Records Clerks, which are facing a
possible surplus, to transition to the higher demand occupations of Certified Medical
Coder, Personal and Home Care Aide, or Home Health Aide. The median hourly wage
can be slightly lower for Home Health Aides and Personal and Home Care Aides, but is
generally higher for Certified Medical Coders.

Some of the more important transferable skills among these positions include writing,
speaking, reading comprehension, and critical thinking. All of the occupations share the
same educational requirements; however, Medical Records Clerks would likely need a
certificate in medical coding to be most competitive for that occupation.


                                        Occupations in High Demand
Career Lattice #2

  Possible	
  Surplus:	
                  Cer(fied	
          • Educa(on:	
  Cer(ficate	
  in	
  
  Medical	
  Record	
                     Medical	
            Medical	
  Coding	
  
        Clerk	
  	
  	
                    Coder	
           • Median	
  Hourly	
  Wage:	
  $21	
  


                                          Personal	
  	
     • Educa(on:	
  High	
  School	
  
                                         and	
  Home	
         Diploma	
  
                                         Care	
  Aide	
      • Median	
  Hourly	
  Wage:	
  $11	
  

    Education: High                         Home	
           • Educa(on:	
  High	
  School	
  
    School Diploma,
   Certificate Preferred                    Health	
           Diploma	
  
                                             Aide	
          • Median	
  Hourly	
  Wage:	
  $10	
  
     Median Hourly
     Wage: $15 - $21




             Transferable Skills: writing, speaking, reading
           comprehension, critical thinking, time management,
           mathematics, coordination, and service orientation.



                                                                                                      B-3
APPENDIX C: HEALTHCARE OCCUPATION PROFILES
INTRODUCTION
This section profiles 25 healthcare occupations categorized into two groups: Tier 1 and
Tier 2. Each profile includes a description of the core activities, top skill requirements,
education and licensing requirements, list of local training providers, career pathway
options, and compatible occupations.

Tier 1 occupations represent those that were selected for inclusion in the BW employer
survey; these occupations were identified using the following criteria:

      •   Healthcare occupations that typically require a 4-year degree or less for
          appropriate entry-level training or certification

      •   Healthcare occupations that have a relatively large number of individuals
          currently employed or expected to be employed in the future.

      •   Healthcare occupations most likely to be undersupplied in the future.

      •   Healthcare occupations that are emerging or facing significant changes among
          employers required skill sets.

      •   Healthcare occupations that develop skill-sets that provide a foundation for
          sustainable career pathways.

      •   Healthcare occupations that provide a living or sustainable wage.25

Tier 2 occupations represent those that may be undersupplied in the near future but, due
to time constraints and resource availability, were not included in the employer survey.
The profiles of the Tier 2 group also include employment projections and wage data for
the healthcare sector. This dataset represents healthcare sector employment only and
excludes occupational employment in other industries, such as government or
education.

The following will list occupational pathways and relevant occupations that are
compatible with each other.

Based on EMSI transitional worker data, only occupations with a compatibility index of
90 or higher and preparation zone of three or less are included. The compatibility index
is zero to 100 (zero indicating no comparable skills with profiled occupation and 100
indicates a perfect skill match). The preparation zone is from 1 to 5; 1 is little or no
preparation needed, 2 is some preparation needed, 3 is medium preparation needed, 4
is considerable preparation needed, and 5 is extensive preparation needed.




25
     City of San Jose, as of July 1, 2009 defined a living wage as $12.83 an hour with health benefits or
                                                                                    th
         $14.08 an hour without benefits. Occupations where the bottom quartile (25 percentile) wage is at or
         above these figures would be considered to provide a living wage.




                                                                                                                C-1
TIER 1 OCCUPATIONS
Certified Medical Coders
Certified medical coders record a patient’s symptoms, diagnoses, and services, using an
alpha-numeric coding system. Coders may use several coding classification systems,
such as those required for hospitals, physician offices, or long-term care. By coding each
procedure and service provided to patients, medical coders ensure that insurance
companies are compensated properly and patients are also billed correctly.

Top Skills of Coders
   • Ability to use computers and computer systems (including hardware and
      software), set up functions, enter data, or process information.
   • Ability to compile, code, categorize, calculate, tabulate, audit, or verify
      information or data.
   • Ability to make precisely coordinated movements of the fingers of one or both
      hands to grasp, manipulate, or assemble very small objects.
   • Ability to arrange things or actions in a certain order or pattern according to a
      specific rule or set of rules.

Education and Licensing Requirements
Most employers prefer to hire credentialed coders with at least a certificate in medical
records and coding. Several associations offer coder and subspecialty certifications
including the American Health Information Management Association (AHIMA), Board of
Medical Specialty Coding (BMSC), and Professional Association of Healthcare Coding
Specialists (PAHCS). Coding subspecialties include: anesthesia, cardiology, emergency
medicine, pediatrics, gastroenterology, general surgery, gynecology, orthopedics,
radiology, urology, and others. These credentialing programs require regular
recertification and continuing education to maintain the credential.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
Higher Education Institution      Name of Program             Type of Program
De Anza College                   Insurance and Coding        Certificate
                                  Medical Biller/Coder/Office
Institute of Business Technology  Specialist                  Certificate
Valley College of Medical Careers Medical Billing and Coding  Certificate
Medical Career College            Medical Billing and Coding  Certificate
Skyline College                   Medical Billing and Coding  Certificate
Techskills                        Medical Coding              Certificate
                                  Medical Insurance Billing
Everest College (formerly Bryman) and Coding                  Certificate




                                                                                             C-2
Career & Education Pathways for Certified Medical Coders

 Certificate Training
                                                      Certified
     In Medical             General
                                                    Medical Coder
   Billing/Coding         Certification




                                                  Associate Degree in
                                                  Health Information     Health Information
                                                     Technology             Technician
                                                      (2 Years)




                                                  Bachelor’s Degree in
                                                   Health Information    Health Information
                                                     Management              Manager/
                                                       (4 Years)           Administrator




          = Education & Training          = Licensing & Certification       = Occupation


Compatible Occupations
  • Physical therapist aides
  • Medical assistants
  • Medical secretaries
  • Dietetic technicians




                                                                                              C-3
Dialysis Technicians – SOC 29-2099
Working under the supervision of physicians and registered nurses, dialysis technicians,
also known as hemodialysis technicians, play a vital role in providing healthcare to those
with kidney problems. They operate kidney dialysis machines that filter normal waste
products and excess fluids from the blood of patients whose kidneys no longer function
properly. They prepare the artificial kidney system equipment for use, as well as monitor
equipment while in use and clean equipment after use. Dialysis technicians must have
both clinical skills related to delivering direct patient care and technical skills related to
regular repair and maintenance of dialysis equipment.

Top Skills of Dialysis Technicians
   • Ability to watch gauges, dials, or other indications to make sure a machine is
      working properly.
   • Ability to control operations of equipment or systems.
   • Ability to tell or recognize when something is wrong.
   • Ability to give full attention to what other people are saying, taking time to
      understand the points being made, and ask questions as appropriate.

Education and Licensing Requirements
Dialysis technicians are required to have one to two years of training post high school. A
typical dialysis training program includes courses in venipuncture, local anesthesia
administration, vital signs monitoring, preparing patients for dialysis, and recognizing the
warning signs of complications. Dialysis programs consist of classroom, clinic and
laboratory training hours.
In California, dialysis technicians are required to be certified by the Department of Public
Health (DPH). The certification requirements include:
    • high school (HS) diploma or equivalency or 4+ years of related work experience,
    • completion of dialysis training program or 2+ years of related work experience,
        and
    • passing score on a standardized test or national examination approved by the
        DPH or Centers for Medicare and Medicaid Services (CMS) For example, the
        Board of Nephrology Examination for Nurses and Technicians (BONENT)
        provides a standardized hemodialysis examination approved by the DPH.

In addition to the initial certification, the state requires 30 continuing education hours
every four years to renew the license.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
Higher Education Institution      Name of Program       Type of Program
                                  Certified
                                  Hemodialysis
Medical Career College            Technician            Certificate

                                        Hemodialysis
Hermodialysis Training School           Technician               Certificate




                                                                                                 C-4
Career & Education Pathways for Dialysis Technicians


  Diploma in Dialysis
       Training
        1Year

                                  Certification + 30         Dialysis
                                 Hours of Continuing        Technician
                                      Education

  Associate Degree in
  Dialysis Technician
       (2Years)




        = Education & Training          = Licensing & Certification      = Occupation


Compatible Occupations
  • Registered Nurses
  • Licensed Vocational Nurses




                                                                                        C-5
Dietitians and Nutritionists – SOC 29-1031
In the healthcare sector, dietitians/nutritionists design and oversee nutritional programs
to promote healthy eating habits or control of disease. They consult with physicians and
healthcare personnel to determine nutritional needs and diet restrictions of the patient. In
addition, they may provide direct counseling to patients on general nutritional principles,
setting up a dietary plan, and preparing healthy foods. Some dietitians/nutritionists are
involved in public policy efforts, such as nutrition labeling and nutrition standards for
school programs.

Top Skills of Dietitians and Nutritionists
   • Ability to give full attention to what other people are saying, taking time to
      understand the points being made, asking questions as appropriate, and not
      interrupting at inappropriate times.
   • Ability to communicate information and ideas so others will understand.
   • Ability to apply general rules to specific problems to produce answers that make
      sense.
   • Ability to generate or use different sets of rules for combining or grouping things
      in different ways.

Education and Licensing Requirements
Most employers prefer to hire Registered Dietitians credentialed by the American
Dietetic Association. The credentialing process involves:
   • Completing a nutritional science or related Baccalaureate degree accredited by
        the Commission on Accreditation for Dietetics Education,
   • Completing a supervised internship, and
   • Passing the Registration Examination for Dietitians administered by the
        Commission of Dietetic Registration.

To maintain the certification, a total of 75 hours of continuing education must be satisfied
every five years. The American Dietetic Association also offers specialty certifications in
areas such as gerontological nutrition, sports dietetics, pediatric nutrition, renal nutrition,
and oncology nutrition.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
     College/School             Name of Program              Type of Program
San Jose State University   Nutritional Science         B.S. / M.S.




                                                                                                  C-6
Career & Education Pathways for Dietitians and Nutritionists

                              Bachelor’s Degree
      Associate                 in Dietetics or                           Master’s in
       Degree                      Nutrition                           Dietetics/Nutrition
       2 Years                     4 Years




 Dietetic Technician,
     Registered
                                                   Commission on
                                                       Dietetic
                                                  Registration (CDR)
                                                        Exam




                                                     Registered                    CDR Specialty
                                                      Dietitian                     Certification




                                                              Experienced Registered
                                                             Dietitian may advance to
                                                                  management or
                                                               supervisor positions




         = Education & Training                   = Licensing & Certification                       = Occupation


Compatible Occupations

              •     There are no immediately compatible occupations.




                                                                                                                   C-7
Health Information Administrators – SOC 29-2071
Health information administrators supervise the development, implementation and
administration of healthcare data collection systems. They oversee the collection,
storage and maintenance of medical data of patients, which include medical history,
symptoms, examination results, diagnostic tests, and treatment methods. One of the
main responsibilities of Health Information Administrators is to ensure the quality,
accuracy, accessibility, and security of health information data. As such, health
information managers must keep current with new technologies, as well as with
legislative requirements. In addition, they regularly communicate with physicians and
other healthcare professionals to clarify diagnoses or to obtain additional information.

Top Skills of Health Information Administrators
   • Ability to use computers and computer systems (including hardware and
      software) to program, write software, set up functions, enter data, or process
      information.
   • Ability to compile, code, categorize, calculate, tabulate, audit, or verify
      information or data.
   • Ability to arrange things or actions in a certain order or pattern according to a
      specific rule or set of rules.
   • The ability to make precisely coordinated movements of the fingers of one or
      both hands to grasp, manipulate, or assemble very small objects.

Education and Licensing Requirements
The minimum education requirement is a bachelor’s degree in health information
management. Although certification is optional, most employers prefer to hire Registered
Health Information Administrators (RHIA), credentialed by the American Health
Information Management Association. The RHIA credentialing process involves
completing a bachelor’s degree program in Health Information Management accredited
by the Commission on Accreditation for Health Informatics and Information Management
Education (CAHIIM) and passing the RHIA examination. The RHIA credentialing
program requires regular recertification and continuing education to maintain the
credential.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties

Higher Education Institution           Name of Program                             Type of
                                                                                   Program
University of Phoenix                  Health Administration                       B.S. / M.S




                                                                                                C-8
Career & Education Pathways for Health Information Administrators

 Associate Degree in
 Health Information
    Technology
     (2 Years)




 Bachelor’s Degree in                              Position with higher
                         Master’s Degree in
  Health Information                               pay and more
                         Health Services or
    Management                                     responsibilities, e.g.
                             Business
      (4 Years)                                    Department Head,
                          Administration
                                                   Director




   Certification as
  Registered Health
    Information
   Administrator




  Entry-level Health
     Information
    Administrator




        = Education & Training          = Licensing & Certification         = Occupation


Compatible Occupations
  • Medical assistants
  • Physical therapists aides
  • Medical secretaries
  • Dietetic technicians




                                                                                           C-9
Physician Assistants – SOC 29-1071
Licensed to practice medicine under the supervision of a physician, physician assistants
review medical histories, examine and treat patients, order and interpret laboratory tests
and x-rays, and make diagnoses. They provide care ranging from treating minor injuries
to specialized surgical treatment.

Top Skills of Physician Assistants
   • Ability to enter, transcribe, record, store or maintain information in written or
      electronic/magnetic form.
   • Ability to use logic and reasoning to indentify various strengths and weaknesses
      related to alternative solutions to problems.
   • Providing personal assistance, medical attention, emotional support, or other
      personal care to others such as coworkers, customers, or patients.
   • Ability to keep up-to-date technically and apply new knowledge to the job.

Education and Licensing Requirements
Physician assistants must be licensed by the National Commission on Certification of
Physician Assistants (NCCPA). To obtain the license, applicants must complete a
physician assistant educational program accredited by the Accreditation Review
Commission on Education for the Physician Assistant (ARC-PA) and pass the NCCPA’s
Physician Assistant National Certifying Examination.

The typically prerequisites of an ARC-PA accredited physician assistant program include
the completion of several science based courses, such as anatomy, physiology,
microbiology and chemistry, and 2-3 years of direct patient care experience. It is
common for applicants of a Physician Assistant program to hold a bachelor’s degree in a
medical science related field.

Upon attainment of the national certification, physician assistants must complete 100
hours of continuing education every 2 years, as well as sit for a recertification exam
every 6 years. In addition to the primary license, NCCPA offers several subspecialty
certifications including: family and general medicine, general internal medicine, general
surgery, pediatrics, emergency medicine, occupational medicine, obstetrics and
gynecology, dermatology, and other areas of medicine.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
      College/School              Name of Program            Type of Program
Foothill College (partnership
w/ Stanford University and    Primary Care Program      Certificate /B.S. / M.S.
Saint Francis University)




                                                                                             C-10
Career & Education Pathways for Physician Assistants

                                                      Health-related work
 Associate Degree in      Bachelor’s Degree          experience (2-3 Years)
  Health or Science      in Health or Science   +    (e.g. nursing, physical
                                                          therapy, etc.)




                                                      Physician Assistant        National
                                                           Program              Certification
                                                         (2-3 Years)




                                                                                 Physician
                                                                                 Assistant




                                                            Physician           Additional
                                                          Assistant with       Education for
                                                           subspecialty          Specialty




         = Education & Training            = Licensing & Certification         = Occupation


Compatible Occupations
  • Registered nurses
  • Licensed vocational nurses
  • Physical therapist assistants
  • Radiation therapists
  • Respiratory therapists
  • Cardiovascular technologists and technicians




                                                                                                C-11
Radiologic Technicians – SOC 29-2034
Radiologic technicians, also known as limited X-ray technicians, prepare and take X-rays
of patients by positioning equipment to obtain optimum view of the specific body area,
while minimizing radiation exposure. They specialize in one or more of the following
areas: chest, dental laboratory, extremities, gastrointestinal, genitourinary, leg podiatric,
skull radiography, torso skeletal and bone densitometry radiography. They are also
responsible for assuring that sterile and non-sterile supplies are present and in working
order, and explaining procedures to patients to reduce anxieties and obtain cooperation.

Top Skills of Radiologic Technicians
   • Ability to keep your hand and arm steady while moving your arm or while holding
      your arm and hand in one position.
   • The ability to quickly and repeatedly adjust the controls of a machine or a vehicle
      to exact positions.
   • The ability to make precisely coordinated movements of the fingers of one or
      both hands to grasp, manipulate, or assemble very small objects.
   • The ability to coordinate two or more limbs (for example, two arms, two legs, or
      one leg and one arm) while sitting, standing, or lying down. It does not involve
      performing the activities while the whole body is in motion.

Education and Licensing Requirements
In California, radiologic technicians must obtain a limited x-ray technician license by the
Department of Public Health. The licensing requirements include completion of a limited
permit X-ray technician program approved by the Radiologic Health Branch and passing
score on the limited scope radiologic examination administered by the American
Registry of Radiologic Technologists. Twenty-four units of continuing education must be
completed every 2 years to maintain the license.

Currently, there are no limited X-ray technician training programs offered in the Santa
Clara, San Mateo, and southern Alameda counties.




                                                                                                C-12
Career & Education Pathways for Radiologic Technicians

    Limited X-Ray
  Technician Training          State
 Program (1 – 2 Years)        License




                           Limited X-Ray            Associate Degree in
                             Technician            Radiologic Technology




                                                           State
                                                          License


                                                                              Experienced technologist
                                                                              may be promoted to
                                                                              supervisor or chief
                                                                              radiologic technologist
                                                        Radiologic
                                                       Technologist
                                                                              Experienced technologist
                                                                              may become instructor in
                                                                              radiologic technology
                                                                              programs




        = Education & Training          = Licensing & Certification        = Occupation


Compatible Occupations
  • Occupational therapist aides
  • Dental assistants
  • Veterinary technologists and technicians
  • Nuclear medicine technologists
  • Occupational therapist assistants
  • Nuclear monitoring technicians




                                                                                                         C-13
Radiologic Technologists – SOC 29-2034
Radiologic technologists produce X-ray films of human body parts for use in diagnosing
medical problems. They prepare patients for examinations, position operating
equipment, and set controls to ensure that the exam is appropriately administered. In
addition, radiologic technologists are responsible for recording, processing and
maintaining patient data and treatment records.

Top Skills of Radiologic Technologists
   • Ability to keep your hand and arm steady while moving your arm or while holding
      your arm and hand in one position.
   • Ability to quickly and repeatedly adjust the controls of a machine or a vehicle to
      exact positions.
   • Ability to make precisely coordinated movements of the fingers of one or both
      hands to grasp, manipulate, or assemble very small objects.
   • Ability to use computers and computer systems (including hardware and
      software) to program, write software, set up functions, enter data, or process
      information.

Educational and Licensing Requirements
Radiologic technologists must obtain a license from the Department of Public Health.
The licensing process involves (1) completing a JRCERT accredited school in diagnostic
radiologic technology and (2) sitting for the diagnostic radiology exam. However,
Radiologic Technologists with ARRT certification may automatically apply and receive
the California license in Diagnostic Radiology.

To obtain the primary ARRT certification, applicants must complete an ARRT-approved
program and pass an exam. ARRT also provides post-primary specialty certification;
several of which are in high demand in California. Some of the specialty areas include:
Mammography, Computed Tomography, Magnetic Resonance Imaging and Quality
Management. State code requires Radiologic technologists to complete 24 hours of
continuing education every two years to renew their license.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties

Higher Education Institution       Name of Program                  Type of Program
Cañada College                     Radiologic Technology            A.S.
Foothill College                   Radiologic Technology            A.S.
Gurnick Academy of Medical
Arts                               MRI Technology                   Certificate
Institute of Medical Education     MRI Technology                   Certificate
Gurnick Academy of Medical
Arts                               Ultrasound                       Certificate

Institute of Medical Education     Ultrasound                       Certificate




                                                                                          C-14
   Career & Education Pathways for Radiologic Technologists

    Certificate in
     Radiologic
    Technology
     1-2 Years




 Associate Degree in
Radiologic Technology         ARRT Certification/           Radiologic               ARRT Specialty               Radiologic
       2 Years                   CA License                Technologist               Certification            Technologist with
                                                                                                                 Specialization




  Bachelor’s Degree
    in Radiologic
     Technology
                                                                Experienced technologist      Experienced technologist
       4 Years
                                                                may become instructor in      may be promoted to
                                                                radiologic technology         supervisor or chief
                                                                programs                      radiologic technologist




               = Education & Training               = Licensing & Certification               = Occupation


   Compatible Occupations
     • Radiologic technicians
     • Cardiovascular technologists and technicians
     • Diagnostic medical sonographers
     • Nuclear medicine technologists
     • Radiation therapists
     • Physical therapy aides
     • Registered nurses
     • Physical therapist assistants
     • Licensed vocational nurses




                                                                                                                            C-15
Registered Nurses – SOC 29-1111
Registered nurses assess patient health problems and needs, develop and implement
nursing care plans, and maintain medical records. They administer nursing care to ill,
injured, convalescent, or disabled patients, and may advise patients on health
maintenance and disease prevention or provide case management. In addition, nurses
educate patients and the public about various medical conditions, and provide advice
and emotional support to patients’ family members. RNs record patients’ medical
histories and symptoms, help perform diagnostic tests and analyze results, operate
medical machinery, administer treatment and medications, and help with patient follow-
up and rehabilitation.

Some of the subspecialties include:
  • Ambulatory care nurses - provide preventive care and treat patients with a variety
      of illnesses and injuries in physicians’ offices or in clinics.
  • Critical care nurses - provide care to patients with serious, complex, and acute
      illnesses or injuries that require very close monitoring and extensive medication
      protocols and therapies.
  • Emergency or trauma nurses - work in hospital or stand-alone emergency
      departments, and provide initial assessments and care for patients with life-
      threatening conditions.
  • Holistic nurses - provide care such as acupuncture, massage and aroma therapy,
      and biofeedback.
  • Home healthcare nurses - provide at-home nursing care for patients, often as
      follow-up care after discharge from a hospital or from a rehabilitation, long-term
      care, or skilled nursing facility.
  • Hospice and palliative care nurses - provide care, most often in home or hospice
      settings, focused on maintaining quality of life for terminally ill patients.
  • Infusion nurses - administer medications, fluids, and blood to patients through
      injections into patients' veins.
  • Medical-surgical nurses - provide health promotion and basic medical care to
      patients with various medical and surgical diagnoses.
  • Occupational health nurses - seek to prevent job-related injuries and illnesses,
      provide monitoring and emergency care services, and help employers implement
      health and safety standards.
  • Perianesthesia nurses - provide preoperative and postoperative care to patients
      undergoing anesthesia during surgery or other procedure.
  • Perioperative nurses - assist surgeons by selecting and handling instruments,
      controlling bleeding, and suturing incisions.
  • Radiology nurses - provide care to patients undergoing diagnostic radiation
      procedures such as ultrasounds, magnetic resonance imaging, and radiation
      therapy for oncology diagnoses.
  • Psychiatric-mental health nurses - treat patients with personality and mood
      disorders.
  • Transplant nurses - care for both transplant recipients and living donors and
      monitor signs of organ rejection.




                                                                                           C-16
Top Skills of Registered Nurses
    • Ability to enter, transcribe, record, store, or maintain information in written or
        electronic/magnetic form.
    • Ability to give full attention to what other people are saying, taking time to
        understand the points being made, asking questions as appropriate, and not
        interrupting at inappropriate times.
    • Ability to analyze information and evaluate results to choose the best solution
        and solve problems.
    • Ability to use relevant information and individual judgment to determine whether
        events or processes comply with laws, regulations, or standards.

Education Requirements
The minimum education requirement is an associate degree in nursing (ADN) from an
accredited community college or private vocational school. These programs typically
take 2 to 3 years to complete in addition to one year of prerequisite courses. Another
common education path to registered nursing is a bachelor’s degree in nursing (BSN),
which typically takes about 4 years to complete. To qualify for an entry level RN position,
graduates of these programs must pass the National Council Licensure Examination
(NCLEX-RN).

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
Higher Education Institution Name of Program                             Type of
                                                                         Program
Cañada College (partnership    Registered Nurse                          B.S.
w/ SFSU)
College of San Mateo           Registered Nurse                          A.S.
De Anza College                Registered Nurse                          A.S.
                               LVN Transition to RN                      A.S.
Evergreen Valley College       Registered Nurse                          A.S.
Gavilan College                Registered Nurse                          A.S. /
                                                                         Certificate
Mission College                Registered Nurse                          A.S.
                               LVN Transition to RN                      A.S.
Ohlone College                 Registered Nurse                          A.S.
San Jose State University      Registered Nurse                          B.S.
                               LVN Transition to RN                      B.S.
                               Nursing                                   M.S.
Unitek College (Fremont)       Registered Nurse                          A.S.
                               LVN Transition to RN                      A.S.
University of Phoenix          Registered Nurse                          M.S.
                               RN Transition to BSN                      B.S.
                               Nursing/Master of Business                M.S.
                               Administration/Healthcare Management
                               Nursing/Master of Health Administration   M.S.




                                                                                              C-17
            Career & Education Pathways for Registered Nurses

                                                              College




                               Registered Nurse           Registered Nurse                  College Graduates
                               Associate Degree         Baccalaureate Degree                with a Degree in
                                (ASN, AD, ADN)                  (BSN)                       Another Field
                                   2 Years                     4 Years




                                                                                               Accelerated
                                                                                               RN Program
                                                                                                  (BSN)
                                                                                                 2 Years




                                  Certification           Master of Science
                               Programs for RNs             in Nursing
                                  (Specialties)                (MSN)
                                                              2 Years




Certified       Certified RN         Clinical Nurse       Nurse                Nursing                Nursing
 Nurse          Anesthetist         Specialist (CNS)   Practitioner           Administra-            Education
Midwife           (CRNA)                                                         tion
 (CNM)




                                                                                                   Doctorate of          Doctorate of
                                                                                                  Nursing Practice       Philosophy
                                                                                                       (DNP)               (PhD)




                 = Education & Training                  = Licensing & Certification                            = Occupation


            Compatible Occupations
              • Licensed Practical/Vocational Nurse
              • Emergency Medical Technicians and Paramedics
              • Physical Therapy Assistants
              • Radiation Therapist




                                                                                                                                        C-18
Respiratory Therapists – SOC 29-1126
Practicing under the direction of a physician, respiratory therapists provide quality care
to patients with breathing disorders. They evaluate and treat all types of patients,
ranging from premature infants whose lungs are not fully developed to elderly people
who have lung disease. Their primary responsibilities include initiating and conducting
therapeutic procedures; maintaining patient records; and setting up and operating
devices such as mechanical ventilators, therapeutic gas administration apparatus,
environmental control systems, and aerosol generators.

Top Skills of Respiratory Therapists
   • Ability to watch gauges, dials, or other indicators to make sure a machine is
      working properly.
   • Ability to arrange things or actions in a certain order or pattern according to a
      specific rule or set of rules.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others such as coworkers, customers, or patients.

Education and Licensing Requirements
Respiratory therapists are required to be licensed by the Department of Consumer
Affairs, Respiratory Care Board of California. The licensing requirements include:
    • Completion of an associate degree accredited or recognized by the United States
         Department of Education
    • Completion of a respiratory therapist training program accredited by the
         Commission on Accreditation of Allied Health Education Programs
    • Passing score on the Certified Respiratory Therapist (CRT) or Registered
         Respiratory Therapist (RRT) examination administered by the National Board for
         Respiratory Care (NBRC) or the CRT examination administered by the
         Respiratory Care Board of California.
    • Completion of a Board-approved Law and Professional Ethics Course. The
         California Society for Respiratory Care (CSRC) and the American Association for
         Respiratory Care (AARC) each offer an online course.

California code requires that Respiratory Therapists complete 15 hours of continuing
education every 2 years to renew their license.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
     Higher Education           Name of Program              Type of Program
         Institution
                           Respiratory Therapy
Foothill College           Technician                   A.S.
Ohlone College             Respiratory Therapist        A.S.
Skyline College            Respiratory Therapy          A.S.




                                                                                             C-19
Career & Education Pathways for Respiratory Therapists

                          Respiratory
 Associate Degree     Therapy Training
                        Program (A.S.,
                      B.S., or Certificate)

                                                            State License             Registered Respiratory
                                                                                             Therapist

                         Respiratory
                      Therapy Associate                   Bachelor’s Degree
                           Degree                             (4 Years)
                                                                     Experienced technologist        Experienced technologist
                                                                     may become instructor in        may be promoted to
                                                                     respiratory technology          supervisor or chief
                                                                     programs                        respiratory technologist




        = Education & Training                = Licensing & Certification              = Occupation


Compatible Occupations
  • Cardiovascular technologists and technicians
  • Respiratory therapy technicians




                                                                                                                       C-20
Surgical Technologists – SOC 29-2055
Under the supervision of surgeons, surgical technologists set up the operation room,
prepare patients for surgery, and assist the surgeon during the operation. They wash
and sterilize equipment using germicides and sterilizers, and maintain a proper sterile
environment in the operation room. During the procedure, they hand instruments and
supplies, such as retractors, cut sutures, sponges, needles, to the surgeon and
surgeon's assistants. Post the procedure, they clean and restock the operating room and
assist with the application of dressings or bandages.

Top Qualities of Surgical Technologists
   • Ability to watch gauges, dials, or other indicators to make sure a machine is
      working properly.
   • Ability to control operations of equipment or systems.
   • Ability to keep your hand and arm steady while moving your arm or while holding
      your arm and hand in one position.
   • Ability to quickly move your hand, your hand together with your arm, or your two
      hands to grasp, manipulate, or assemble objects.

Education and Licensing Requirements
The minimum education requirement is a postsecondary vocational award. Some
employers prefer to hire surgical technologists certified by the National Board of Surgical
Technology and Surgical Assisting (NBSTSA). To qualify for the Certified Surgical
Technologist (CST) exam, applicants must complete a surgical technology program
accredited by the Commission on Accreditation of Allied Health Education Programs
(CAAHEP) or accredited by the Accrediting Bureau of Health Education Schools
(ABHES).

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
Higher Education           Name of Program              Type of Program
Institution
Skyline College            Surgical Technology          A.S. / Certificate
Western Career College
(San Jose)                 Surgical Technology          Certificate




                                                                                              C-21
Career & Education Pathways for Surgical Technologists


   Postsecondary
     Certificate

                                 Entry Level          Specialization
                                  Surgical         e.g. Neurosurgery or   First Assistant
                                Technologist       Open Heart Surgery     to the Surgeon



     NBSTSA
    Certification




       = Education & Training           = Licensing & Certification       = Occupation


Compatible Occupations
  • Licensed practical nurses
  • Registered nurses
  • Paramedics and EMTs
  • Physical therapist assistants
  • Diagnostic medical sonographers
  • Cardiovascular technologists and assistants
  • Radiation therapists
  • Radiologic technologists




                                                                                            C-22
TIER 2 OCCUPATIONS
Cardiovascular Technologists / Technicians – SOC 29-2031
Under the supervision of a physician, cardiovascular technologists or technicians
conduct or assist with diagnostic tests that detect problems with pulmonary or
cardiovascular systems. They assist physicians with electrocardiograms, cardiac
catheterizations, pulmonary-functions, lung capacity, and similar tests. In addition to
assisting with patient exams, cardiovascular technologists or technicians schedule
appointments, maintain patient files, and operate and repair testing equipment.

In 2009, there were 213 cardiovascular technologists employed by the healthcare sector
in the Silicon Valley. By 2014, employment for cardiovascular technologists within the
healthcare sector is expected to increase by 25 jobs, for a total of 238 positions. The
current median hourly wage of cardiovascular technologists is $32.00.26

Top Skills of Cardiovascular Technologists and Technicians
   • Ability to watch gauges, dials, or other indicators to make sure a machine is
      working properly.
   • Ability to arrange things or actions in a certain order or pattern according to a
      specific rule or set of rules.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others such as coworkers, customers, or patients.

Education and Licensing Requirements
The typical education of a cardiovascular technologist is a 2-year Associate degree in
cardiovascular technology or related field accredited by the Commission on
Accreditation of Allied Health Professionals (CAAHEP). Bachelor’s degree programs are
also common. Technicians typically complete a 1-year certificate program or receive on-
the-job training.

Most employers prefer to hire cardiovascular technologists and technicians credentialed
by the Cardiovascular Credentialing International (CCI) or the American Registry of
Diagnostic Medical Sonographers (ARDMS). CCI offers several certifications, including
Certified Cardiographic Technicians, Certified Rhythm Analysis Technicians, Registered
Congenital Cardiac Songrapher, Registered Cardiovascular Invasive Specialist,
Registered Cardiac Sonographer, and Registered Vascular Specialists. ARDMS offers
several specializations as well, including Adult Echocardiography, Fetal
Echocardiography, Pediatric Echocardiography and Vascular Technology.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
       College/School           Name of Program              Type of Program
Institute of Business      EKG Technician               Certificate
Technology


26
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-23
Career & Education Pathways for Cardiovascular Technologists / Technicians

 Certificate Program                                 Associate Degree
  in Cardiovascular      Cardiovascular              in Cardiovascular    Certification
     Technology            Technician                   Technology
                                                         (2 Years)




                         Cardiovascular
                        Technologist with              Subspecialty      Cardiovascular
                            Specialty                  Certification      Technologist




        = Education & Training            = Licensing & Certification    = Occupation


Compatible Occupations
  • Surgical technologists
  • Registered nurses
  • Physical therapists
  • Diagnostic medical sonographers
  • Radiation therapists




                                                                                          C-24
Clinical Laboratory Scientists / Medical Laboratory Technologists – SOC 29-2011
Clinical laboratory scientists (CLS), also known as medical laboratory technologists,
perform complex medical laboratory tests for diagnosis, treatment, and prevention of
disease. CLSs conduct chemical analysis of blood or tissue samples to determine
presence of normal and abnormal components. These tests aid in detecting cancer,
heart attacks, diabetes, infectious bacteria or viruses as well as detecting drug abuse.
CLSs are also responsible for establishing and monitoring quality control processes and
for training and supervising lab assistants and/or medical laboratory technicians (MLTs).

In 2009, there were 967 clinical laboratory technologists employed by the healthcare
sector in the Silicon Valley. By 2014, employment for CLS within the healthcare sector is
expected to increase by 106 jobs, for a total of 1,073 positions. The current median
hourly wage of CLS is $41.76 per hour.27

Top Skills of Clinical Laboratory Scientists
   • Ability to watch gauges, dials, or other indicators to make sure a machine is
      working properly.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to inspect equipment, structures, or materials to identify the cause of
      errors or other problems or defects.
   • Ability to conduct tests and inspections of products, services, or processes to
      evaluate quality or performance.

Education and Licensing Requirements
Clinical laboratory scientists are required to obtain a license by the California
Department of Public Health. CLS licensing requirements include:
    • A bachelor’s degree approved by the California Department of Public Health,
        Laboratory Field Services (LFS);
    • Completion of a one-year clinical internship program specializing in the area of
        medical laboratory technology; and
    • Passing score on the CLS licensure exam administered by Laboratory Field
        Services.

In addition, certifications in various specialty areas are available through recognized
professional associations like the Board of Registry of the American Society for Clinical
Pathology, American Medical Technologists, National Credentialing Agency for
Laboratory Personnel, and the Board of Registry of the American Association of
Bioanalysts. Specialties for clinical laboratory technologists include clinical chemistry
technology, microbiology technology, blood bank technology, cytotechnology, and
molecular biology technology.




27
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-25
Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties

     College/School                Name of Program                                    County
San Jose State University       CLS Training Program                         Santa Clara

Career Pathways for Clinical Laboratory Scientists

                                                       Bachelor’s Degree
 Associate’s Degree    Clinical Laboratory                 in Medical
     (2 Years)             Technician                     Technology
                                                            (4 Years)

                                                       Bachelor’s Degree
                                                           (4 Years)

                                                       Clinical Laboratory                   Certification
                                                             Scientist                      (by Specialty)



                                                       Bachelor’s Degree
                                                           (4 Years)


                                       Master’s Degree in
                                       Medical Technology              Doctoral Degree in
                                         or Chemistry                  Laboratory Science




                                         Chief Laboratory             Laboratory Director
                                          Technologist or
                                             Manager




       = Education & Training                = Licensing & Certification                      = Occupation


Compatible Occupations
  • Surgical technologists
  • Diagnostic medical sonographers
  • Cardiovascular technologists and assistants
  • Radiation therapists
  • Radiologic technologists
  • Licensed practical nurses
  • Registered nurses




                                                                                                             C-26
Diagnostic Medical Sonographers – SOC 29-2032
Diagnostic medical sonographers are vital members of the medical imaging team.
Diagnostic medical sonographers provide patient services using medical ultrasound
(high-frequency sound waves that produce images of internal structures). Working under
the supervision of a physician, sonographers help gather data to diagnose a variety of
conditions and diseases, as well as monitor fetal development. Sonographers operate
the sonographic equipment that collects reflected echoes and forms an image that may
be videotaped, transmitted, or photographed for interpretation and diagnosis by a
physician. In assisting physicians in gathering sonographic data, the diagnostic medical
sonographer must be able to:
    • Obtain, review, and integrate patient history and supporting clinical data
    • Perform appropriate procedures and record anatomical, pathological, and/or
        physiological data for interpretation by a physician
    • Record and process sonographic data and other observations made during the
        procedure for presentation to the physician
    • Exercise discretion and judgment in the performance of sonographic services
    • Provide patient education related to medical ultrasound
    • Promote principles of good health

In 2009, there were 318 diagnostic medical sonographers employed by the healthcare
sector in the Silicon Valley. By 2014, employment for diagnostic medical sonogrpahers
within the healthcare sector is expected to increase by 28 jobs, for a total of 346
positions. The median hourly wage of diagnostic medical sonographers is $43.70.28

Top Skills of Diagnostic Medical Sonographers
   • Ability to control operations of equipment or systems.
   • Ability to watch gauges, dials, or other indicators to make sure a machine is
      working properly.
   • Ability to quickly and repeatedly adjust the controls of a machine or a vehicle to
      exact positions.
   • Ability to keep your hand and arm steady while moving your arm or while holding
      your arm and hand in one position.

Education and Licensing Requirements
There are several education and training paths to becoming a diagnostic medical
sonographer. Sonographers may train in hospitals, vocational-technical institutions, and
colleges or universities. Colleges and universities offer formal training in both 2- and 4-
year programs, resulting in either an associate or a bachelor’s degree. Two-year
programs are the most prevalent. There are a few one-year programs that typically result
in a vocational certificate and these are also accepted as proper education by
employers. However, one-year certificate programs are generally useful only for workers
already employed in healthcare and who seek to increase their marketability by training
in sonography.

Currently, there are no state requirements for licensure in diagnostic medical
sonography, but sonographers may become certified and registered by passing an
28
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-27
examination given by either the American Registry for Diagnostic Medical Sonography
(ARDMS) or and the American Registry of Radiologic Technologists (ARRT). To become
registered, applicants have completed the proper education, training, or work
experience. The exam typically includes a physics and instrumentation exam in a
sonography specialty. Sonographers can specialize in the following areas: obstetric and
gynecologic sonography, abdominal sonography, neurosonography, and breast
sonography. To keep their registration current, sonographers must complete continuing
education to stay informed of technological advances relevant to their work.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
  College/School               Name of Program                            County
Foothill College       Diagnostic Medical                        Santa Clara
                       Sonography/Sonographer and
                       Ultrasound Technician

Career Pathways for Diagnostic Medical Sonographers


  Vocational Program        Associate’s Degree           Bachelor’s Degree
       (1 Year)                 (2 Years)                    (4 Years)




                            Diagnostic Medical
                               Sonographer




                               Certification
                              (Optional) by
                                Specialty




       = Education & Training           = Licensing & Certification          = Occupation

Compatible Occupations
  • Surgical technologists
  • Physical therapists
  • Physical therapist assistants
  • Cardiovascular technologists and assistants
  • Radiation therapists
  • Radiologic technologists
  • Licensed practical nurses
  • Registered nurses




                                                                                            C-28
Licensed Vocational Nurses – SOC 29-2061
Licensed vocational nurses (LVNs) or licensed practical nurses (LPNs) provide bedside
nursing care for sick, injured, convalescing, elderly, and physically or mentally disabled
persons. Under the direction and supervision of a physician or registered nurse, LVNs
observe patients, check vital signs, perform basic assessments, and report and
document changes in a patient’s condition. LVNs are employed by hospitals, clinics,
doctors’ offices, nursing and long-term care facilities, ambulatory surgical centers,
emergency medical centers, private homes, and group homes. They work a variety of
shifts and often stand for long periods of time during their work day.

Other duties can vary depending on where the LVN works. In nursing care facilities,
LVNs help to evaluate residents’ needs and develop care plans. In doctors’ offices and
clinics, they make appointments for patients, keep records, and perform other clerical
duties. Those who work in private homes sometimes prepare meals, keep rooms
orderly, see that patients are comfortable and in good spirits, and teach family members
simple nursing tasks.

Licensed vocational nurses may operate medical machinery such as cardiac output and
glucose monitors. They use hypodermic needles, nebulizers, or extremity restraints.
They also use computer software for calendar and scheduling and to enter medical
records electronically.

In 2009, there were 2,913 licensed vocational nurse positions within the healthcare sector
in the Silicon Valley; by 2014, employment for LVNs within the healthcare sector is
expected to increase by 278 jobs, for a total of 3,191 positions. The median hourly wage
for licensed vocational nurses is $27.23.29

Top Skills of Licensed Vocational Nurses
     • Ability to provide customer and personal services.
     • Ability to give full attention to what other people are saying, taking time to
        understand the points being made, asking questions as appropriate, and not
        interrupting at inappropriate times.
     • Ability to use logic and reasoning to identify the strengths and weaknesses of
        alternative solutions, conclusions or approaches to problems
     • Ability to enter, transcribe, record, store, or maintain information in written or
        electronic/magnetic form.
     • Ability to perform physical activities that require considerable use of your arms
        and legs and moving your whole body, such as climbing, lifting, balancing,
        walking, stooping, and handling of materials.
     • Ability to keep your hand and arm steady while moving your arm or while
        holding your arm and hand in one position.
	
  
Education and Licensing Requirements
Licensed vocational nurses must be at least 17 years of age; possess a high school
diploma or the equivalent; and complete a vocational, or practical, nursing program
approved by California’s Bureau of Vocational Nursing and Psychiatric Technicians


29
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-29
(BVNPT). State-approved training programs are likely to fall within one of the following
two educational institutions: 1) a certificate program at a vocational school or 2) an
associate program at a community college. A certificate or an associate program
typically lasts one to two years, with both classroom study and supervised clinical
practice.

In addition to completing a state-approved training program, licensure applicants must
pay the required fees to the BVNPT, successfully pass a fingerprint background check
by the California Department of Justice and the Federal Bureau of Investigations,
complete a record of conviction form, and pass the licensing examination, known as the
National Council Licensing Examination for Practical (Vocational) Nurses (NCLEX-PN).

In order to maintain an active license, California law requires licensed vocational nurses
pay a renewal fee and to complete 30 hours of continuing education every two years.
Courses must be taken through a BVNPT recognized continuing education provider.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
   College/School                 Name of Program                              County
Gavilan College            Licensed Practical /Vocational             Santa Clara
                           Nurse Training (LPN, LVN,
                           Cert, Dipl, AAS)
Mission College            Licensed Practical /Vocational             Santa Clara
                           Nurse Training (LPN, LVN,
                           Cert, Dipl, AAS)

Career Pathways for Licensed Vocational Nurses

  Associate Degree or
      Certificate in         Licensure/
  Licensed Vocational       Certification
  Nursing (1-2 Years)




                                                                                Registered
                         Licensed Vocational           Associate in               Nurse
                                Nurse                   Nursing                (ADN, BSN)




       = Education & Training               = Licensing & Certification         = Occupation

Compatible Occupations
  • Surgical technologists
  • Physical therapist assistants
  • Cardiovascular technologists and assistants
  • Radiation therapists
  • Diagnostic medical sonographers




                                                                                               C-30
Medical Assistants – SOC 31-9092
Medical assistants perform administrative and certain clinical duties under the direction
of the office manager, physician, or another health practitioner. Administrative duties
may include scheduling appointments, maintaining medical records, billing, and coding
for insurance purposes. Clinical duties may include interviewing patients to obtain
medical information and measure their vital signs; preparing rooms for patient exams;
sterilizing instruments and disposing of contaminated supplies; and administering
medications as directed by the physician.

In 2009, there were 4,390 medical assistants employed by the healthcare sector in the
Silicon Valley. By 2014, employment for medical assistants within the healthcare sector
is expected to increase by 294 jobs, for a total of 4,684 positions. The current median
hourly wage of medical assistants is $18.21 per hour.30

Top Skills of Medical Assistants
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic or magnetic form.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others.
   • The ability to listen to and understand information and ideas presented through
      spoken words and sentences.
   • Ability to identify information by categorizing, estimating, recognizing differences
      or similarities, and detecting changes in circumstances or events.

Education and Licensing Requirements
The minimum education requirement is a high school diploma. However, most
employers prefer to hire applicants who have completed a formal training program in
medical assisting. Medical assistant training programs typically take less than one year
to complete and include courses that cover topics such as medical terminology, office
practices, insurance billing, medical law, and ethics.

In addition to a formal training program, national certification may give an applicant a
competitive advantage in the hiring process. Several national associations, such as the
American Association of Medical Assistants (AAMA) and Association of Medical
Technologists (AMT), award certification credentials to medical assistants for primary
care and subspecialties. Subspecialties include: ophthalmology, optometry, or podiatry.

Most employers also screen applicants for basic customer service skills such as oral
communication and listening comprehension. Customer service skills are essential to the
position because medical assistants interact with patients on a regular, ongoing basis.




30
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-31
Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
      Higher Education          Name of Program              Type of Program
          Institution
Biohealth College          Medical Assisting            Certificate
Boston Reed College (Palo
Alto)                      Clinical Medical Assisting   Certificate
Boston Reed College
(Santa Clara)              Clinical Medical Assisting   Certificate
Boston Reed College
(Union City)               Clinical Medical Assisting   Certificate
Cañada College             Medical Assisting            A.S. / Certificate
Center for Employment      Medical Administrative
Training                   Assisting                    Training
De Anza College            Medical Assisting            A.S. / Certificate
Everest College (formerly  Medical Administrative
Bryman College)            Assistant                    Certificate
Everest College (formerly
Bryman College)            Medical Assisting            Certificate
Gavilan College            Clinical Medical Assisting   Certificate
Heald College              Medical Assisting            A.S. / Certificate
                           Medical Office
Heald College              Administration               A.S. / Certificate
Institute of Business
Technology                 Medical Assisting            Certificate
Institute of Medical
Education                  Medical Assisting            Certificate
Jobtrain                   Medical Office Assistant     Adult Ed
                           Medical Office
Pacific Technical College  Administration               Certificate
Santa Clara Adult
Education (partnership w/
Boston Reed College)       Clinical Medical Assistant   Adult Ed / Certificate
Skyline College            Medical Office Assisting     Certificate
                           Medical Office
Techskills (San Jose)      Administration               Certificate
Unitek College (Fremont)   Medical Assisting            Certificate
Unitek College (Santa
Clara)                     Medical Assistant            Certificate
Valley College of Medical
Careers                    Medical Assistant            Certificate
West Valley College        Clinical Assisting           Certificate
                           Medical Administrative
West Valley College        Assistant                    Certificate
West Valley College        Medical Assistant            A.S.
Western Career College
(San Jose)                 Medical Assisting            Certificate




                                                                                 C-32
Career & Education Pathways for Medical Assistants

 Certificate in Medical                               Associate Degree
        Assisting         Medical Assistant              in Medical
    1 Year or Less                                        Assisting
                                                           2 Years




                               B.S. in                    Certified
                              Nursing                      Coder




                             Registered
                               Nurse




           = Education & Training             = Licensing & Certification   = Occupation


Compatible Occupations
  • Medical records and health information technicians
  • Medical secretaries
  • Medical transcriptionists
  • Dental assistants
  • Licensed practical and licensed vocational nurses
  • Nursing and psychiatric aides
  • Pharmacy technicians and aides
  • Physical therapist assistants and aides




                                                                                           C-33
Medical or Clinical Laboratory Technicians – SOC 29-2012
Medical laboratory technicians (MLT), also known as clinical laboratory technicians, work
under the supervision of clinical technologists and pathologists. MLTs perform, verify,
and report results of moderately complex laboratory tests including but not limited to:
blood gas analyses, approved mononucleosis testing, complete blood counts, negative
urine cultures, activated clotting times, other moderately complex microbiology tests, and
basic metabolic panels. MLTs perform testing completely, accurately, within established
timeframes, and according to established policies and procedures.

In 2009, there were 1,208 medical laboratory technicians employed by the healthcare
sector in the Silicon Valley. By 2014, employment for medical laboratory technicians
within the healthcare sector is expected to increase by 149 jobs, for a total of 1,357
positions. The current median hourly wage of medical laboratory technicians is $24.01.31

Top Skills of Medical Laboratory Technicians
   • Ability to make precisely coordinated movements of the fingers of one or both
      hands to grasp, manipulate, or assemble very small objects.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to perform routine maintenance on equipment and determining when and
      what kind of maintenance is needed.
   • Ability to keep your hand and arm steady while moving your arm or while holding
      your arm and hand in one position.

Education and Licensing Requirements
Medical laboratory technicians are required to obtain a license by the California
Department of Public Health. MLT licensing requirements include:
   • An Associate degree from a program accredited by the National Accrediting
      Agency for Clinical Laboratory Sciences (NAACLS) or approved by the California
      Department of Public Health, Laboratory Field Services (LFS);
   • Completion of a six-month clinical internship program specializing in the area of
      medical laboratory technology; and
   • Passing score on the MLS licensure exam administered by Laboratory Field
      Services.

The MLT license must be renewed every two years, which requires 24 continuing
education units. In addition to the state licensing requirements, MLTs must obtain
national certification by the American Association of Bioanalysts (AAB) or American
Society of Clinical Pathologists (ASCP).




31
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-34
Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
      Higher Education          Name of Program             Type of Program
          Institution
                           Medical Laboratory
De Anza College            Technician                  A.S. / Certificate
Institute of Medical       Medical Laboratory
Education                  Technician                  Certificate


Career Pathways for Medical Laboratory Technicians

 Associate’s Degree in
 Medical Technology      Medical Laboratory
       (2 Years)            Technician




                          Bachelor’s Degree            Clinical
                              in Medical              Laboratory
                             Technology                Scientist

                          Bachelor’s Degree
                              (4 Years)

                         Master’s Degree in        Bachelor’s Degree
                         Medical Technology        Chief Laboratory
                                                       (4 Years)
                           or Chemistry             Technologist or
                                                      Managers

                          Bachelor’s Degree
                              (4 Years)

       = Education & Training            = Licensing & Certification   = Occupation


Compatible Occupations
  • Medical equipment repairers
  • Chemical technicians




                                                                                      C-35
Medical Records Clerks – SOC 29-2071
Medical records clerks collect, process, and maintain medical records of hospital and
clinic patients in a manner consistent with medical, administrative, ethical, legal, and
regulatory requirements of the healthcare system. Moreover, they process patient
admission and discharge documents, as well as prepare business forms.

In 2009, there were 2,740 medical record clerks employed by the healthcare sector in
the Silicon Valley. By 2014, employment for medical record clerks within the healthcare
sector is expected to increase by 150 jobs, for a total of 2,890 positions.32 The current
median hourly wage of medical records clerks is approximately $18.09.33

Top Skills of Medical Records Clerks
   • Ability to use computers and computer systems (including hardware and
      software) to program, write software, set up functions, enter data, or process
      information.
   • Ability to compile, code, categorize, calculate, tabulate, audit, or verify
      information or data.
   • The ability to make precisely coordinated movements of the fingers of one or
      both hands to grasp, manipulate, or assemble very small objects.
   • Ability to arrange things or actions in a certain order or pattern according to a
      specific rule or set of rules.

Education and Licensing Requirements
Most employers prefer to hire medical clerks with at least a certificate or Associate
degree in medical information technology or related field. Typical coursework includes
medical terminology, anatomy and physiology, health data requirements and standards,
clinical classification and coding systems, data analysis, healthcare reimbursement
methods, and database security and management.

Certification as a registered health information technician is offered by the American
Health Information Management Association (AHIMA), which may give applicants a
competitive advantage in the hiring process.




32
   Employment data for medical records clerks is included with related occupations under the broad
      occupational titles “Information and record clerks, all other” (SOC 43-4199); “Office clerks, general”
      (SOC 43-9061); and “Billing and posting clerks and machine operators” (SOC 43-3021).
33
   EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
      Alameda County due to limitations related to combining county and zip region data. Weighted
      average across the three broader occupational titles “Information and record clerks, all other” (SOC
      43-4199); “Office clerks, general” (SOC 43-9061); and “Billing and posting clerks and machine
      operators” (SOC 43-3021).




                                                                                                               C-36
Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
      College/School             Name of Program             Type of Program
Carrington College
California (formerly Western Health Information         Certificate
Career College)              Technology
Center for Employment
Training                     Medical Clerk              Training
De Anza College              Medical File Clerk         Certificate
De Anza College              Medical Records Clerk      Certificate


Career Pathways for Medical Records Clerks

  Certificate in Health
      Information             Medical
      Technology            Records Clerk
 (6 Months to 1 Year)




 Associate Degree in                                   Health Information
                          Health Information
 Health Information                                         Manager
                            Administrator
    Management




        = Education & Training              = Licensing & Certification     = Occupation


Compatible Occupations
  • Medical assistants
  • Physical therapist aides
  • Medical secretaries
  • Dietetic technicians




                                                                                           C-37
Nurse Practitioners – SOC 29-1199.03 (under Health Diagnosing and Treating
Practitioners, All Other)
A nurse practitioner (NP) is a registered nurse (RN) who has completed advanced
education (master’s degree or higher) and training in the diagnosis and management of
common medical conditions. Nurse practitioners provide some of the same care
provided by physicians and maintain close working relationships with physicians. A
nurse practitioner can serve as a patient’s regular healthcare provider. They diagnose
and treat a wide range of health problems. They also conduct physical examinations,
order diagnostic tests, develop treatment plans and prescribe drugs or other therapies.
In addition, nurse practitioners also provide health education and promotion, disease
prevention, and counseling to patients.34

In 2009, the estimated employment of health diagnosing and treating practitioners- all
other, which included nurse practitioners, totaled 830 in the Silicon Valley healthcare
sector, with 13% projected growth (112 jobs) by 2014.35 The 2009 median hourly wage
for health diagnosing and treating practitioners-all other, $23.12 should be considered
along with the EDD 2010 reported California RN median hourly wage, $40.22.36

Top Skills of Nurse Practitioners
    • Ability to provide personal assistance, medical attention, emotional support, or
        other personal care to others such as coworkers, customers, or patients.
    • Ability to use relevant information and individual judgment to determine whether
        events or processes comply with laws, regulations, or standards.
    • Ability to tell when something is wrong or is likely to go wrong. It does not
        involve solving the problem, only recognizing there is a problem.
    • Ability to use logic and reasoning to identify the strengths and weaknesses of
        alternative solutions, conclusions or approaches to problems.
    • Ability to combine pieces of information to form general rules or conclusions
        (includes finding a relationship among seemingly unrelated events).
    • Ability to use computers and computer systems (including hardware and
        software) to program, write software, set up functions, enter data, or process
        information.
    • Ability to enter, transcribe, record, store, or maintain information in written or
        electronic/magnetic form.

Education and Licensing Requirements
Since nurse practitioners provide medical services similar to those of physicians, they
must have advanced education and clinical training beyond their registered nurse
preparation. To satisfy this educational requirement, a master’s degree or a doctorate in
nursing must be completed. Some nurse practitioners pursue national certification in a
specialty area.

34
   Occupational profile information compiled from EDD’s Labor Market Information Division
      (LaborMarketInfo), the US Dept of Labor (O*NET), Women’s Health Channel, and California’s Board
      of Registered Nursing.
35
   Employment data for nurse practitioners is included with related occupations under the broad occupational
      title “Health Diagnosing and Treating Practitioners, All Other” (SOC 29-1199)
36
   EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
      Alameda County due to limitations related to combining county and zip region data.




                                                                                                               C-38
Nurse practitioners must also be licensed to practice. In California, regulations require
licensure applicants to 1) be licensed as a registered nurse and 2) have an advanced
degree or have received nurse practitioner certification by a recognized institution, such
the American Nurses Credentialing Center (ANCC), American Academy of Nurse
Practitioners (AANP, National Certification Board of Pediatric Nurse Practitioners &
Nurses (NCBPNP&N) or (NAPNAP), and National Certification Corporation for the
Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC).

Education/Training Providers near Santa Clara, San Mateo, and southern Alameda
counties
   College/School                Name of Program                                      Type of Program
 UCSF                     Master’s of Science in:                              M.S.
                          Acute Care NP, Pediatric NP,
                          Adult Nurse NP, Neonatal NP
                          Family NP, Acute Care NP, and
                          Midwifery/Women’s Health NP

Career Pathways for Nurse Practitioners

  Registered Nurse        Registered Nurse               College Graduates
  Associate Degree          Baccalaureate                 with a Degree in
   (ASN, AD, ADN)              Degree                      Another Field
       2 Years             (BSN) – 4 Years
                               2 Years




                         Master of Science
                           in Nursing                    Doctoral in Nursing
                              (MSN)                        Practice (DNP)
                             2 Years




                                         State Certification
                                              for NPs




                                            National
                                         Certification for
                                            Specialty




       = Education & Training                = Licensing & Certification                    = Occupation

Compatible Occupations
Currently there is no compatible occupational data available for nurse practitioners.




                                                                                                           C-39
Occupational Therapist Assistants – SOC 31-2011
Working under the supervision of occupational therapists, occupational therapist
assistants provide rehabilitative services to persons with mental, physical, emotional, or
developmental impairments. In accordance with state law, they help develop treatment
plans, selecting therapy activities to fit patients’ needs and capabilities. They are also
responsible for monitoring and recording patients’ performance in therapy activities and
for reporting on patients' progress, attitudes and behavior.

In 2009, there were 83 occupational therapist assistants employed by the healthcare
sector in the Silicon Valley. By 2014, employment for occupation therapist assistants
within the healthcare sector is expected to increase by 7 jobs, for a total of 90 positions.
The current median hourly wage of occupational therapist assistants is $26.17.37

Top Skills of Occupational Therapist Assistants
   • Ability to tell when something is wrong or is likely to go wrong. It does not involve
      solving the problem, only recognizing there is a problem.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others such as coworkers, customers, or patients.
   • Ability to monitor and review information from materials, events, or the
      environment, to detect or assess problems.

Education and Licensing Requirements
Occupational therapist assistants are required to be licensed by the Board of
Occupational Therapy, California Department of Consumer Affairs. The licensing
requirements include:
   • Completion of an occupational therapist assistant degree program approved by
       National Board for Certification in Occupational Therapy. NBCOT approved
       programs typically take 1 to 2 years to complete and include academic
       coursework and hands-on clinical experience.
   • Passing score on the certified occupational therapy assistant examination
       administered by the NBCOT.

Occupational therapist assistants must renew their license every 2 years, which requires
24 hours of professional development units. Subspecialty certifications are available
through the American Occupational Therapy Association in areas such as gerontology,
mental health, pediatrics, physical rehabilitation and others.




37
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-40
Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
    Higher Education            Name of Program              Type of Program
       Institution
San Jose State University  Occupational Therapy         B.S. / M.S.


Career & Education Pathways for Occupational Therapist Assistants

    Certificate or
  Associate Degree      State License               Occupational
  in Occupational                                    Therapist
      Therapy




                                                   Specialization
                                                   (Gerontology,
                                                   Pediatrics, etc.)




                                             Those with Experience May
                                             Become Supervisor of
                                             Occupational Therapist
                                             Assistants




       = Education & Training           = Licensing & Certification      = Occupation


Compatible Occupations
  • Psychiatric technicians




                                                                                        C-41
Paramedics and Emergency Medical Technicians– SOC 29-2041
Emergency medical technicians (EMTs) and paramedics are trained to provide
emergency care to people who have suffered from an illness or an injury outside of a
hospital setting. EMTs and Paramedics work under protocols approved by a physician
medical director to recognize, assess, and manage medical emergencies and transport
critically ill or injured patients to definitive medical care at a hospital. EMTs and
paramedics may be employed by a private ambulance company, fire department, police
department, public EMS agency, private ambulance company, hospital, or combination
of the above. 38

EMTs and paramedics generally work in teams. During the transport of a patient, one
EMT or paramedic drives, while the other monitors the patient’s vital signs and gives
additional care, as needed. Some paramedics work as part of a helicopter’s flight crew to
quickly transport critically ill or injured patients to hospital trauma centers.

At the medical facility, EMTs and paramedics help transfer patients to the emergency
department, report their observations and actions to emergency department staff, and may
provide additional emergency treatment. After each run, EMTs and paramedics document
the trip, replace used supplies and check equipment. EMTs and paramedics also provide
transportation for patients from one medical facility to another, particularly if they work for
private ambulance services.

In 2009, employment for EMTs and paramedics within the healthcare sector in the
Silicon Valley totaled 657 and is expected to increase to 739 by 2014. The median
hourly wage of paramedics and emergency medical technicians is $17.09.39 Those in
Emergency Medical Services (EMS) as part of fire or police departments, receive the
same benefits as firefighters or police officers.

Top Skills of Paramedics and EMTs
    • Ability to tell when something is wrong or is likely to go wrong. It does not
        involve solving the problem, only recognizing there is a problem.
    • Awareness of others’ reactions and understanding why they react as they do.
    • Ability to combine pieces of information to form general rules or conclusions
        (includes finding a relationship among seemingly unrelated events).
    • Ability to keep your hand and arm steady while moving your arm or while
        holding your arm and hand in one position.
    • Ability to make precisely coordinated movements of the fingers of one or both
        hands to grasp, manipulate, or assemble very small objects.
    • Ability to enter, transcribe, record, store, or maintain information in written or
        electronic/magnetic form.



38
   Occupational profile information compiled from EDD’s Labor Market Information Division
      (LaborMarketInfo), US Dept. of Labor (O*NET), US Bureau of Labor Statistics (Occupational Outlook
      Handbook); the American Medical Association (Health Care Careers Directory, 2010-2011); and
      California’s Emergency Medical Services Authority (www.emsa.ca.gov).
39
   EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
      Alameda County due to limitations related to combining county and zip region data.




                                                                                                          C-42
Education and Licensing Requirements
EMT programs are offered at community colleges, technical schools, hospitals, and
universities as well as EMS, fire, and police academies. These programs have three
levels: EMT-Basic, EMT-Intermediate, and Paramedic. At the EMT-Basic level,
coursework emphasizes emergency skills, such as managing respiratory, trauma, and
cardiac emergencies, and patient assessment. Training in this level lasts from 2 to 6
months. To advance to EMT-Intermediate training, an EMT-Basic student must have at
least one year of patient field care experience. At the EMT-Intermediate level, students
learn advanced skills such the use of airway devices, intravenous fluids, and some
medications. The most advanced level of training for this occupation is Paramedic. At
this level, the student receives training in anatomy and physiology as well as advanced
medical skills. Completing all three levels can take up to two years and may result in an
associate degree.

California law requires all ambulance attendants to be trained to the EMT-Basic level and
many fire agencies require firefighters to be EMT-Basic trained. In California, licensing and
certification is also required to become an EMT or paramedic. Graduates of approved
EMT-Basic training programs must pass a written and practical examination administered
by California Emergency Medical Services Authority (CEMSA). Additional licensing
information is provided in the table below.

                                              EMT-Intermediate        PARAMEDIC
                       EMT-Basic
                                              (limited advanced       (advanced life
                       (basic life support)
                                              life support)           support)
                       Administered by the    Administered by         Administered by the
Written and Skills
                       National Registry of   training program or     National Registry of
Exams
                       EMTs                   local EMS agency        EMTs
Length of              2 year certification   2 year certification
                                                                      2 year licensure
Certification or       with retesting every   with verification of
                                                                      without retesting
Licensure              4 years                compliance
                                              48 hours of CE
Refresher Course/      24 hour refresher
                                              every 2 years & 6       48 hours of CE
Continuing             course or 24 hours
                                              field care audits per   every 2 years
Education (CE)         of CE every 2 years
                                              year
                                                                      Licensed by
                       Certified              Certified
Certification &                                                       State/valid
                       locally/valid          locally/valid only
License Provisions                                                    statewide; local
                       statewide              where certified
                                                                      accreditation

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
  College/School                 Name of Program                    County
Skyline College       Emergency Medical Technician (EMT)/     San Mateo
                      Paramedic
Foothill College      Emergency Medical Technician (EMT)/     Santa Clara
                      Paramedic




                                                                                                C-43
Career Pathways for Paramedics and Emergency Medical Technicians

                           State Approved
                          Training Program




     Licensure/
    Certification            EMT - Basic




     Licensure/
    Certification                EMT –
                             Intermediate




     Licensure/
    Certification            Paramedic




   Supervisors/              Instructors of                 Registered Nurses
   Managers of                Paramedic                  (requires additional
 Emergency Services            Programs                  education & training)




         = Education & Training               = Licensing & Certification        = Occupation


Compatible Occupations
  • Surgical technologists
  • Registered nurses
  • Radiation therapists




                                                                                                C-44
Pharmacy Technicians – SOC 29-2052
Pharmacy technicians receive prescription requests, count tablets, label bottles, and
verify that the information on the prescription is complete and accurate. They are also
responsible for establishing and maintaining patient profiles and answering customer
inquiries in person and over the phone. In addition, they may maintain proper storage
and security for drugs, manage inventory, and sterilize work areas and equipment
according to prescribed methods.

In 2009, there were 295 pharmacy technicians employed by the healthcare sector in the
Silicon Valley. By 2014, employment for pharmacy technicians within the healthcare
sector is expected to increase by 40 jobs, for a total of 335 positions. The current
median hourly wage of pharmacy technicians is $18.98 per hour.40

Top Skills of Pharmacy Technicians
   • Ability to select and use training/instructional methods and procedures
      appropriate for the situation when learning or teaching new things.
   • Ability to apply general rules to specific problems to produce answers that make
      sense.
   • Ability to compile, code, categorize, calculate, tabulate, audit, or verify
      information or data.
   • Ability to use computers and computer systems (including hardware and
      software) to program, write software, set up functions, enter data, or process
      information.

Education and Licensing Requirements
Pharmacy technicians are required to obtain a license by the Board of Pharmacy,
California Department of Consumer Affairs. The licensing requirements include:
    • High school diploma or its equivalent.
    • Completion of one of the following (1) an Associate degree in pharmacy; (2) a
        course of training specified by the Board of Pharmacy; (3) a school of pharmacy
        program approved by the American Council on Pharmaceutical Education or
        recognized by the Board of Pharmacy; (4) certification by the Pharmacy
        Technician Certification Board or (5) military training.
    • Recertification every 2 years, which requires 20 hours of continuing education.

Pharmacy technician training programs cover a variety of topics, such as medical and
pharmaceutical terminology, pharmaceutical calculations, pharmacy recordkeeping,
pharmaceutical techniques, and pharmacy law and ethics. Many training programs also
include internships, through which students gain hands-on experience.

Although voluntary, national certification is available through several organizations such
as the Pharmacy Technician Certification Board (PTCB) and the Institute for the
Certification of Pharmacy Technicians (ICPT).




40
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-45
Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
      Higher Education          Name of Program              Type of Program
         Institution
Biohealth College          Pharmacy Technician          Certificate
Boston Reed College
(Milpitas)                 Pharmacy Technician          Certificate
Boston Reed College (Palo
Alto)                      Pharmacy Technician          Certificate
Boston Reed College (San
Jose)                      Pharmacy Technician          Certificate
Boston Reed College
(Santa Clara)              Pharmacy Technician          Certificate
Boston Reed College
(Union City)               Pharmacy Technician          Certificate
Foothill College           Pharmacy Technician          A.S.
Pacific Technical College  Pharmacy Technician          Certificate
Santa Clara Adult
Education (partnership w/
Boston Reed College)       Pharmacy Technician          Adult Ed / Certificate
Skyline College            Pharmacy Technician          Certificate
Unitek College (Fremont)   Pharmacy Technician          Certificate
Valley College of Medical
Careers                    Pharmacy Technician          Certificate
Techskills (San Jose)      Pharmacy Technicians         Certificate
Heald College              Pharmacy Technology          A.S. / Certificate

Career & Education Pathways for Pharmacy Technicians

    A.S. in Pharmacy
 Technician or Approved          State                   Pharmacy        Bachelor’s Degree
    Training Program            License                  Technician       in the Sciences

                                                                         Bachelor’s Degree
                                                                             (4 Years)


                                                                           Doctorate in
                                                         Pharmacist         Pharmacy
                                                                            (4 Years)

                                                                         Bachelor’s Degree
                                                                             (4 Years)


       = Education & Training             = Licensing & Certification   = Occupation


Compatible Occupations
  • Pharmacy aides
  • Veterinary technologists and technicians




                                                                                             C-46
Physical Therapist Assistants – SOC 31-2021
Physical therapist assistants assist physical therapists in providing treatments and
procedures. As directed by a physical therapist, they instruct, motivate, safeguard and
assist patients as they practice exercises and functional activities. The may also
administer active and passive manual therapeutic exercises, therapeutic massage,
aquatic physical therapy, and heat, light, sound and electrical modality treatments. In
addition, physical therapist assistants observe and record the patients activities, confer
with physical therapy staff about how to improve the treatment plan and monitor and
require use of equipment.

In 2009, there were 275 physical therapist assistants employed by the healthcare sector
in the Silicon Valley. By 2014, employment for physical therapists within the healthcare
sector is expected to increase by 21 jobs, for a total of 296 positions. The current
median hourly wage of physical therapists is $25.88.41

Top Skills of Physical Therapy Assistants
   • Ability to listen to and understand information and ideas presented through
      spoken words and sentences.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others such as coworkers, customers, or patients.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to monitor and review information from materials, events, or the
      environment, to detect or assess problems.

Education and Licensing Requirements
In California, physical therapy assistant are required to obtain a license from the
Physical Therapy Board of California, Department of Consumer Affairs. The licensing
requirements include:
    • Completion of an accredited PTA program (typically an Associate degree).
        Accredited PTA programs are divided into academic coursework and hands-on
        clinical experience. In the absence of completion of an accredited PTA program,
        applicants may qualify for the license if they can show proof of equivalent training
        and experience.
     • Passing score on the National Physical Therapy Assistant Examination and the
         California Law Examination.
Physical therapy assistants must renew their license every 2 years, which requires 15 to
30 hours of continuing education.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
       College/School           Name of Program             Type of Program
Ohlone College              Physical Therapy Assistant A.S.
Institute of Medical        Physical Therapy Assistant Certificate
Education

41
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-47
Career Pathways for Physical Therapist Assistants

  Associate Degree
      in PTA            State License
     (2 Years)




                                                     Supervisor of Physical
                      Physical Therapist            Therapy Assistants with
                          Assistant                 Additional Education and
                                                            Training




       = Education & Training              = Licensing & Certification         = Occupation


Compatible Occupations
  • Surgical technologists
  • Registered nurses
  • Physical therapists
  • Licensed practical nurses
  • Medical assistants
  • Radiologic technologists




                                                                                              C-48
Psychiatric Technicians – SOC 29-2052
Under the supervision of a psychiatrist or psychiatric nurse, psychiatric technicians
provide care for mentally impaired or emotionally disturbed individuals. They monitor
patients' physical and emotional well-being and report to medical staff. They may
participate in rehabilitation and treatment programs, help with personal hygiene, and
administer oral medications and hypodermic injections. In addition, they may be
responsible for admitting and interviewing patients, record-keeping, administering
medications, and conducting therapy sessions.

In 2009, there were 585 psychiatric technicians employed by the healthcare sector in the
Silicon Valley. By 2014, employment for psychiatric technicians within the healthcare
sector is expected to increase by 32 jobs, for a total of 617 positions. The current
median hourly wage of psychiatric technicians is $27.87.42

Top Skills of Psychiatric Technicians
   • Ability to select and use training/instructional methods and procedures
      appropriate for the situation when learning or teaching new things.
   • Ability to tell when something is wrong or is likely to go wrong. It does not involve
      solving the problem, only recognizing there is a problem.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others such as coworkers, customers, or patients.

Education and Licensing Requirements
Psychiatric technicians are required to obtain a license by the Board of Vocational
Nursing and Psychiatric Technicians (BVNPT), California Department of Consumer
Affairs. The licensing requirements include:
    • Applicants must be at least 18 years of age
    • High school diploma or its equivalent
    • Completion of a California accredited psychiatric technician program, or
         equivalent education and/or experience, or nursing service in the Medical Corps
         of any branch of the Armed Forces of the United States
    • Passing score on the California Psychiatric Technician Licensure Examination

Psychiatric technician education typically takes one to two years to complete. Some
hospitals may also require previous work experience as a nursing aide or home health
aide.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
    Higher Education            Name of Program              Type of Program
        Institution
Mission College            Psychiatric/Mental Health    A.S. / Certificate
                           Services Technician


42
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-49
Career Pathways for Psychiatric Technicians

 Associate Degree
     Psychiatric             State                        Psychiatric
     Technician           Licensing                       Technician
      (2 Years)




                                        A.S. or B.S. in             B.S. in Social Work
                                          Nursing                     or Counseling

                                      Bachelor’s Degree                 Bachelor’s Degree
                                          (4 Years)                         (4 Years)



                                      Psychiatric Nurse                    Counselor
                                            (RN)

                                      Bachelor’s Degree                 Bachelor’s Degree
                                          (4 Years)                         (4 Years)


       = Education & Training         = Licensing & Certification                           = Occupation


Compatible Occupations
  • Psychiatric aides
  • Occupational therapist assistants
  • Occupational therapist aides




                                                                                                           C-50
Speech-Language Pathologist Assistants – SOC 31-9099 (under Healthcare
Support Workers, All Other)
Under the supervision of licensed speech-language pathologists, speech-language
pathologist assistants (SLPA) assist in the assessment and treatment of speech,
language, voice, and fluency disorders. They implement speech and language programs
or activities as planned and directed by speech-language pathologists. They also
monitor the use of alternative communication devices and systems, and assist in
speech-language and hearing screenings.

In 2009, the estimated employment of healthcare support workers- all other, the
category that speech-language pathologist assistants fall under, totaled 961 in the
healthcare sector in the Silicon Valley. By 2014, employment for healthcare support
workers- all other within the healthcare sector is expected to increase by 128 jobs, for a
total of 1,089 positions.43 The current median hourly wage is $20.09.44

Top Skills of Speech-Language Pathology Assistants
   • Ability to tell when something is wrong or is likely to go wrong. It does not involve
      solving the problem, only recognizing there is a problem.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.
   • Ability to provide personal assistance, medical attention, emotional support, or
      other personal care to others such as coworkers, customers, or patients.
   • Ability to monitor and review information from materials, events, or the
      environment, to detect or assess problems.

Education and Licensing Requirements
Speech-language pathologist assistants (SLPA) are required to be licensed by the
Speech-Language Pathology and Audiology Board, California Department of Consumer
Affairs. The licensing requirements include one of the following:
    • Completion of an SPLA Associate degree approved by the Speech-Language
         Pathology and Audiology Board. In addition to coursework, SPLA Board
         approved programs include 15 hours of direct observation and 70 hours of field
         work experience.
    • Completion of an accredited bachelor’s degree program in speech-language
         pathology or communication disorders, plus 70 hours of field work experience or
         nine months of full-time work experience performing the duties of a speech-
         language pathology assistant.

California code requires speech-language pathologist assistants to complete 12 hours of
continuing education units every 2 years to renew their license.

Currently, there are no Board approved Associate degree programs or bachelor’s
degree programs in speech-language pathology offered in Santa Clara, San Mateo, and
southern Alameda counties.

43
   Employment data for Speech-Language Pathology Assistants is included with related occupations under
      the broad occupational title “Healthcare Support Workers, All Other” (SOC 31-9099)
44
   EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
      Alameda County due to limitations related to combining county and zip region data.




                                                                                                         C-51
Career & Education Pathways for Speech-Language Pathologist Assistants

  Associate’s Degree
       in SLPA            State License                SLPA
      (2 Years)




        = Education & Training            = Licensing & Certification   = Occupation


Compatible Occupations
Currently there is no compatible occupational data available for speech-language
pathology assistants.




                                                                                       C-52
Sterile Processing Technicians – SOC 31-9093 (under Medical Equipment
Preparers)
Sterile processing technicians prepare, sterilize, inspect and clean surgical equipment,
instruments and other medical tools. They manage inventory of instruments and medical
tools, conduct sterilization tests, and record results. In addition, they are responsible for
organizing and assembling routine and specialty instrument trays.

In 2009, there were 365 sterile processing technicians employed by the healthcare
sector in the Silicon Valley. By 2014, employment for sterile processing technicians
within the healthcare sector is expected to increase by 33 jobs, for a total of 398
positions. The current median hourly wage of sterile processing technicians is $18.72.45

Top skills of Sterile Processing Technicians
   • Ability to conduct tests and inspections of products, services, or processes to
      evaluate quality or performance.
   • Ability to arrange things or actions in a certain order or pattern according to a
      specific rule or set of rules.
   • Ability to inspect equipment, structures, or materials to identify the cause of
      errors or other problems or defects.
   • Ability to enter, transcribe, record, store, or maintain information in written or
      electronic/magnetic form.

Education and Licensing Requirements	
  
Most employers prefer to hire sterile processing technicians with at least six months of
training related central services technology/sterile processing. Typical coursework
includes: basic anatomy, infection control and microbiology, types of sterilization,
decontamination and disinfection, legal issues and regulations in sterile processing, and
inventory control.

Two national associations, the Certification Board for Sterile Processing and Distribution
(CBSPD) and the International Association of Healthcare Central Service Materiel
Management (IAHCSMM) offer sterile processing certifications. The CBSPD also offers
specialty certifications such as flexible endoscope re-processor, ambulatory surgery
technician, supervisor, and manager.

Education/Training Providers in Santa Clara, San Mateo, and southern Alameda
counties
      College/School            Name of Program             Name of Program
Skyline College            Central Services             Certificate
                           Technology/ Sterile
                           Processing




45
     EMSI Complete Employment - 4th Quarter 2009. The median hourly wage estimate excludes southern
        Alameda County due to limitations related to combining county and zip region data.




                                                                                                      C-53
Career Pathways for Sterile Processing Technicians

 Community College /       Sterile Processing         National Certification
  Vocational School            Technician                with Specialty
 (6 Months to 1 Year)




                                                        Sterile Processing
                                                         Technician with
                                                             Specialty




       = Education & Training            = Licensing & Certification           = Occupation


Compatible Occupations
  • Veterinary technologists and technicians
  • Medical equipment preparers




                                                                                              C-54
APPENDIX D: HIT OCCUPATIONS
Due to the rapid pace of technology implementation, the Bureau of Labor Statistics does
not yet have appropriate, specific occupational data for HIT workers. The project team
has identified the following traditional occupational titles that include HIT workers or are
most likely to be affected by HIT. The occupations, along with their O*NET descriptions,
are summarized in this section.

Budget Analysts

Examine budget estimates for completeness, accuracy, and conformance with
procedures and regulations. Analyze budgeting and accounting reports for the purpose
of maintaining expenditure controls.

Computer and Information Systems Managers

Plan, direct, or coordinate activities in such fields as electronic data processing,
information systems, systems analysis, and computer programming. Exclude "Computer
Specialists."

Computer Operators

Monitor and control electronic computer and peripheral electronic data processing
equipment to process business, scientific, engineering, and other data according to
operating instructions. May enter commands at a computer terminal and set controls on
computer and peripheral devices. Monitor and respond to operating and error messages.
Excludes "Data Entry Keyers."

Computer Programmers

Convert project specifications and statements of problems and procedures to detailed
logical flow charts for coding into computer language. Develop and write computer
programs to store, locate, and retrieve specific documents, data, and information. May
program web sites.

Computer Software Engineers, Systems Software

Research, design, develop, and test operating systems-level software, compilers, and
network distribution software for medical, industrial, military, communications,
aerospace, business, scientific, and general computing applications. Set operational
specifications and formulate and analyze software requirements. Apply principles and
techniques of computer science, engineering, and mathematical analysis.

Computer Support Specialists

Provide technical assistance to computer system users. Answer questions or resolve
computer problems for clients in person, via telephone or from remote location. May
provide assistance concerning the use of computer hardware and software, including
printing, installation, word processing, electronic mail, and operating systems. Exclude
"Network and Computer Systems Administrators.”




                                                                                               D-1
Customer Service Representatives

Interact with customers to provide information in response to inquiries about products
and services and to handle and resolve complaints. Exclude individuals whose duties
are primarily sales or repair.

Data Entry Keyers

Operate data entry device, such as keyboard or photo composing perforator. Duties may
include verifying data and preparing materials for printing. Exclude "Word Processors
and Typists.”

Medical Records and Health Information Technicians

Compile, process, and maintain medical records of hospital and clinic patients in a
manner consistent with medical, administrative, ethical, legal, and regulatory
requirements of the heath care system. Process, maintain, compile, and report patient
information for health requirements and standards.

Operations Research Analysts

Formulate and apply mathematical modeling and other optimizing methods using a
computer to develop and interpret information that assists management with decision
making, policy formulation, or other managerial functions. May develop related software,
service, or products. Frequently concentrates on collecting and analyzing data and
developing decision support software. May develop and supply optimal time, cost, or
logistics networks for program evaluation, review, or implementation.

Procurement Clerks

Compile information and records to draw up purchase orders for procurement of
materials and services.

Purchasing Managers

Plan, direct, or coordinate the activities of buyers, purchasing officers, and related
workers involved in purchasing materials, products, and services. Include wholesale or
retail trade merchandising managers and procurement managers.

Registered Nurses

Assess patient health problems and needs, develop and implement nursing care plans,
and maintain medical records. Administer nursing care to ill, injured, convalescent, or
disabled patients. May advise patients on health maintenance and disease prevention or
provide case management. Licensing or registration required. Include advance practice
nurses such as: nurse practitioners, clinical nurse specialists, certified nurse midwives,
and certified registered nurse anesthetists. Advanced practice nursing is practiced by
RNs who have specialized formal, post-basic education and who function in highly
autonomous and specialized roles.




                                                                                             D-2
APPENDIX E: HEALTHCARE GROWTH MAPS


      Map 1: Acute Care Employment in 2009   Map 2: Acute Care Employment in 2014




                                                                                    E-1
Map 3: Healthcare Office and Clinic Employment in 2009   Map 4: Healthcare Office and Clinic Employment in 2014




                                                                                                              E-2
Map 5: Outpatient Care & Medical Lab Employment in   Map 6: Outpatient Care & Medical Lab Employment in
                       2009                                                 2014




                                                                                                          E-3
Map 7: Long-term and Residential Care Employment in   Map 8: Long-term and Residential Care Employment in
                       2009                                                  2014




                                                                                                       E-4
APPENDIX F: SUMMARY OF HEALTHCARE REFORM ACT
Signed into law by President Obama in March 2010, the Patient Protection and
Affordable Care Act (H.R. 3590), later amended by HR 4872, is expected to increase the
demand for healthcare workers. As such, the Act includes hundreds of provisions related
to developing a quality healthcare workforce. The Association of American Medical
Colleges recently released a paper summarizing the Act’s workforce provisions. Below is
an overview of the AAMC’s synopsis of the Act. The full summary may be accessed at
www.aamc.org/workforce/healthcarereform.pdf.

Major Provisions             Tactics
National Healthcare          Establishes a commission that will provide recommendations to
Workforce Commission         Congress and the Administration on national health workforce priorities,
                             goals, and policies. They will also be responsible for reviewing
                             information related to the current supply and demand of healthcare
                             workers, assessing the effectiveness of education and training
                             mechanisms, and identifying workforce “high priority” areas. The board
                             will consist of 15 members with the majority directly involved in health
                             professions education or practice.
Health Workforce Data,       Establishes the National Center for Health Workforce Analysis, which will
Analysis, and Planning       collect, analyze and report on data related to the health workforce and
                             related issues. In addition, the Act authorizes $8 million for workforce
                             planning grants and another $150 million in grant funds to implement
                             workforce strategies.
Primary Care Related         Establishes “Teaching Health Centers” for training of primary care
Provisions                   residents in Community Health Centers, provides grants to
                             develop/expand primary care residency programs, provides grants to
                             develop fellowship programs that support geriatric education, and
                             provides funds to support rural physician training.
Public and Community         Establishes a loan repayment program for public health professionals
Health                       that work in a Federal, State, local, or tribal public health agency for a
                             minimum of 3 years upon graduation. The Act also provides scholarships
                             for mid career training and provides funds to expand fellow ship
                             programs in epidemiology, lab science, public health informatics, and
                             epidemic intelligence service.
Nursing Provisions           Establishes funds to support primary care family nurse practitioner
                             training programs, increases the max loan amount for nurses, issues
                             grants to eligible hospitals to develop or expand an Advanced Practice
                             Nursing program and offers grants to improve the retention of nurses
                             through training, education and career development programs.
Other Health Workforce       Authorizes funds for (1) tuition assistance for students that agree to
Provisions                   practice in direct care positions (geriatrics, disability services, and long-
                             term care), (2) provide support to low-income individuals to enter health
                             profession training in shortage fields, (3) recruit students for training in
                             mental and behavioral health, (4) provides grants to programs that train
                             or employ dental healthcare providers in rural/underserved areas. The
                             Act also expands the role of physician assistant in Medicare.
Community Health             Establishes a CHC fund, develops a prospective payment system for
Centers (CHC) and            FQHCs, and specifies that CHCs can contract with rural clinics, critical
Federally Qualified Health   access hospitals, and sole community hospitals for delivery of primary
Centers (FQHCs)              care services if they use a sliding scale for low income patients.




                                                                                                             F-1
APPENDIX G: EMPLOYER SURVEY TOPLINES
                                                                                Silicon Valley
                                                                 Healthcare Employers (n=200)
                                                                              September 2010
                                                                                     Toplines

                                 Healthcare Employer Survey
````````````````````````````````````````````````````````````````````````````````````````````````````````````
`````````````````````
Introduction:

Hello, my name is __________. May I please speak to [name] or the person
handling staffing at [organization]?

Hello, my name is ________ and I’m calling on behalf of NOVA Workforce
Investment Board. NOVA would value your participation in a brief survey that
will help address your future organization needs for trained and educated
employees with healthcare skills and knowledge.

(If needed): The survey should take approximately ten minutes of your time. By
answering this survey, you can help the regional workforce investment system
develop the appropriate type of training that will prepare the employees you will
be looking for in the future.

(If needed): This survey has been commissioned by the NOVA Workforce
Investment Board, which is committed to developing the regional workforce. The
survey is being conducted by BW Research, an independent research
organization.

(If needed): Your individual responses will not be published; only aggregate
information will be used in the reporting of the survey results.


````````````````````````````````````````````````````````````````````````````````````````````````````````````
`````````````````````
           PLEASE NOTE: TRADITIONAL ROUNDING RULES APPLIED
              NOT ALL PERCENTAGES WILL EQUAL EXACTLY 100%

County:
       11%        Alameda
       28%        San Mateo
       62%        Santa Clara



                                                                                                               G-1
Segment from Sample:
            8%         Acute care
           64%         Offices and clinics
            8%         Outpatient and labs
           20%         Long term care




SECTION 1 - Organization-Related Questions
I’d like to begin by asking you a few general questions about your location.

1. Including all full-time and part-time employees, how many permanent
   employees work at your location?

     Total full-time and part-
        time permanent                                               More Conservative
            employees                            Mean                     Mean46            Median
              10,479                             53.46                     16.82             5.00


Breakdown:

            1%         No permanent employees
           51%         5 or less permanent employees
           15%         6 to 10 permanent employees
           13%         11 to 24 permanent employees
            8%         25 to 49 permanent employees
            6%         50 to 99 permanent employees
            3%         100 to 249 permanent employees
            1%         250 to 499 permanent employees
            0%         500 to 999 permanent employees
            2%         1,000 or more permanent employees
             2%        (DON’T READ) DK/NA




46
     With outliers (i.e. largest employers) removed: 4 firms with 1,000 or more employees




                                                                                                     G-2
2. Of your [TAKE Q1 #] permanent employees, how many would you estimate
   are part-time?

 Total estimated part-time                                          More Conservative
        employees                                Mean                    Mean47         Median
           3,307                                 16.96                    6.03           2.00


Percentage of permanent employees that are part-time:

           34%        0 percent
            1%        1 to 5 percent
           17%        6 to 24 percent
           21%        25 to 49 percent
           16%        50 to 74 percent
            9%        75 to 100 percent
            3%        (DON’T READ) DK/NA




47
     With outliers removed: 3 firms with 600 or more part-time employees




                                                                                                 G-3
Current Part-Time Employment
(Calculated by only examining employers with both full-time and part-time data)

                               Total Permanent                        Part-Time
                             Employees (Full and                     Permanent
                                     Part-Time)                      Employees
 n                                           194                            194
 Mean                                                42.62                      15.40
 Median                                                5.00                      2.00
 Total                                               8,269                      2,987
 Employees
 % Part-Time                                                                36.1%


More Conservative Statistics on Current Part-Time Employment48
(Calculated by only examining employers with both full-time and part-time
data)

                               Total Permanent                        Part-Time
                             Employees (Full and                     Permanent
                                     Part-Time)                      Employees
 n                                                     192                        192
 Mean                                                29.79                       8.53
 Median                                                5.00                      2.00
 Total                                               5,719                      1,637
 Employees
 % Part-Time                                                                28.6%


3. If you currently have [TAKE Q1 #] full-time and part-time permanent
   employees at your location, how many more or less permanent employees do
   you expect to have at your location 12 months from now?
       [If amount differs by 10% or more in either direction, ask: ]
       Just to confirm, you currently have ____ permanent employees and you expect to have _____
       (more/less) employees, for a total of ____ permanent employees 12 months from now.

           27%        More permanent employees[record #_______]
            3%        Less permanent employees [record #_______]
           61%        (DON’T READ) Same number of permanent employees
            9%        (DON’T READ) DK/NA



48
     With two outliers removed: Firms with 600 or more part-time that account for 50% or more of their employees




                                                                                                                   G-4
Expected Full-Time and Part-Time Permanent Employment in 12 months
(Calculated by only examining employers with both current and projected
data)

                                                12
                           Current          months
n                                 181             181
Mean                            56.49           60.12
Median                            5.00            6.00
Total                          10,224          10,882
Employees
New                                              658
Employees
% Growth                                       6.4%

4. How many temporary or contract employees work at your firm location?

      Total temporary or                                            More Conservative
     contract employees                       Mean                       Mean49               Median
             1,424                            7.23                        2.94                 .00

Breakdown:

           72%        No temporary or contract employees
           18%        5 or less temporary or contract employees
            4%        6 to 10 temporary or contract employees
            1%        11 to 24 temporary or contract employees
            1%        25 to 49 temporary or contract employees
            2%        50 to 99 temporary or contract employees
            1%        100 to 249 temporary or contract employees
            1%        250 to 499 temporary or contract employees
            2%        500 to 999 temporary or contract employees
            0%        1,000 or more temporary or contract employees
             0%       (DON’T READ) DK/NA


5. If you currently have [TAKE Q4 #] temporary or contract employees at your
   firm location, how many more or less temporary or contract employees do you
   expect to have at your location 12 months from now?
       [If amount differs by 10% or more in either direction, ask: ]
       Just to confirm, you currently have ____ temporary or contract employees and you expect to have
       _____ (more/less) employees, for a total of ____ temporary or contract employees 12 months from
       now.


49
     With outliers removed: 2 firms with 350 or more temporary or contract employees




                                                                                                         G-5
     14%    More temporary or contract employees [record #_______]
      2%    Less temporary or contract employees [record #_______]
     79%    (DON’T READ) Same number of temporary or contract employees
      6%    (DON’T READ) DK/NA


Expected Temporary or Contract Employment in 12 months
(Calculated by only examining employers with both current and projected
data)

                                                 12
                                  Current    months
N                                     188       188
Mean                                  5.61      7.26
Median                                 .00       .00
Total Temporary or Contract          1,055     1,365
Employees
New Temporary or Contract
Employees                                      310
% Growth                                     29.4%




                                                                          G-6
More Conservative Statistics on Expected Temporary or Contract
Employment in 12 months50
(Calculated by only examining employers with both current and projected
data)

                                                                          12
                                                      Current         months
N                                                            185             185
Mean                                                         5.08            6.14
Median                                                        .00             .00
Total Temporary or Contract                                  940           1,135
Employees
New Temporary or Contract
Employees                                                                 195
% Growth                                                                20.7%


SECTION 2 – Overall Workforce and Recruitment needs

6. Now, I’m going to read a list of issues facing the region’s healthcare
   workforce in the coming
   years. Please tell me how much difficulty your organization faces in
   addressing each workforce need.

     Here’s the (first/next) one _________ (READ ITEM): Please tell me whether
     your organization has no difficulty, some difficulty, or great difficulty in dealing
     with this issue.
RANDOMIZE                                                                                                     (DON’T
                                                                           No        Some          Great      READ)
                                                                       difficulty   difficulty   difficulty   DK/NA
A. Replacing workers with qualified employees
    within the organization ................................... 61% 25%                            5%         10%
B. Replacing workers with qualified candidates
    from outside the organization......................... 47%      36%                           12%          5%
C. Recruiting employees that are trained and experienced
    with the latest healthcare information technology               52%                           31%         10%
   7%
D. Retraining and educating entry-level employees so
    they can advance to a new position with greater pay
    and/or responsibilities ................................... 62% 24%                            4%         10%


50
 With three outliers removed: Two firms adding 40 or more temporary or contract workers with growth of 50% or more
AND one firm increasing them by 1500%




                                                                                                                       G-7
7. Next, I’d like to ask you about how your firm recruits applicants for hiring. As I
   read each of the following recruitment practices, please indicate whether your
   firm uses each practice.
RANDOMIZE                                                                            (DON’T
                                                                                      READ
                                                                   Yes         No    DK/NA
A.   Using social media tools, such as facebook, twitter
      and linkedin to recruit potential applicants ..... 13%                   84%   3%
B.   Advertising on job-finder websites like monster.com                       25%   70%      6%
C.   Participating at local and regional job fairs ....... 22%                 76%   3%
D.   Advertising in local newspapers, on the web or in print                   53%   45%      3%
E.   Advertising on craigslist .................................... 58%        40%   3%
F.   Partnering with local and regional educational
      providers ........................................................ 40%   55%    6%


8. Thinking in general about recent hires at your firm, which of the following
   skills would you say that recent hires tend to be most deficient in?
     (For this question, we are interested in your general perception about skill
     deficiencies for recent hires across occupations at your organization –
     ALLOW MULTIPLE RESPONSES)

       34%        Technical competence specific to the position
       34%        Ability to communicate effectively in English
       32%        Ability to speak more than one language
       24%        Ability to use the most current healthcare information technology
       14%        Other (Please specify_        _)
        1%        (DON’T READ) Depends on occupation
       22%        (DON’T READ) DK/NA


9. How much difficulty does your organization face finding qualified applicants
   that can communicate with the different languages needed to effectively
   communicate with your customers?

       56%        No difficulty
       40%        Some difficulty
        3%        Great difficulty
        1%        (DON’T READ) DK/NA


10. Do you use or need certified healthcare interpreters or medical translators at
    your work location?




                                                                                                   G-8
     18%      Yes
     81%      No [SKIP TO Q12]
      2%      (DON’T READ) Not Sure or DK/NA [SKIP TO Q12]


11. Do you have certified healthcare interpreters or medical translators on staff or
    do you use a company that provides interpreters or translators?

   Percentages among those that use or need certified healthcare interpreters or
   medical translators (n=35)

     34%      Interpreters or translators are on staff
     57%      Interpreters or translators are provided by an outside company
      6%      (DON’T READ) Other (specify ________________)
      3%      (DON’T READ) Not Sure or DK/NA




                                                                                       G-9
SECTION 3 – Occupation-Related Questions

[NOTE PLEASE COMMUNICATE TO RESPONDENT THAT WE WILL BE
USING GENERAL OCCUPATIONAL TITLES RATHER THAN SPECIFIC JOB
TITLES THAT MAY BE USED WITHIN EACH ORGANIZATION]

12. Now, I’m going to ask you about specific occupations within your
    organization. The occupational titles we are using may differ from the specific
    position titles used in your organization. For these questions, I would like you
    to try to equate your organization’s specific position titles with the more
    general ones we will use here.

   Please only assign one occupation to each employee at your location.

   Please tell me if your organization employs, at your location, individuals in
   positions matching the following general occupational titles:

   Here’s the (first/next) one: _____________ (READ ITEM & BRIEF
   DEFINITION, THEN ASK): Do you have employees who fit this occupational
   description at your location? (1 = Yes, 2 = No, 3 =DK/NA)

   Occupational List (Read brief definition of occupation only if needed by
respondent)
                                                                                     (DON’T
                                                                                     READ)
                                                                            Yes        No     DK/NA
     A. Registered Nurses (RNs) ....................................... 27%          73%       0%
     B. Surgical Technicians or Technologists ................... 9%                 91%       1%
     C. Health Information Administrators ............ 29%                           69%      3%
     D. Certified Coders ..................................................... 17%   84%       0%
     E.   Radiologic Technologists........................... 8%                     93%      0%
     F.   Radiologic Technicians ............................ 8%                     93%      0%
     G.   Dietitians and Nutritionists ........................ 18%                  82%      0%
     H.   Physicians Assistants ............................... 15%                  86%      0%
     I.   Dialysis Technicians .................................. 3%                 97%      1%
     J.   Respiratory Therapists .............................. 4%                   96%      0%


(SELECT UP TO 4 OF THE OCCUPATIONS THAT THE RESPONDENT INDICATED ARE REPRESENTED AT THEIR
LOCATION IN Q13 –Q18 TO BE ASKED THE FOLLOWING OCCUPATIONAL QUESTIONS)

[NOTE: FOR DATA COLLECTION, EACH OCCUPATION SHOULD HAVE ITS OWN NUMBER AND THAT NEEDS TO
BE USED FOR ENTIRE DATA COLLECTION – FOR EXAMPLE, OCCUPATION 6 SHOULD ALWAYS BE
OCCUPATION 6 – RESPONSES TO Q16 FOR OCCUPATION 6 SHOULD BE FOUND UNDER Q13.6]

(READ THE OCCUPATIONS IN THE SAME ORDER FOR EACH OF THE OCCUPATION-SPECIFIC QUESTIONS: Q13
– Q18)




                                                                                                      G-10
Next I’m going to ask you a few questions about some of the occupations you
mentioned, including _____ (READ LIST OF OCCUPATIONS TO BE USED)

13. As I read each of the following occupations, please tell me how many
    individuals you have at your location that are currently employed either full-
    time or part-time in this occupation.
     [CREATE INTERNAL CONTROL SO THAT THE COMBINED OCCUPATIONAL EMPLOYMENT IS
     NOT MORE THAN OVERALL EMPLOYMENT – UNLESS DUE TO TEMP EMPLOYEES THEN OKAY
     BUT NOTE IN DATA]

Small sample size for five of the 10 occupations - caution generalizing their results.

Current Employment:


                                                  Surgical           Health
                              Registered       Technicians or     Information       Certified       Radiologic
                                                             ¥                                                  ¥
                             Nurses (RNs)      Technologists     Administrators     Coders        Technologists
n                                49                 14                53              28               11
Mean                            37.63              10.71             1.62            1.21             6.55
Conservative                    4.31               3.85                                               4.90
Mean51
Median                          2.00                1.50             1.00            1.00             2.00
Total Employees                 1,844               150               86              34               72


                              Radiologic        Dietitians and    Physicians        Dialysis       Respiratory
                                         ¥                                                    ¥               ¥
                             Technicians        Nutritionists     Assistants      Technicians      Therapists
n                                 11                 33               25              4                7
Mean                             2.00               3.09             2.04            8.75            10.86
Conservative                                        2.25                             5.00            7.20
Mean
Median                           1.00               1.00             1.00            7.00            15.00
Total Employees                   22                102               51              35              76




¥
 Small sample size – caution generalizing the results.
51
   With outliers (i.e. largest occupational employers) removed




                                                                                                                    G-11
14. Thinking about the current number of individuals you have in each of the
    occupations, I would like to know how many you expect will retire or need to
    be replaced for other reasons in the next 12 months. Small sample size for
    five of the 10 occupations - caution generalizing.
                                                                                   Surgical Technicians or
                                                                                                      ¥
                                              Registered Nurses (RNs)                   Technologists
                                                           Number expect to                    Number expect to
                                                            retire or replace                   retire or replace
                                                              over next 12                        over next 12
                                             Current             months           Current            months
N                                             46                    46             13                  13
Mean                                         22.13                1.11            11.46               1.15
Median                                       2.00                  .00            2.00                .00
Total Employees                              1,018                  51             149                 15
% Expect to retire or replace
over next 12 months
                                                                  5.0%                               10.1%
                                          Health Information Administrators            Certified Coders
                                                            Number expect to                     Number expect to
                                                             retire or replace                    retire or replace
                                                               over next 12                         over next 12
                                            Current               months          Current              months
N                                              52                   52             13                  13
Mean                                          1.62                 .08            11.46               1.15
Median                                        1.00                 .00            2.00                .00
Total Employees                                84                   4              149                 15
% Expect to retire or replace
over next 12 months
                                                                  4.8%                               10.1%
                                                                          ¥                                 ¥
                                              Radiologic Technologists             Radiologic Technicians
                                                            Number expect to                    Number expect to
                                                             retire or replace                   retire or replace
                                                               over next 12                        over next 12
                                             Current              months          Current             months
N                                              11                   11             10                   10
Mean                                          6.55                 .36            2.10                 .10
Median                                        2.00                 .00            1.50                 .00
Total Employees                                72                   4              21                   1
% Expect to retire or replace
over next 12 months
                                                                  5.6%                                4.8%
                                              Dietitians and Nutritionists          Physicians Assistants
                                                             Number expect to                  Number expect to
                                                              retire or replace                 retire or replace
                                                                over next 12                      over next 12
                                             Current               months         Current            months
N                                              31                  31              23                   23
Mean                                          2.39                .29             1.74                 .13
Median                                        1.00                .00             1.00                 .00
Total Employees                                74                  9               40                   3
% Expect to retire or replace
over next 12 months
                                                                 12.2%                                7.5%
                                                                      ¥                                    ¥
                                                Dialysis Technicians               Respiratory Therapists
                                                            Number expect to                    Number expect to
                                                             retire or replace                   retire or replace
                                                               over next 12                        over next 12
                                             Current              months          Current             months

¥
    Small sample size – caution generalizing the results.




                                                                                                                      G-12
N                                           4                     4                   6           6
Mean                                       8.75                  .50                 9.67        1.33
Median                                     7.00                  .00                 8.00        .00
Total Employees                             35                    2                   58          8
% Expect to retire or replace
over next 12 months
                                                                5.7%                            13.8%
15. As I read each of the occupations again, please tell me how many more or
    less employees you estimate will be employed, in total, in each of the
    occupations 12 months from now.

Use the following format for each one:

If you currently have [TAKE Q13 #] [INSERT OCCUPATION TITLE] _____ at
your location, how many more or less [INSERT OCCUPATION TITLE] do you
expect to have at your location 12 months from now?

[If amount differs by 10% or more in either direction, ask: ]
Just to confirm, you currently have ____ (insert occupation title) and you expect
to have _____ (more/less), for a total of ____ (insert occupation title) 12 months
from now.

Small sample size (less than 25) for five of the 10 occupations - caution generalizing their results.
                                                                                                    (DON’T
                                                                                                    READ)
                                                                            More      Less   Same   DK/NA
A. Registered Nurses (RNs) (n=51) ..................................... 27%           2%     63%     8%
B. Surgical Technicians or Technologists (n=15) ................. 27%                 0%     73%     0%
C. Health Information Administrators (n=54)......... 11%                              0%     85%     4%
D. Certified Coders (n=29) ................................................... 17%    0%     79%     3%
E.   Radiologic Technologists (n=12) ....................... 8%                       0%     83%    8%
F.   Radiologic Technicians (n=13) ......................... 15%                      0%     69%    15%
G.   Dietitians and Nutritionists (n=34)...................... 3%                     0%     94%    3%
H.   Physicians Assistants (n=26)............................ 12%                     4%     81%    4%
I.   Dialysis Technicians (n=5)................................ 20%                   0%     60%    20%
J.   Respiratory Therapists (n=7) ............................ 14%                    0%     71%    14%




                                                                                                             G-13
Expected Employment in 12 months:
(Calculated by only examining firms with both current and projected data)

Small sample size for five of the 10 occupations - caution generalizing their results.

                                                           Surgical
                            Registered Nurses           Technicians or        Health Information
                                                                      ¥
                                  (RNs)                 Technologists          Administrators        Certified Coders
                            Current    12 months     Current      12 months   Current   12 months   Current   12 months
n                            47          47            14           14         52          52        27         27
Mean                        38.6        39.70         10.7         11.14      1.62        1.75      1.22       1.41
                              8                        1
Median                      2.00         3.00         1.50          2.00      1.00        1.00      1.00       1.00
Total                       1,81        1,866         150           156        84          91        33         38
Employees                     8
New
Employees                                48                           6                    7                    5
% Growth                                2.6%                        4.0%                 8.3%                 15.2%


                                Radiologic                   Radiologic          Dietitians and         Physicians
                                            ¥                           ¥
                              Technologists                 Technicians          Nutritionists          Assistants
                            Current    12 months     Current      12 months   Current   12 months   Current   12 months
n                            11           11           11            11        32          32        24         24
Mean                        6.55         6.82         2.00          2.18      2.94        2.94      1.71       1.92
Median                      2.00         2.00         1.00          2.00      1.00        1.00      1.00       1.00
Total                        72           75           22            24        94          94        41         46
Employees
New
Employees                                 3                           2                    0                    5
% Growth                                4.2%                        9.1%                 0.0%                 12.2%


                                  Dialysis                  Respiratory
                                            ¥                          ¥
                                Technicians                 Therapists
                            Current    12 months     Current      12 months
n                            4            4            6             6
Mean                        8.75         9.25         9.67         10.00
Median                      7.00         8.00         8.00         8.00
Total                        35           37           58           60
Employees
New
Employees                                 2                           2
% Growth                                5.7%                        3.4%

¥
    Small sample size – caution generalizing the results.




                                                                                                                          G-14
16. For the same list of occupations, I’m interested in the level of difficulty your
    organization has in finding entry-level applicants who meet the organization’s
    hiring standards. As I read each occupation, please tell me whether your
    organization has no difficulty, some difficulty, or great difficulty finding
    qualified entry-level applicants. (PRESENT IN ORDER THEY WERE
    PREVIOUSLY PRESENTED)

Small sample size (less than 25) for five of the 10 occupations - caution generalizing their results.

                                                                                                       (DON’T
                                                                   No        Some          Great       READ)
                                                               difficulty   difficulty   difficulty    DK/NA
A.   Registered Nurses (RNs) (n=51) ...................... 67%               22%          8%           4%
B.   Surgical Technicians or Technologists (n=15).. 67%                      27%          0%           7%
C.   Health Information Administrators (n=54)......... 57%                   26%          9%           7%
D.   Certified Coders (n=29) .................................... 59%        14%          14%          14%
E.   Radiologic Technologists (n=12) ...................... 58%              25%          8%           8%
F.   Radiologic Technicians (n=13) ......................... 54%             15%          15%          15%
G.   Dietitians and Nutritionists (n=34)..................... 68%            15%          3%           15%
H.   Physicians Assistants (n=26)............................ 77%            23%          0%           0%
I.   Dialysis Technicians (n=5)................................ 80%          0%           0%           20%
J.   Respiratory Therapists (n=7) ............................ 86%           14%          0%           0%


17. Now, for the same list of occupations, I’d like to know the typical education
    requirements for successful applicants within each occupation. The
    categories are (READ OPTIONS). As I read each occupation, please indicate
    the typical education requirement for that occupation.

        1        Completion of high school or equivalent
        2        Certificate from an Accredited College
        3        Associate’s Degree from Accredited College
        4        Bachelor’s Degree (B.A., B.S.)
        5        Master’s or other Graduate Degree (M.A., M.S., MPA, MBA, Ph.D.,
J.D.)
        6        (DON’T READ) DK/NA
Small sample size (less than 25) for five of the 10 occupations - caution generalizing their results.

                                                  1        2         3          4         5       DK/NA
A. Registered Nurses (RNs) (n=51) .... 0%      6% 27% 57% 2%                                          8%
B. Surgical Technicians
    or Technologists (n=15) .............. 27% 40% 7% 27% 0%                                          0%
C. Health Information Administrators (n=54) 9%     30% 11% 30%                                        6%   15%



                                                                                                                 G-15
D.   Certified Coders (n=29) ................. 17%      55% 3%  7%  3% 14%
E.   Radiologic Technologists (n=12) .... 0%            33% 25% 17% 17% 8%
F.   Radiologic Technicians (n=13) ....... 0%           54% 8%  8%  8% 23%
G.   Dietitians and Nutritionists (n=34)... 6%          15% 6% 38% 21% 15%
H.   Physicians Assistants (n=26)......... 15%          31% 8% 15% 12% 19%
I.   Dialysis Technicians (n=5).............. 0%        80% 0%  0%  0% 20%
J.   Respiratory Therapists (n=7) .......... 0%         57% 14% 14% 0% 14%


18. Next, for the same list of occupations, I’d like to know the typical levels of on
    the job or related work experience for successful applicants in each of the
    occupations. The categories are (READ OPTIONS). As I read each
    occupation, please indicate the work experience expected for that occupation.

     1          No formal work experience is needed
     2          Some related work experience, 3 months to 2 years in a related
occupation
     3          Some specific work experience, 3 months to 2 years in the
                occupation that is being applied for
       4        At least 2 years experience, working in the specific occupation that
                is being applied for
       5        (DON’T READ) DK/NA

Small sample size (less than 25) for five of the 10 occupations - caution generalizing their results.

                                                  1       2        3       4     DK/NA
A.   Registered Nurses (RNs) (n=51) ... 14%             37% 22% 24%               4%
B.   Surgical Technicians
      or Technologists (n=15) .............. 20%        7%      33%      40% 0%
C.   Health Information Administrators (n=54)           4%      44%      13% 31%           7%
D.   Certified Coders (n=29) .................. 3%      41%     14%      38% 3%
E.   Radiologic Technologists (n=12) .... 8%            8%      33%      33% 17%
F.   Radiologic Technicians (n=13) ....... 0%           31%     38%      23% 8%
G.   Dietitians and Nutritionists (n=34)... 9%          38%     18%      26% 9%
H.   Physicians Assistants (n=26).......... 8%          38%     27%      23% 4%
I.   Dialysis Technicians (n=5).............. 0%        20%     40%      40% 0%
J.   Respiratory Therapists (n=7) ......... 14%         29%     43%      0% 14%



[ASK Q19 ONLY IF THEY HAVE EITHER OF THE RADIOLOGIC TECHNOLOGISTS/TECHNICIANS
OCCUPATIONS OTHERWISE SKIP]




                                                                                                        G-16
19. Are there any specific certifications or additional qualifications that you would
    prefer to see for those applicants applying for a Radiologic technologist or
    technician position?

   Percentages among firms with Radiologic technologists or technicians (n=23)

      22%     Provided comment (verbatim responses on file)
      78%     No comment


20. Are there any specific occupations in allied health that we have not discussed
    today for which you are having difficulty finding qualified applicants, if so what
    are they?

      19%     Provided comment (verbatim responses on file)
      81%     No comment




                                                                                         G-17
SECTION 4 – Healthcare Information Technology Assessment

21. Of the [TAKE Q1 # + Q4 #] permanent, temporary, and contract employees at
    your location, approximately how many spend at least half of their time on
    supporting or installing information technology applications? [RECORD
    NUMBER IF THEY DO NOT ANSWER A NUMBER OFFER THE
    CATEGORIES]


 Employees that spend
   at least half of their
 time on supporting or
  installing information
technology applications         Mean            Median
            206                 1.14             .00

Breakdown:

      69%     0 employees
      17%     1 to 2 employees
       4%     3 to 5 employees
       5%     6 or more employees
       6%     (DON’T READ) DK/NA


Current IT Application Employment
(Calculated by only examining employers with both current and IT data)

                                                      Employees that spend at
                                Total Employees       least half of their time on
                                    (Permanent,         supporting or installing
                                 Temporary, and         information technology
                                       Contract)                     applications
n                                              177                           177
Mean                                          32.56                           .86
Median                                         6.00                           .00
Total Employees                               5,764                          152
% IT (at least 50%
                                                                           2.6%
of their time)




                                                                                    G-18
22. In the last 3 years, has your organization begun to use new healthcare
    information technologies, including electronic health records?

     41%     Yes
     27%     No, but we are considering new healthcare information
technologies in the future
     29%     No, and we do not expect to be adopting any new healthcare
             information technologies in the immediate future
      4%     (DON’T READ) DK/NA


   [IF Q22 = 1 OR 2 ASK Q23 OTHERWISE SKIP TO Q24]



23. What is your level of concern finding new workers or developing current
    workers who can effectively use the tools and applications associated with
    healthcare information technology?

   Percentages among firms using or considering new healthcare information
   technologies (n=135)

     55%      No difficulty
     37%      Some difficulty
      6%      Great difficulty
      2%      (DON’T READ) DK/NA


24. In the last 12 months, has your firm outsourced any work to vendors that are
    supporting the development, installation, or training of health information
    technology applications?

     13%      Yes
     85%      No
      3%      (DON’T READ) DK/NA


   Before we finish, I’d like to ask you a general question and verify your
                              contact information.


25. Are you interested in receiving information from your local Workforce
    Investment Board, including the findings of this research?

     15%      Yes




                                                                                   G-19
     83%      No
      2%      (DON’T READ) DK/NA


Thank you for completing the survey. Since it sometimes becomes
necessary for the project manager to call back and confirm responses to
certain questions, I would like to verify your contact information.



First and Last Name of Respondent ___________________

Position of Respondent __________________________

Phone of Respondent _____________

Email of Respondent______________

Name of Organization___________________

Address of Organization (including City) ___________________


                        Those are all the questions I have.
                       Thank you very much for your time.

Date of Interview ___________________

Time of Interview ___________________

Name of Interviewer ___________________

County ___________________

Primary NAICS ___________________




                                                                          G-20
APPENDIX H: METHODOLOGY
Data compiled for this report were drawn from both primary and secondary data sources.
The table below provides a brief overview of the methodology utilized for the project.
Table 6 Overview of Project Methodology

                         Secondary research of the healthcare sector using existing data
                         sources
        Method           Telephone survey of healthcare sector firms
                         Executive interviews with healthcare and information technology
                         firms

       Number of         200 firms in the healthcare sector completed a telephone survey
      Participants       10 participants completed an executive interview
 Field Dates for Telephone survey: August 12 – September 13, 2010
     Primary
    Research     Executive Interviews: August 19 – September 20, 2010

                         4,107 Healthcare sector firms in San Mateo, Santa Clara, and
Survey Universe
                         southern Alameda52 counties
     Survey Margin The maximum margin of error for questions answered by all 200
        of Error   respondents was +/-6.76% at the 95% level of confidence.

SECONDARY RESEARCH
For this study, the healthcare sector was defined as NAICS codes 621, 622, and 623
minus NAICS 62121 “Offices of dentists.” Please see Appendix A for a complete listing
of the NAICS codes for the study. As footnoted throughout the report, a variety of
secondary sources were utilized in compiling data for this report, including information
from EMSI, InfoUSA, US Bureau of Labor Statistics (Occupational Outlook Handbook),
and US Dept. of Labor (O*NET Online).

Specific occupational and industry association resources utilized to develop the
occupational profiles in Appendix B include: American Academy of Nurse Practitioners;
American Association of Medical Assistants; American Dietetic Association; American
Health Information Management Association; American Medical Association (Healthcare
Careers Directory; 2010-2011www.ama-assn.org/ama/pub/education-careers/careers-
health-care/directory.shtml); American Registry of Diagnostic Medical Sonographers;
American Registry of Radiologic Technologists; Association of Medical Technologists;
Board of Medical Specialty Coding; Board of Occupational Therapy: California
Department of Consumer Affairs; Board of Pharmacy: California Department of
Consumer Affairs; Board of Vocational Nursing and Psychiatric Technicians (BVNPT):
California Department of Consumer Affairs; California Emergency Medical Services

52
     Southern Alameda County includes the following zip codes: 94536 Fremont, 94537 Fremont,
        94538 Fremont, 94539 Fremont, 94555 Fremont, 94560 Newark, and 94587 Union City.




                                                                                               H-1
Authority; California's Bureau of Vocational Nursing and Psychiatric Technicians;
Cardiovascular Credentialing International (CCI); Certification Board for Sterile
Processing and Distribution (Degreedirectory.org); Department of Consumer Affairs:
Respiratory Care Board of California; Department of Public Health; International
Association of Healthcare Central Service Materiel Management; National Board of
Surgical Technology and Surgical Assisting; National Certification Board of Pediatric
Nurse Practitioners & Nurses; National Commission on Certification of Physician
Assistants; Occupational profile information compiled from EDD's Labor Market
Information Division (www.labormarketinfo.edd.ca.gov); Physical Therapy Board of
California: Department of Consumer Affairs; Professional Association of Healthcare
Coding Specialists; Speech-Language Pathology and Audiology Board: California
Department of Consumer Affairs; US Bureau of Labor Statistics (Occupational Outlook
Handbook www.bls.gov/oco); US Dept. of Labor (O*NET
http://online.onetcenter.org/link/details/29-2061.00#Skills).

The secondary research helped frame the direction for the primary research phase of
the study.

PRIMARY RESEARCH
Two phases of primary research were conducted as part of this project -- qualitative
executive interviews with 10 industry leaders, prominent employers, human resource
directors, and technology managers within the healthcare and information technology
sectors that are either developers or super users of healthcare information technology
and a quantitative telephone survey of 200 healthcare employers.

SURVEY AND DISCUSSION GUIDE DESIGN
Through an iterative process, the project team worked closely with NOVA to develop a
survey instrument and executive interview discussion guide that met all the research
objectives of the study. In developing the survey instrument, BW Research utilized
techniques to overcome known biases in survey research and minimize potential
sources of measurement error within the survey.

EXECUTIVE INTERVIEWS
Ten executive interviews were conducted by telephone as part of the project from
August 19 through September 20, 2010. The executive interviews were designed to
provide additional perspective on the implementation and development of health
information technology. NOVA identified individuals in the healthcare sector and Green
LMI identified individuals in the IT arena who are developing healthcare technologies.
Ten individuals from the original list of 19 participated in an interview. Participants
included industry leaders, prominent employers, human resource directors, and
technology managers within the healthcare and information technology sectors in the
Silicon Valley that are implementers, developers, or super users of healthcare
information technology.

Half of the interviews were conducted with individuals who work in the healthcare sector
who are working with IT (implementers) and the other half were done IT professionals
who are developing the HIT solutions.




                                                                                           H-2
TELEPHONE SURVEY
Sampling Method
Records were purchased for all healthcare firms with telephone numbers in San Mateo,
Santa Clara, and southern Alameda counties. The list of firms was stratified based on
healthcare segment, size, and county and efforts were made to gather data from a
representative sampling of firms across those key variables.

Data Collection
Prior to beginning data collection, BW Research conducted interviewer training and also
pre-tested the survey instrument to ensure that all the words and questions were easily
understood by respondents. Telephone interviews were generally conducted from 9:00
am to 4:30 pm Monday through Friday. The data collection period was August 12
through September 13, 2010.

A Note about Margin of Error and Analysis of Sub-Groups
The overall margin of error for the survey, at the 95% level of confidence, is between
+/-4.06 percent and +/- 6.76 percent (depending on the distribution of each question) for
questions answered by all 200 respondents.

However, it is important to note that questions asked of smaller groups of respondents
(such as questions that were only asked of firms with the occupations of interest for the
study) will have a margin of error greater than +/-6.76 percent, with the exact margin of
error dependent on the number of respondents in each sub-group.




                                                                                            H-3
APPENDIX I: MAP COMPANION MEMO
FUTURE FORCES OF CHANGE: 2010-2020 TRENDS SHAPING
THE HEALTHCARE WORKFORCE

THE INSTITUTE FOR THE FUTURE
The Institute for the Future (IFTF) is an independent nonprofit research group. Founded
in 1968 by a group of former RAND Corporation researchers with a grant from the Ford
Foundation to take leading-edge research methodologies into the public and business
sectors, IFTF is committed to building the future by understanding it deeply.
IFTF works with organizations of all kinds to help them make better, more informed
decisions about the future. IFTF provides the foresight to create insights that lead to
action. IFTF brings a combination of tools, methodologies, and a deep understanding of
emerging trends and discontinuities to our work with companies, foundations, and
government agencies.

METHODS
To develop the trends depicted on the map of Future Forces of Change: Trends Shaping
the Healthcare Workforce 2010-2020, IFTF researchers from across disciplines worked
together to identify the trends and discontinuities shaping the future landscape of health,
information, communication, the workforce, and technology.

In launching the project, the researchers consulted the Institute’s existing research
project findings, including: Future of Health and Health Care 2020 highlighting the
pressing challenges facing health and health care, along with key response strategies
likely to shape the direction of change over the next ten years; The Future of Work
looking at convergent trends in technology and how a new workforce, with new
technological skills, waits in the wings for their chance to run the show; Mobile Health
examining the explosion of ubiquitous mobile communications and computing devices
and the landscape of opportunities for innovation in health management, service delivery
and consumer/patient engagement; Open Health applying the principles of open
innovation to the global health economy; Baby Boomers: The Next 20 Years exploring
the transition of the country’s 77 million boomers from mid-life to later life over the next
two decades; Biocitizenship and Social Media introducing the concept of biological
citizens, whose communities of interest have turned into communities of collective
action, and examines how this transformation has relied on advances in technology and
social media; Personal Health Ecologies Framework outlining a broad set of
resources, practices and strategies people leverage to support their health, make
decisions, and interact with the health care system; Rethinking Disability arguing that
the disability space is emerging as a major hot zone of marketplace innovation in
contrast to the common market view of new product development, for people with
disabilities, as a niche undertaking at best; and, Ruby’s Bequest examining the future
of caregiving in the United States.

IFTF infused a Healthcare Workforce focus with our previous findings by applying a
modified Delphi method to aggregate expert opinion, test assumptions, and build on
experts’ ideas. IFTF researchers and experts focused primarily on disruptive trends that




                                                                                               I-1
would expand the traditional thinking around the future of Silicon Valley’s Healthcare
Workforce and training strategies over the coming decade.

INTRODUCTION
IFTF’s map of trends shaping the healthcare workforce in Silicon Valley 2010-2020
highlights key disruptive shifts in the technology and socio-demographic landscape, new
ways that people will conceive of and manage health and caregiving, and new
intersections between health, the environment, and food.

IFTF intends this map to help you think about the future of the healthcare
workforce in engaging and constructive ways. The map’s forces of change indicate
new concepts or patterns of behavior that will disrupt traditional narratives and
assumptions about the future of health and healthcare in Silicon Valley over the next
decade. The influencing forces will demand new sets of worker skills and produce new
workforce opportunities. The five identified forces of change are:

   •   Children’s health commons
   •   Collaborative caregiving
   •   Diversity redefined
   •   Green health
   •   Quantified selves

Anticipated and underlying Silicon Valley health, demographic, and technological
changes embed themselves in the disruptive shifts, such as:

   •   The demographic transition underway is driving demand for more healthcare
       services, both inside and outside traditional healthcare settings.
   •   Compounded by the aging of the Valley, chronic conditions—such as asthma,
       diabetes, and various ailments associated with obesity—will require delivery of
       more continuous care in contextually relevant settings.
   •   Finally, the changing infrastructure of how to communicate, manage, and store
       healthcare information will radically change the face of healthcare service
       delivery. Employers continue to roll out large health information technology
       system as propelled by policy enactments such as the Health Information
       Technology for Economic and Clinical Health (HITECH) legislation and market
       initiatives such as Kaiser Permanente’s HealthConnect. Digital storage of health
       data and electronic exchanges of information between patients and providers,
       patients and payers, providers and payers, and peer-to-peer exchanges
       constitute the healthcare delivery system’s technological foundation for the next
       ten years.

The convergence of an aging population, chronic disease burden, and the next decade’s
changing technological landscape serves as the springboard for the disruptive forces of
change identified on this map. These forces will change how one works within and
receives care in the healthcare system. Review and consider what this will mean to
workers and patients. The purpose herein is to spark new conversations about roles and
employment opportunities that may open up in the health ecosystem of Silicon Valley
over the next decade. The purpose of the map is to spark conversation.




                                                                                           I-2
FIVE FORCES OF CHANGE

CHILDREN’S HEALTH COMMONS
In the interest of our collective long-term future, a creation of a commons, or a new
cultural platform, will facilitate an integrated approach to improving the health and
wellbeing of children.

Who is responsible for the alarming rates of childhood obesity in California?53 Is it the
food companies marketing treats to children that are high in calories and low in
nutritional value? The parents who are buying these types of food products, or schools
that are no longer teaching physical education but do offer a plethora of sweet cafeteria
snacks? The enabling national policies resulting in nutritionally dense foods being more
expensive than calorically dense foods, such as those sweetened by high fructose corn
syrup? Are the local level policies or fiscal priorities responsible because they result in
the closure of parks and other safe spaces where children to could exercise?

The epidemic of childhood obesity, along with associated health, financial, and societal
impacts incurred, propels powerful forces to unite in various, shared efforts to improve
childhood nutrition and encourage physical activity. This drives the formation of a
commons, or a new cultural platform to redefine our relationships to each other, to
resources, and to our collective long-term future.54 A commons around children’s health
is emerging to integrate the expertise of parents, pediatricians, mental health
professionals, behavioral psychologists, nutritionists, exercise physiologists, urban
planners, public health officials, game designers, and educators in order to intervene
more efficaciously to improve children’s health and wellbeing. With leadership and
financial backing provided at the local, state, and national levels, as well as the non-
profit and private sectors, a regional infrastructure of information, tools and resources
develops in the Silicon Valley to tackle the serious health challenges facing children over
the next decade.

Workforce Implications
More community-based interventions will open up employment opportunities to prevent
and reduce childhood obesity outside of formal healthcare settings and channels. There
will be a preventative occupational focus, with jobs for specially trained fitness coaches
to motivate and instruct children; nutritionists and cooking instructors, specialized in
teaching the skills required to prepare nutritious, affordable family meals; and software
and game designers to develop fun, engaging technological tools to encourage physical
activity for the young and technologically-minded.
Schools will manage health conditions, emerging as a result of increased childhood
obesity, such as diabetes. This will produce more jobs in schools and across
communities to support health management for children’s chronic conditions. Already,

53
   California Center for Public Health Advocacy, Child Overweight Rates on the
Rise in California Assembly Districts, 2005. Online:
http://www.publichealthadvocacy.org/growingepidemic.html
54
   IFTF, Culture: New Commons, SR 1140, 2008 Online:
www.iftf.org/system/.../SR-1140%20IFTF%20TYF2008%20Overview.pdf



                                                                                              I-3
California schools are required to have non-medical staff members trained to administer
insulin and help children monitor blood-sugar levels.55 More ancillary positions will
become available to support children in managing their health conditions in a variety of
settings.

Pace of Change: Near-term (0-3 years)
According Santa Clara County’s Public Health Department, the total annual costs of
obesity and related conditions in Santa Clara County is already estimated to be $2.1
billion.56 As of result of the substantial financial and health consequences, pressure is
mounting for communities to tackle the obesity epidemic, with pediatric obesity
presenting itself as the least controversial entry point to the topic as a whole. With
initiatives rolling out across the country from the White House to California health plans
to food retailers to local communities, a commons’ approach to preventing and treating
childhood obesity is already underway.57

COLLABORATIVE CAREGIVING
New technologies will allow for greater remote presence in and intelligent awareness of
patients' lives, enabling professional caregivers to focus on providing more meaningful
social support.
Caregiving will be one of most important—and redefined—health roles of the 21st
century.58 Over the next decade, the generation of aging boomers will face an
intersection with both prolonged healthy lifespans and a growing burden of chronic
diseases—drivers equally yielding a large population with daily external assistance
requirements.
Today, those whose work and lives structure around care-providing responsibilities are
the ones meeting that majority of caregiving needs, such as paid professionals and
family members. These traditional sources of care face the strains of overworked
individuals and reduced outside funding for professional care. This strain forces the
profession to adapt on technological and system levels. In the coming years, research
into and practical applications of assistive technologies for caregiving will produce
changes in mainstream practice, from cheap lightweight sensors worn on the body or
ones embedded in a house that constantly report data, to the first stage of practical
robotic and mechanical support for common household tasks. Current versions of these
systems already aggregate multiple data points from relatively simple sensors to provide

55
   Anita Manning, “Calif. Schools required to give medical help to kids with
diabetes” in USA Today, (August 8, 2007) Online:
http://www.usatoday.com/news/health/2007-08-09-diabetes-school_N.htm
56
  David Hill, “Santa Clara County: How Socioeconomic Status Influences Our
Health Profile” Presentation given January 28, 2010. Online:
www.healthysiliconvalley.org/.../2010_SCC_PublicHealth_Presentation.ppt
57
     Apps for Health Kids, Competition, Online: http://www.letsmove.gov/

58
  IFTF, Ruby’s Bequest From Caregiving to Caring: A new approach to civic
engagement. Online: http://www.iftf.org/RubysBequest.




                                                                                             I-4
an overall picture of a person’s current health status. The systems create a wealth of
data about people in need of care—from their current physiological state and daily
prescription compliance to even moment-by-moment emotional states. On the horizon
are more effective opportunities for caregiver intervention created by sensor systems
incorporating data from wearable biological sensors to augment cruder presence data.
Consumer demand exists beyond the technological promise of cheaper sensors and
ubiquitous connective technologies. The enablement of at-home care is apparent.
Currently, thousands of people live in environments outfitted with sensors that
continuously detect and report varied types of health and behavioral information. In the
2008 AARP Health@Home membership survey, 87% of respondents indicated a
preference for caregiving in their own homes and would be willing to give up some
privacy to make that possible.59

Workforce Implications
With these new means of insight and support, the role of the caregiver will be
transformed—from constantly-needed nurse and housekeeper to a more intelligently
applied companion. The unbundling of the roles and responsibilities of caregiving will
allow for advances in technology to take care of the monitoring and maintenance
aspects, and allow caregivers to concentrate on the more subtle, nuanced social support
for those in need. Early examples of this change already exist in the “dashboard”
interfaces for nurses who remotely monitor the vital signs and daily self-reports of large
groups of patients. Remote monitoring will demand caregivers with skills and expertise
around sensing and identifying patterns out of a deluge of data. Additional opportunities
will arise for those able to connect large health IT systems to sensor networks and
personal monitoring technologies that people are using in their homes and assisted
living situations.

Pace of Change: Mid-term (3-5 years)
An aging population and more people with disabilities or chronic conditions will drive the
future demand for caregiving. Developments in robotics and sensor technologies are
advancing rapidly to meet that demand. Initiatives, such as the recent alliance between
G.E. and Intel to research, develop, and market “home-based health technologies,”
(beginning with joint distribution of two existing products: Intel’s Health Guide for doctors
to remotely track patients with chronic diseases, and G.E.’s QuietCare sensor-based
system for basic activity monitoring in the home) are suggestive of market offerings to
come. Still, it will take about five years for the price point to fall significantly enough to
make these smart technologies readily available to a wide range of people. In the
meantime, traditional caretaking roles such as health home aides are projected to grow
much faster than the average for all occupations.60



59
  Linda L. Barrett, Healthy @ Home, AARP Foundation, 2008. Online:
assets.aarp.org/rgcenter/il/healthy_home.pdf

60
  US Department of Labor, Bureau of Labor Statistics, “Home Health Aides and
Personal and Home Care Aides” in Occupational Outlook Handbook 2010-2011.
Online: http://www.bls.gov/oco/ocos326.htm



                                                                                                 I-5
DIVERSITY REDEFINED
Comprehensive cultural care will be delivered based on a richer understanding of
health—viewed not only in strictly biological terms, but also in terms of the social,
emotional, and spiritual wellbeing of people across cultures.
Over the next decade, diversity will reshape both the healthcare workforce and patient
populations of Silicon Valley. Santa Clara County already has one of the largest
immigrant populations in California, amplifying the importance of addressing racial and
ethnic disparities in health and healthcare. Currently, over 50% of residents in Silicon
Valley speak a language other than English at home.61 About one-fifth of that population
does not speak English very well.62 Linguistically sensitive care will be important for
favorable health outcomes, however over the next decade cross-cultural care will go
beyond providing language services. Deep understanding of socio-cultural health
aspects will inform delivery of health information and interventions. Socio-economic
compatibility between patients and their providers will improve the ability of people who
face cultural, economic, or linguistic barriers to access and navigate the healthcare
system.63

Workforce Implications
In addition to medical interpreter and translator employment (projected to increase 22%
between 2008 and 2018), an increased awareness of the differences in the norms,
behaviors, and attitudes around the meaning of health across cultures will open up
opportunities for community healthcare workers whose cultural backgrounds and
upbringings resemble those of the people they serve.64 Healthcare navigators will assist
in determining the most appropriate care regimens by communicating healthcare
provider needs as well as the circumstances and understandings of the patients.
Increased transparency around persistent racial, cultural, and socioeconomic disparities
in health outcomes will drive new supporting occupations to aid medical professionals in




61
   US Census, “Selected Social Characteristics in the United States: Santa Clara
County, California” American Community Survey, 2008. Online:
http://factfinder.census.gov/servlet/ADPTable?_bm=y&-
geo_id=05000US06085&-context=adp&-ds_name=ACS_2008_1YR_G00_&-
tree_id=308&-_lang=en&-_caller=geoselect&-format=.
62
   Ibid.
63
   Kate Meyers, “Racial and Ethnic Health Disparities: Influences, Actors, and
Policy Opportunities” Kaiser Permanente Institute for Health Policy. 2007, Online:
www.kpihp.org/.../Meyers%20IHP_Disparities-
Influences,%20Actors%20031907.pdf
64
   US Department of Labor, Bureau of Labor Statistics, “Interpreters and
Translators” in Occupational Outlook Handbook 2010-2011. Online:
http://www.bls.gov/oco/ocos175.htm.




                                                                                            I-6
determining the environmental, social, and economic realities of their diverse patient
population in order to provide better care. 65

Pace of Change: Mid-term (3-5 years)
As diversity initiatives move from a numerical or structural objective of Human
Resources to a strategic imperative for the entire organization, more health systems will
be actively recruiting talent that can best serve the diverse population of Silicon Valley.
In the next five years, new legislation will provide financial coverage for thousands of
residents previously without access to healthcare services. Many of these newly insured
will be unfamiliar with the delivery system and will be in need of support to navigate the
various choices available to them.

GREEN HEALTH
Sustainability initiatives--from the design and construction of green hospitals, to the
greening of pharmaceuticals, medical and cleaning supplies, to green sourcing of food
and beverage offerings within a healthcare setting--are sprouting up across the
healthcare industry, and new metrics and accounting structures will be required to
demonstrate their efficacy.

Increasingly, people are linking their personal health to the environment surrounding
them.66 In doing so, they are scrutinizing the way healthcare is delivered. From the
design and construction of hospitals, to the collateral health impacts of pharmaceuticals,
to the medical and cleaning supplies and the food and beverage offerings within a
healthcare setting, healthcare institutions are actively working to reduce their
environmental footprints.67 Over the next decade, patient-driven demand and higher
regulatory scrutiny will reclassify environmentally friendly efforts from voluntary and self-
directed initiatives, to strategic imperatives for healthcare organizations. This
reclassification of green health initiatives will have significant implications on internal
processes and practices, and require the implementation of new metrics and accounting
structures in order for organizations to demonstrate the efficacy of their efforts.68

Workforce Implications
Increased attention from the healthcare industry to manage, monitor, and improve its

65
  Los Angeles County Department of Public Health, Office of Health Assessment
and Epidemiology. Mortality in Los Angeles County 2007: Leading causes of
death and premature death with trends for 1998-2007. June 2010.
66
  IFTF, Green Health: Connecting the natural, the ecological, and the healthy
(SR 1163), 2008. Online:
www.iftf.org/system/.../Genealogy%20of%20Green%20Health%20Map.pdf
67
   Kaiser Permanente, “Kaiser Permanente to Energize 15 California Facilities
with Solar Power.” Online:
http://xnet.kp.org/newscenter/pressreleases/nat/2010/033010solarpower.html,
March 30, 2010.
68
     Green Guide for Healthcare. Online: http://www.gghc.org/.




                                                                                                I-7
environmental footprint will spur new demand for performance managers, evaluators and
auditors to develop new metrics, collect data, and analyze the costs and the benefits of
all green initiatives. 69 In addition, the building, renovating and refurbishing of hospitals,
assisted living settings, labs, and clinician offices will be heavily influenced by this trend
of green health. Healthcare organizations will function as building companies, many with
mandates to procure green materials and implement green processes. Inside hospitals,
the trend toward fresher, local, and organic food will flourish with in-hospital farmers
markets and partnerships with small, local farms.70 An emphasis on locally sourced,
healthy food choices will create staffing needs focused on developing localized supply
chains, and new employment opportunities will open up in the reprocessing and
remanufacturing of medical devices.71

Pace of Change: Long-term (5-10 years)
Given the acute cost constraints facing healthcare organizations, sustainability initiatives
are more aspirational than actionable at present. Today, they are often viewed as good
PR or community outreach endeavors. Over the next decade, however, the real health
effects of environmental degradation and climate change will begin to be felt in certain
pockets of Silicon Valley. Increased awareness of noxious fumes, dangerous chemicals,
and unsafe food supplies will intensify the demands on all organizations to provide
services in an environmentally-friendly way. Healthcare facilities will need to be able to
demonstrate that they are delivering effective and safe healthcare that does not harm
the physical environment or adversely affect the health of the people living nearby.

QUANTIFIED SELVES
People will be tracking, visualizing, and analyzing their fitness levels, chronic pain, sleep,
diet, and other factors, and healthcare providers will be looking for support in integrating
this patient-generated data into clinical HIT infrastructure.
Presently, the emphasis around health information and communication technologies
(ICTs) is focused on building large, interoperable clinical information systems.
Overlooked in discussions of HIT systems is the growing practice of self-quantification.
People are increasingly tracking and measuring themselves, from fitness to mood to
chronic pain. With gadgets to track sleep, mobile apps to record food intake, and ever
easier-to-use data visualization tools, individuals are becoming experts at understanding
the patterns of their bodies and lives. Over the next 10 years, self-quantification will
become invisible—embedded in everyday technology from shoes to pillows to pill
bottles.72 Advances in nanotechnology are already building capabilities into common


69
   Global Health and Safety Initiative. Online:
http://www.globalhealthandsafety.org/about/.
70
   Kaiser Permanente, “Building Green: Kaiser Permanente’s Green Building
Practices” Online:
http://xnet.kp.org/newscenter/aboutkp/green/factsheets/index.html


72
 Handhelds in Healthcare: The World Market for PDAs, Tablet PCs, Handheld
Monitors, & Scanners Online:



                                                                                                 I-8
items such as contact lenses.73 By wearing contact lenses, a person can monitor body
temperature, cholesterol and glucose levels, fatigue, inflammation, and possible
infections. Soon, the collected health information will be transmitted to the user’s mobile
phone or computer screen. In other words, people will have an increasing amount of
data about their health and well-being, and, to be effective, clinical information systems
will have to be able to harmonize with individuals' broader personal information
ecologies.

Workforce Implications
Healthcare providers will need support in integrating the personal health data collected
by individuals with health data captured in the clinical setting. Self-quantification opens
up opportunities for new medical device innovators to make gadgets for capturing data,
and for mobile application developers to build apps for recording and viewing data.74
Jobs in data analytics and visualization will be needed to make sense of the raw data
and be able to interweave it into a care regimen prescribed by a health provider.

Pace of Change: Long-term (5-10 years)
Advances in mobile technologies are enabling new practices in personal health
management. Early adopters are already demonstrating the potential for these new tools
and technologies to assist individuals in managing their personal health, but the cost of
smart phones and portable devices, not to mention the technological literacy required to
use the new applications, are still barriers to more widespread use. Over the next
decade, however, the technologies and tools will not only become more affordable, they
will be more intuitive, relying more on verbal cues and visual displays. Improving the
delivery of information will make the new innovations in personal health management
accessible to a broader population.




http://www.informationweek.com/news/healthcare/mobile-
wireless/showArticle.jhtml?articleID=225702193) July 2, 2010.
73
  Veronica Chufo, “Contact Lens Monitors Health” in Health Key (August 4,
2010) Online: http://www.healthkey.com/sns-health-contact-lens-monitors-
health,0,2617306.story
74
   Indeed, “Job trends for Mobile Application Developer and iPhone Developer
from July 2005-January 2010” Online:
http://www.indeed.com/jobtrends?q=mobile+application+developer%2Ciphone+d
eveloper



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