Lifestyle

PROGNOSIS: JOB-HEAVY

A funny thing is happening in the healthcare field: Jobs are on the rise, even as the economy shrinks.

And as baby boomers continue to age, with a life expectancy unimaginable to their great-grandparents, the coming decade is predicted to bring only further growth.

And it’s not just caregivers who are in demand. Opportunities abound in non-patient fields like health information management, and with the government’s current push toward computerization of health records, they’re expected to grow even more.

With many top health-care institutions based here, New York City residents are especially well positioned to benefit from all this growth. But how exactly? What jobs are available? What kind of training is needed, and what’s the nature of the work?

To find out, we took a look at several jobs where demand is high and opportunities are many.

Certified Registered Nurse Anesthetist

The goal of a certified registered nurse anesthetist (CRNA) is simple enough: to ease patients’ pain. But tending to patients in a wide variety of circumstances is anything but simple, says Kim Lanfranca, the chief CRNA in the anesthesiology department at NYU’s Langone Medical Center.

“It’s never the same thing, even if it’s the same type of surgery. It’s different patients, different meds — there’s lots of critical thinking in this specialty,” she says. “It keeps you on your toes!”

Like an anesthesiologist, a CRNA administers anesthesia to patients who are undergoing surgery, receiving pain-management treatment or having babies.

“Working in the OR, we’re doing everything an anesthesiologist does,” says Lanfranca. “Like interviewing patients. Anesthesia is a scary thing for some people. This is the nursing side for me — I like to develop the trust. That’s what we’re there for.”

Lanfranca isn’t alone in liking her job — in a recent survey by the American Association of Nurse Anesthetists (AANA), more than 94 percent of respondents reported a high degree of job satisfaction.

Salary could figure into that: CRNAs are the highest paid nursing specialists today, with a median salary in New York City over $170,000.

And with a 12.8 percent job vacancy rate, there’s no shortage of work, says AANA president Jackie Rowles.

“The job outlook is still very good, because a CRNA can fill an anesthetist slot” for far less money, explained Rowles.

CRNAs work in hospitals, surgical centers, physician and dental offices — anywhere anesthesia is administered.

Becoming a CRNA requires a four-year nursing degree, at least a year of experience in an acute care setting and a graduate degree in nurse anesthesia, which typically takes two to three years to complete. (In the New York area, there are two such programs, at SUNY Health Science Center in Brooklyn and at Columbia University.) After graduating, CRNAs must pass a national certification exam, and meet recertification requirements every two years.

Hours can be long. Lanfranca works three 13-hour shifts a week, starting at 7 a.m. and going until 8 p.m. And dealing with patients in crisis can be harrowing.

“Everything’s peaches and cream when it’s an easy day, with healthy patients,” says Lanfranca. “But sometimes it’s extremely sick patients on the verge of death, or a complicated surgery where they’re losing blood, and you’re praying they’re going to come through alive.”

But therein lies the rewards as well as the challenges, she says.

“If the outcome is positive — and for the most part it is — to know you had a part in maintaining that person’s life is an amazing thing.”

Physician Assistant

Jason McGrade credits his mom — a nurse — for introducing him to his life’s calling.

“One of my first jobs was when I was 18 or 19,” says McGrade, who’s now 33 and the associate chief physician assistant in cardiothoracic surgery at Lenox Hill Hospital. “My mom helped me get a job in a hospital doing secretarial work, and I was exposed to what physician assistants do.”

What a physician assistant (PA) does is practice medicine under the general supervision of a doctor. PAs have greater autonomy than nurses, who usually care for patients according to a doctor-prescribed plan of treatment. They can examine and diagnose patients, assist in surgery, read X-rays, write prescriptions and perform many medical procedures, from bandaging fingers to closing surgical incisions.

Given the level of responsibility, training is rigorous. An aspiring PA must have an undergraduate degree, usually in a science- or health-related field, and then complete an accredited program, which typically takes two to three years. To practice, one must pass national board exams and apply for a state license. The median salary locally is approximately $95,000.

Opportunities for PAs have expanded dramatically over the last several years, says Larry Herman, director of admissions for the physician assistant program at New York Institute of Technology, one of a handful of schools offering such programs locally. (Others include Weill Cornell Medical College, and Pace and Stony Brook Universities.)

“We have graduates working in cardiothoracic surgery, orthopedics, pediatric endocrinology and forensics, and increasingly in specialties,” says Herman, whose program boasts a 100 percent job-placement rate. “Nowadays, PAs are pretty much everywhere.”

In a medical office, the PA’s skills allow the physician to concentrate on more demanding cases. In the operating room, the PA brings a trained set of hands to difficult procedures. In a rural or underserved community, the PA may provide desperately needed primary or emergency care.

McGrade’s daily duties include 6:30 a.m. rounds in the cardiothoracic ICU. At 7:30, he’s off to the operating room. During a typical bypass surgery, the surgeon may be opening the heart while McGrade is harvesting a vein from the leg. After the operation, McGrade may help sew up the chest and then take the patient back to the ICU.

“I love the challenge of seeing people who are so acutely sick get better,” he says. “I still wake up every day and wonder that they pay me to do this.”

Health Information Manager

After graduating from high school, Ericka Perez wanted a career more rewarding than her job as a cashier at a restaurant.

“My friend told me about her job as a medical assistant and said, ‘Why don’t you try it?,'” says the Queens resident.

Perez tried it, liked it, and went on to earn an associate’s degree as a medical assistant and take a job at a billing company. Then she became intrigued by what the billers at her firm were doing, and ended up in school again, taking medical-coding classes at Long Island University.

Today she’s a medical coder at the New York Eye and Ear Infirmary, taking diagnoses from doctors’ charts and translating them into the correct computer medical codes.

As such, Perez is one of a growing number of people working in health information management. The field — which is expected to grow even further due to $19 billion federal stimulus money for investment in electronic health records — offers a wide-open career path for those who have a good eye for detail and “would like to get into health care, but prefer not to have direct patient contact,” says Patt Peterson of the American Health Information Management Association.

The most basic requirements for working in the field are a high school diploma and a one-year certificate in medical coding, which is taught at many local schools. Higher-level professional certifications include Registered Health Information Technician (RHIT), which requires a two-year associate’s degree, and Registered Health Information Management Administrator (RHIA), which calls for a four-year bachelor’s degree. There are also master’s RHIA programs available.

In New York City, those with RHIA certification can expect to earn between $45,000 and $75,000 with a bachelor’s degree, and up to $100,000 with a master’s.

Michele Bohley, director of health advisory services for PricewaterhouseCooper’s health-care division, started as a medical coder but went back to college for a bachelor’s degree in health information management.

Now Bohley works with software developers on computer systems that reduce the risk of fraud in hospital coding. She travels widely, conducting training sessions in hospitals and medical offices. Other health information managers may specialize in areas such as electronic medical records, data analysis and risk management.

“People see us as paper pushers, but there are so many opportunities, it’s incredible,” says Bohley.

Genetic counselor

As our understanding of the role genetics plays in disease grows, so does the need for genetic counselors.

A unique combination of scientist and psychologist, genetic counselors help clients assess their risk for certain conditions, providing information, discussing testing options and offering referrals to specialists and other resources.

“Our job is to give people the tools to understand what tests are available and to understand the risks, benefits and limitations of each test,” said Steven Keiles, president of the National Society of Genetic Counselors.

That can mean helping people navigate some difficult situations, which means good counseling skills are important.

“It’s a good field if you like to interact and help people,” says Keiles.

That’s what drew Laura Carpiniello to the field, after a short stint in a genetics lab as a researcher. She enrolled in the master’s in genetics program at Sarah Lawrence College, one of two board-approved area programs in genetics counseling (the other is at Mount Sinai School of Medicine). After completing the two-year program, she had to pass a national board certification exam.

Today, as a counselor at NYU School of Medicine’s Human Genetics Program, Carpiniello helps clients determine their risk for certain types of cancer by looking at a three-generation family history. She then discusses the risks, benefits and limitations of genetic testing with clients, looking at possible management measures such as increased screenings.

She’s also involved in outreach programs, such as a screening program for college students of Ashkenazi Jewish ancestry.

“It’s something different every day,” she says.

She and her colleagues won’t be lacking in work anytime soon. As the number of genetic tests grows, the field is expected to grow significantly in the coming years, according to Keiles. And wages are good: genetic counselors in New York City earn a median salary of about $70,000.

The job isn’t without difficult moments, says Carpiniello.

“Having to give bad news — that never gets easy, no matter how many times you do it.”

But overall, Carpiniello finds genetic counseling a field with myriad opportunities, especially given the number of local research hospitals.

“There’s really room for growth in genetics, and that’s exciting,” she says. “I feel like the possibilities are endless.”