This industry consists of establishments of health care practitioners engaged in the practice of health fields not elsewhere classified. Practitioners may or may not be licensed or certified, depending on the state in which they practice. Establishments operating as clinics of health practitioners, not elsewhere classified, are included in this industry. Specific health care practitioners included in this industry include: acupuncturists (except M.D.s), audiologists, Christian Science practitioners, dental hygienists, hypnotists, respiratory therapists, midwives, naturopaths, nurses (except home health service nurses), nutritionists, occupational therapists, paramedics, physical therapists, physician's assistants, psychiatric social workers, clinical psychologists, psychotherapists (except M.D.s), speech clinicians, and speech pathologists.
Offices of Mental Health Practitioners (except Physicians)
Offices of Physical, Occupational, and Speech Therapists and Audiologists
Offices of All Other Miscellaneous Health Practitioners
The offices and clinics of health care providers in this industry are characterized by their contrast and competition with offices and clinics of medical doctors. In America, many sectors of this industry have not enjoyed the public acceptance given to medical doctors. As a whole, this industry has become more accepted during the latter part of the twentieth century as a result of various social and economic factors.
This industry earns income from the tens of thousands of health providers in private practice who are either self-employed or employed through health maintenance organizations (HMOs).
Since the mid 1980s, the "graying" of America has helped to fuel the growth of offices and clinics of respiratory therapists, physical therapists, and nurses, with a substantial number employed by home health care services.
In 2005 the overall industry reported 77,763 offices and clinics of practitioners, employing 292,573 medical professionals and posting revenues of $11.8 billion, while the 17,813 offices and clinics of practitioners sector generated more than $1.9 billion in revenues, with a workforce of 50,313 people.
Offices and clinics in this industry belong to either hospitals, where the practitioners may be employed by the hospital, or those that work independently of hospitals. Occupational and physical therapists, psychologists, and acupuncturists often work, to some extent, with hospitals. Occupational and physical therapists are frequently employed by general and rehabilitation hospitals, and many psychotherapists work at psychiatric hospitals treating the mentally ill.
Unlike the offices of medical doctors and dentists, establishments in this industry do not rely on payments made through insurance companies or government programs like Medicare and Medicaid as their main source of income. However, occupational and physical therapists receive the largest portion of their incomes from employee compensation plans. Practitioners in this industry use referral services, such as those of profession associations, as a tool to ensure a steady flow of self-funded patients.
Common to the background of many of the professions represented by this industry, such as acupuncturists, is their long global history. Many of these practices, however, have gained acceptance in the United States only during the twentieth century. Another common feature of these professions has been their rapid growth since the 1970s, when "natural" and Eastern medicine gained popularity; at the same time, the rising costs of traditional health care spurred patients to seek new approaches to health care.
Acupuncture is a system of medicine that uses needles on nerve and "energy" points to cure disease and modify certain behaviors. Developed in ancient China, acupuncture was not widely practiced in America, outside Chinese communities, until the 1960s. Today acupuncture and other forms of Oriental medicine are among the fastest growing segments of health care in America. According to the National Acupuncture and Oriental Medicine Alliance, at the end of the 1990s some thirty-eight states and the District of Columbia had recognized the practice of acupuncture, and legislation had been introduced in eight additional states. The number of licensed acupuncturists in the United States rose from 5,525 in 1992 to 10,512 in 1998. Nearly all full-time acupuncturists in the United States are self-employed. Others, mostly medical doctors, have been trained in acupuncture and use the technique mostly as a form of anesthesia.
Audiologists work in the diagnosis and treatment of hearing problems; in addition, these practitioners work in public health, providing instruction and counseling for the hard of hearing. This sector of the health care industry has grown steadily since the 1970s, in part because of a maturing patient base and in part because of technological advances that allow increasingly effective treatment of patients with hearing difficulties.
Speech-language pathologists treat and counsel people with communication disorders caused from hearing loss, brain injury, learning disability, mental retardation, or emotional problems. These practitioners are mostly self-employed and work at rehabilitation hospitals and clinics and out of private offices. In 1993, the American Speech-Language-Hearing Association reported that nearly 58,000 speech-language pathologists were established in the United States. In 1992, it was estimated that nearly 8 million Americans sought treatment from speech-language pathologists. Of those, more than 3 million were children undergoing therapy for speech impairments, primarily stuttering.
In 1997 there were about 87,000 speech-language pathologists and audiologists practicing in America. The median annual salary in 1997 for speech-language pathologists was $44,000 and $43,000 for audiologists. One half provided services in preschool, elementary, or secondary schools, or in colleges and universities; 10 percent worked in hospitals. Both of these fields are expected to grow because of the aging population and federal laws that guarantee special education for all eligible children.
These practitioners, in following the Christian Science faith, use spiritual healing to cure ailments. This form of healing, which relies on prayer and Bible reading, dates back to the start of the Christian Science religion, founded by Mary Baker Eddy in 1866. Throughout this profession's history, efforts have been made, mostly by governing bodies, to prohibit this form of health care; however, laws guaranteeing the right to religious practices have continually fought this opposition. Some states have passed laws specifically designed to protect the rights of this profession.
Nationally, this profession suffered negative publicity in the 1980s following several incidents where children died under the care of a Christian Science practitioner; in these cases, medical experts testified that the children would not have perished under the care of a medical doctor. These incidents were highlighted by legislation brought about in 1983 that drew the public's attention to spiritual healing. That year the federal government defined a parent's failure to provide medical care—which excludes spiritual healing—for a child as child neglect. Additionally, the government had the right to intervene if a parent's actions prohibited medical treatment. Consequently, the parents of children who died under the care of Christian Science practitioners faced criminal charges.
Most of these cases were dismissed on the basis of lack of due process, while another case was dismissed due to freedom of religion acts; other cases remain in the appeals system. In 1993, however, a...