Physical Therapist

physical therapy ranked highest in job satisfaction, according to a survey conducted by the National Opinion Research Center at the University of Chicago. More than three quarters of physical therapists reported being "very satisfied" with their occupation. In a similar survey by the Wall Street Journal's Career Journal, physical therapy rated one of the eight best careers.

And it's easy to understand why:

•You're a one-on-one coach, a role that many people enjoy. It's a bit like a fitness coach but with more skills and you're helping people with more acute problems.

•You usually see real progress. For example, it's touching to see a patient, who came in on a stretcher or in a wheelchair, walk out at the end of treatment.

•Unlike physicians, who often are restricted to 12-minute appointments, you typically see a patient for an hour.

•You have considerable autonomy in how to solve problems, yet, unlike in self-employment, you can get a steady and pretty good paycheck.

•There's variety: Most physical therapists are generalists. You might treat, for example, a brain-injured child, a football player who broke his arm, an Iraq War veteran amputee, and an aged stroke patient.

•You can choose from a wide range of work settings, notably hospitals, physical therapy clinics, schools, physicians' offices, and patients' homes.

•Unlike many other health professionals who must work nights and weekends, you usually have normal work hours.

•Despite increased use of lower-cost physical therapy assistants, the job market for physical therapists is projected to remain strong as the baby boomers are reaching the age where they get more weekend-warrior athlete injuries and more serious problems.

Like all careers, physical therapy has downsides:

•This career is physically demanding. All day, you're moving patients around, demonstrating exercises, and so on. That's a plus for some people and a minus for others who might prefer a desk job. It's not uncommon to leave work with sore muscles.

•Burnout risk. Many of your patients will be newly disabled, in pain, progressing slowly, and/or frustrated by the painful exercises you prescribe. That can take a toll on you.

•Training requirements have been ratcheted up. Not long ago, a bachelor's degree would do. Now, a master's is the minimum, with a three-year doctor of physical therapy increasingly the norm.

Nevertheless, if you're a science- and helping-oriented person, fascinated with the human body, and have an optimistic personality, a physical therapy career may heal your career pains.

Optometrist

Optometrist. Ophthalmologist. Optician. Many people confuse them, but a career as an optometrist offers unmistakable advantages. Optometrists on average earn more than twice as much as opticians (the people who grind lenses and fit you for glasses). And optometrists get to do most of what ophthalmologists do, without the medical degree: diagnose and treat eye diseases, perform minor surgery (in some states), and of course fit people for glasses and contact lenses. Yet the required training is years shorter than it is for an ophthalmologist: a four-year, post-bachelor's program

With so many aging boomers in need of vision care, the job prospects are strong. Laser surgery that corrects vision problems has slightly diminished demand for optometrists, but in the future that's likely to be outweighed by demographic trends and other factors. There's also a lot of satisfaction in this career, since most vision problems can be corrected with lenses or relatively minor surgery.

Because the job is so appealing, it can be tough to land a spot in optometry school. Most optometrists are self-employed, so it helps if you have an entrepreneurial bent and a knack for smart marketing approaches, like conducting free vision screenings in shopping malls.

Smart Specialty

Pediatric optometry. The eye problems of children are generally among the most remediable. And the American Optometric Association projects high growth in this niche.

Occupational Therapist

We take for granted our ability to button a shirt, use a computer, or drive a car. But many people—injured adults, children born with disabilities, elders beset by aging—cannot assume those skills. The occupational therapist helps such people live as fully and independently as possible. Thirty percent of OTs work in schools, helping, for example, autistic kids learn how to interact with other children. The majority of OTs work in hospitals or visit patients in their homes.

Most older adults wish to remain in their homes as long as possible, so OTs often help elders avoid long-term-care facilities. An OT might, for example, recommend a robot that can climb stairs to retrieve needed items, help develop workarounds that enable stroke patients to feed themselves, or suggest memory aids and computer programs to help an Alzheimer's patient. This is a challenging career that's best for creative, practical people who find satisfaction in small successes.

Smart Specialty


OT Consultant. As people age, their reaction time, night vision, and peripheral vision decline. A person might hire an OT consultant to assess an aging parent's driving and perhaps offer training or recommend devices to help keep him safely behind the wheel. Some OT consultants may never see a patient. For example, a real-estate developer might hire an OT to assist in designing a senior housing development.

Registered Nurse

Smart Specialties


Nurse practitioner. Like a physician's assistant, you'll typically provide most of the direct patient care normally handled by a physician. Training is shorter than for physicians, there's less paperwork, and you're likely to work with healthier patients—which means a high success rate.

Nurse anesthetist. With anesthesiologists often earning $300,000 a year, healthcare providers are increasingly looking to nurse anesthetists to lower costs. You're usually the last person to see a patient before surgery and help ensure a pain-free surgery and after-surgery experience. The job can be stressful, but the high demand (especially in rural and inner-city hospitals ), high pay (average is well over $100,000), and high psychological reward make this a smart specialty indeed.

There's great unmet demand for nurses, and you'll have lots of options. If you want to work directly with patients, you can specialize in everything from neonatology to hospice care. You can work in a hospital, a doctor's office, or a patient's home. Outside of patient care, options range from nurse informatics (helping nurses get access to computerized information) to legal nurse consulting (helping lawyers assess a claim's validity.)

On the downside, many registered nurses must work nights and weekends, and burnout is a factor, especially in medical/surgical wards, and in critical-care specialties such as surgery, oncology, and emergency medicine. There are potential hazards, too: exposure to people with communicable diseases and back injuries from moving patients.

Something to think about: Studies report large numbers of errors by healthcare providers that endanger or kill patients. This is a career for people who are both caring and extremely attentive to detail—even when stressed

Engineer

How would you like to design the next-generation iPhone? A more energy-efficient air conditioner? Or software that would more quickly decode a person's genome? If you're an inveterate tinkerer, with enough math and science ability to survive a five-to-six-year engineering or computer science bachelor's degree, engineering could be your calling. Turnover is very low, although twice as many women as men leave the profession. And there's strong demand for engineers, who are among the highest-paid bachelor's-level professionals.

One trend to keep an eye on: Employers are offshoring ever more lower-skill engineering work to low-cost countries like India and China, where thousands of bright engineers are willing to work for a fraction of the going rate in the United States. While the job market for many engineering specialties will be strong in the private sector, as in many fields, the most secure jobs will be in the government.

A Day in the Life. On your computer, you draft a design for a valve for an improved artificial heart, running simulations of how well different materials would work. You then work with a model maker at your medical device company, who will create a prototype of your design. Meanwhile, a fellow engineer is devising a machine to test your prototype. Once the prototype has been tested, you'll meet with your boss and three other engineers—each of whom developed a different prototype valve. You'll discuss the advantages and disadvantages of each, so you can settle on one that incorporates the best features of all three.

Biomedical Equipment Technician

Imagine you're in a hospital bed, hooked up to a heart monitor and a ventilator. Those machines had better be working properly. Fortunately, they almost always are. Whom do you thank? A biomedical equipment tech.

This is one of the few health careers in which you are key to helping patients recover yet there's (usually) no blood or gore. Biomed techs enjoy other pluses, too. You're not limited to repairing stuff: You install, train, calibrate, and perform maintenance. And you're always working on new, ever better equipment such as combined PET/CT scanners and robotic radiosurgery units, which irradiate a tumor but not the surrounding cells. Only a two-year degree is required, and the job market is terrific—you're unlikely to ever hear the word "layoff." This career is resistant to off-shoring, although some state-of-the-art machines allow remote diagnostics, so if a Texas MRI machine breaks down in the middle of the night, a tech in Indiana or India can figure out what's wrong.

This career's main downside is periodic stress. If that heart-lung machine stops working in the middle of a bypass operation, you'd better fix it now. Of course, if you do save the day, you are a true hero. A more significant downside is that biomed techs increasingly need aptitude both for fixing equipment and for tweaking the computers embedded in leading-edge machines, like an automatic infusion pump that can say, "No. That's too big a dose." Ever more knowledge of computer hardware, software, and networking is required.

Another downside is that perhaps one week a month, you'll be on 24-hour call—that patient on the heart-lung machine can't wait until the morning. Fortunately, you're likely to be called in only once or twice a week.

Next time you're visiting someone in the hospital and hear those lifesaving beeps and alarms, think about whether you just want to be grateful to a biomed tech or become one.

Day in the Life. The way the day started, you would never have guessed that this would be one of your most stressful days ever. You arrive at the community hospital that employs you and start on routine maintenance of EKG, ultrasound, and defibrillator machines, and you recalibrate a laser scalpel.

You're interrupted by an emergency page to a patient room—the ventilator isn't working properly. Worse, the hospital's other ventilators are all in use. You race in to check the machine's components: Yes, it's dispensing the oxygen at the proper rate, but you discover that the depth of the "respiration" is too low. Fortunately, the problem is just that a rubber tube came loose. You fix it, and the patient begins breathing normally again.

You're relieved that your next task is to help the manufacturer's field rep install your hospital's second CT scanner. Cool—the new machine is a real improvement over the old one. But the calm doesn't last long. You receive a distress call from a temporary nurse who doesn't understand how to get the new patient monitor to retrieve the needed information. You train her, as a few other nurses look on.

Surgery calls to tell you that the voice-controlled surgical table won't lift the patient's legs up. Lucky again, it's simply a dead battery in the voice-control module.

Finally, you want to give yourself a reward, so, rather than going back to the routine maintenance you started your day with, you tackle repairing the hospital's X-ray film processor. You tinker with it: no luck. You peruse the manual: no luck. But fortunately, there's no rush with this; X-ray film processors aren't used much in today's era of digital radiography. It can wait until tomorrow.

The future of audiology is safe.

Hearing care will never go the route of "entirely implant." Cochlear implants are only a viable option for a very small percentage of persons with hearing loss. Could you imagine having a mild hearing loss and someone telling you that a surgical prosthesis must be implanted into your skull as treatment? Ridiculous.

Also, for the person with a cochlear implant the audiologist plays a vital role in the follow-up and care of. In its rudimentary form, the C.I. is a surgically implanted hearing aid. It still relies on electrical signals and modified settings for the end-user that must be performed by an audiologist.

Audiology survived through the 70's when legislation would not allow practicing audiologists to dispense hearing aids. Regardless of hearing aid technology, hearing aid users will always require management and care, especially among the elderly and those with hearing losses of greater severity. I truly believe that at the present time legislation that allows hearing aid dispensers with no formal education to play a role in hearing management is what really holds the profession back. There are just too many unqualified "professionals" making vital decisions on client care.

They only situation that could truly put the profession of audiology at risk is hair cell regeneration in the cochlea. At the present time this technology looks to be several decades, if even in our lifetimes, away.

The field is dynamic and changing (for the better). There is a good outlook for the career of an audiologist.

Audiologist

Overview. One-on-one helping careers are among the most pleasant. And this one offers the promise that over your career, the tools to help patients will get better and better. Already, today's computer-controlled hearing aids are more effective and enjoyable than traditional ones. America's most famous user: Bill Clinton. Another plus for this profession is that you'll often get out of the office. You might spend part of your day in a hospital clinic, part in a school, and part at a hearing aid store. If you're bright and ambitious, you might even be on a research team developing the next generation of hearing aids.

Yet another advantage is that audiology is an under-the-radar career—few people consider it, so competition isn't as keen as it might be. You'd think demand for audiologists would be rapidly increasing, with all the aging boomers and the increased special-education testing of children. But increasingly, lower-salaried ear technicians do much of what audiologists do. So, job growth in this small profession (13,000 people nationwide) is expected to be just average. The education requirement isn't, however: Now, a doctor of audiology degree is required.

A Day in the Life. Your first patient is a severely deaf child who has just been fitted with a surgically implanted cochlear implant, a device that bypasses the ear and sends signals directly to the auditory nerve. Your job is to optimize the device for the child's needs and train the child how to interpret the sounds—they're different from sounds heard by the ear. Your second patient is an 80-year-old having trouble retaining his balance. You examine him and provide an analysis that will help his physician determine the cause. Most of your patients, though, are children and older adults with limited hearing loss. You counsel them about hearing aids and in some cases deliver the good news that the only treatment required is removing their excess earwax.