What does the future hold?
A typical adult devotes over 25 percent of his/her life between the ages of 25 and 65 to work. The decision how to spend that time is critical to one's quality of life and economic well-being.
How does a person make the "right" career decision, one that enhances the quality of a complete adult work life, ensures continuing growth and challenge, and provides sufficient economic reinforcement to live comfortably? The first step in making an informed career decision is to learn about career options. According to Tofler (1990):
"Knowledge itself turns out to be not only the source of the highest-quality power, but also the most important ingredient of force and wealth. Put differently, knowledge has gone from being an adjunct of money power and muscle power to being the very essence of power. It is, in fact, the ultimate amplifier" (p. 18).
The choice of a career must be based on knowledge of the environment, knowledge of the occupational options, knowledge of self, the conviction to make an informed decision, and the flexibility to change.
The focus of this paper is to aid you in developing a personal flamework for making a knowledgeable career decision. Sargent and Pfleeger (1990) indicate that people "who carefully select their career objectives, acquire the most appropriate academic preparation, are most adept at locating job openings, and market their abilities will enjoy the smoothest transition from school to work" (p. 8).
If a person is creative, energetic, caring, dependable, flexible, and willing to learn about the diversity of human experience, a career in rehabilitation may be an exciting option. However, to determine the specific focus of this career requires a knowledge of employment options, sufficient academic preparation and a realistic self-appraisal.
The Rehabilitation Environment
The world of work is changing dramatically. Johnston and Packer (1987) anticipate five major shifts in the 1990's. These workplace changes will have major implications for the rehabilitation professional in the decade of the 1990's:
* The workforce will grow more slowly than at any time since the 1930's.
* The average age of those in the workforce will rise, and the pool of young workers entering the labor market will shrink.
* More women will enter the workforce.
* Minorities will be a larger share of new entrants into the labor force.
* Immigrants will represent the largest increase in the workforce since World War I.
Staffing patterns will also change in the 1990's. Brand (1990) described six factors which underlie changes in future staffing patterns. These are: (1) trends in law, law enforcement, and government regulations; (2) changes in the way medical care is provided; (3) demographic trends; (4) increases in research and development expenditures; (5) changes in business practices; and (6) the growing use of computers and other automation and technological change (p. 41).
Johnston and Packer's changing worker characteristics and Brand's six factors which will impact staffing patterns serve as a useful basis for examining careers in rehabilitation.
Trends in law, law enforcement, and government regulations. The reauthorization of the Individuals With Disabilities Education Act (IDEA) and the Rehabilitation Act of 1973, as amended, will insure continued federal support of public programs serving children and adults with disabilities. Of special importance is the implementation of federal initiatives from the Rehabilitation Act. Rehabilitation services are provided through a state-federal partnership. Education and research are initiated by the Rehabilitation Services Administration and the National Institute on Disability and Rehabilitation Research. Services in independent living, employment, transition from school to work, and advocacy for client rights are all integral elements of this legislation. The enactment of the Americans with Disabilities Act (ADA) in 1990 will dramatically affect current discriminatory practices in employment, transportation, public accommodations, and telecommunications.
With each of these federal legislative mandates, there is an increased need for qualified rehabilitation personnel to provide services, work as advocates, and to develop, implement, and manage service delivery approaches to meet the needs of people with disabilities.
Changes in medical care delivery. In 1990, the Department of Commerce indicated the "expenditures on health care in the U.S. are expected... to increase 10 to 14 percent annually during the next five years" (p. 49-1). These increases will be in nursing home care and related care homes(1) and home health care in addition to traditional acute care hospitals. It is inevitable that future health care planning and legislation will focus on service models that promote cost containment, the expansion of preventive approaches to health care, and the expansion of communitybased services. In the allied health and social service sectors, the Department of Labor (1988) indicated social service agencies (individual and family counseling, adult day care, senior citizen centers, group homes, halfway homes, and rehabilitation centers) will grow at a real annual rate of 3 percent through the year 2000. The general population will continue to demand effective and efficient medical, allied health, and social services. The focus of this demand will be the need for quality service providers and services delivered in a cost-effective and community-based approach.
Demographic trends of the population are rapidly changing. The Bureau of the Census (Spencer, 1989) in identifying the following "high-risk groups" for work-related disability, indicates target populations for rehabilitation services(2):
* workers age 45-64;
* workers with fewer than 8 years of school (which constitute 29.7 percent of the "high-risk group" category);
* workers with exactly 8 years of school (24.6 percent of those in high-risk groups);
* workers attaining 12th grade or less (17.7 percent); and
* African-American workers (13.7 percent).
Another important demographic trend is aging. The national mean age by the end of the decade will be approaching 40. Spencer (1989) indicated that "at present 9.6 percent of those in the 65-and-over group are 85 and above. This percentage will grow steadily to 15.5 percent in 2010..." (p. 9). Similar increases will be seen in all age groups over 40. In rehabilitation there will be a significant turnover of service providers, supervisors, administrators, and educators by the end of the decade. There will be an increase of people from all ethnic groups with a significant increase of those of Hispanic heritage. In rehabilitation there will be increased consumer participation in planning and initiating rehabilitation services. The continued trend toward deinstitutionalization will increase the demand for community-based services. The latter trend will be precipitated by strained government budgets and increasing consumer demands. Thus, demographic characteristics of people receiving, providing, and administering rehabilitation will experience significant changes in the future.
Increases in research and development expenditures. Medical research is having a dramatic impact on the delivery of rehabilitation services. Recent innovations are saving people with heretofore inoperable diseases and catastrophic injuries. People with heart disease, spinal cord injuries, acquired brain injuries, and AIDS are receiving rehabilitation. Many of these were not previously involved in rehabilitation services. Treatment approaches for those with substance abuse, emotional and psychiatric disorders, and behavioral problems are expanding the repertoire of rehabilitation services. The increasing sophistication of research and development efforts in medicine, allied health and human services is and will continue to have a dramatic impact on rehabilitation service delivery. These innovations will add to the longevity of the population and an expanded continuum of care.
Changes in business practices. The interface between business and rehabilitation is becoming stronger. The changes in worker's compensation, expansion of employee assistance programs and wellness centers, job restructuring, and ergonomics are current examples of this interface. The implementation of ADA and the Amendments to the Rehabilitation Act have increased the awareness of business and industry about rehabilitation services.
Management is moving toward employee empowerment. Murphy (1988) indicated that the organizational leader of the future must develop a shared vision, ask questions, cope with weaknesses, listen and acknowledge, depend on others, and let go. Both the employee and the employer of the future will have an increased awareness about the quality of one's work life.
Business is becoming increasingly complex. Reduced management levels are forcing businesses to identify discrete cost centers, share resources, develop cooperative ventures, expand education and training, and continually balance quality and efficiency demands. Jacobs (1989) emphasized the need for qualified personnel when he indicated that: "... the diagnosis of the (issues) of business eventually comes around to the issue of worker education and training. Employing new technologies depends on the know-how of the people who use them" (p. 66).
The business of rehabilitation is no exception. Annually, billions of dollars are expended in the rehabilitation industry. Human capital is the most important resource (Agor, 1989). In many rehabilitation organizations, the costs for administrative staff, service providers, and support personnel exceed 70 percent of the annual operating costs. Quality rehabilitation is a labor intensive human services program. The business of rehabilitation, by its very definition, is labor intensive and requires constant attention to sound practices of leadership, management, and supervision.
The growing use of computers and other automation and technological change. The 17th Institute on Rehabilitation Issues (1991) indicated that current technological advances are facilitating independence and a higher quality of life for people with disabilities. The technological opportunities for independence in all aspects of one's life are expanding the options for all people with disabilities. Adaptations in the home, community, and work place are expanding the accessibility for people with disabilities. Further, the use of automation for rehabilitation personnel will dramatically improve the timeliness of services and change the roles and responsibilities of the rehabilitation service providers, support personnel, and administrative personnel in the actual delivery of rehabilitation services.
Each of these six shifts in staffing patterns and work environments will have a significant impact on careers in rehabilitation. Each of these six shifts are interrelated. Each of these shifts will impact the current and future delivery of rehabilitation services. Each of these shifts will influence the academic preparation of future rehabilitation professionals. And, ultimately, each will impact the quality of rehabilitation services for people with disabilities. All of these shifts will also impact upon each person who chooses a career in rehabilitation.
Knowledge of Occupational Options and Opportunities
When considering the rehabilitation environment over the course of the next 20 to 30 years, the occupational options and opportunities become increasingly diverse. For a person contemplating a career in rehabilitation there must be an understanding of the factors which are significant. These factors may include such characteristics as the degrees of autonomy, flexibility, client contact, security, leadership, entrepreneurial opportunities, and personal and professional development.
Generally, the occupational options in rehabilitation will involve employment in the public sector (local, state, or federal government), in community-based programs through nonprofit or proprietary organizations, in education, and in business/industry. These employment organizations offer a wealth of options. Within these options, consideration might be given to acute care treatment in traditional medical settings, rehabilitation programs for both in- and outpatient services, the state-federal program of rehabilitation, and community-based programs focusing on specializations such as occupational therapy, physical therapy rehabilitation engineering, prosthetics and orthotics, rehabilitation counseling, and independent living. Educational settings provide opportunities for teaching, counseling, and administration. Expanded career opportunities are available in the business and industry community working in programs such as wellness, employee assistance, personnel, training, and human resources.
A guide for those pursuing a career in rehabilitation and examining employment organizations is presented in the illustration. This is not meant to be an exclusive analysis; however, it serves as a general guideline for a person considering occupational options and employment organizations. When one examines occupational options, he/she must consider the organizational setting which is most conducive to his/her professional and personal needs and expectations.
Your Personal Framework: The Most Important Factor
The most critical aspect of choosing a career in rehabilitation, or choosing a career in any occupation, rests with one's personal characteristics. There are essential personal qualities that must be considered when choosing a career in rehabilitation.
First, one must have a commitment to people and a belief in their inherent positive characteristics. The field of rehabilitation, regardless of setting, services, or position title, exposes each service provider to the full spectrum of individual needs, wants, and expectations. Disability is not specific to socio-economic groups. Disabling conditions will impact the majority of people in society, either directly or through a significant other or family member. In working in the field of rehabilitation one encounters people of all ages, both genders, and every economic status and ethnic group. A person must be willing to work with clients from diverse population groups.
Second, an aspirant to a career in this field should not expect his or her greatest rewards to be financial. Sufficient economic rewards are available and probable, but for purely economic reasons other careers may be more desirable.
These a priori qualities cross the occupational options in rehabilitation. When considering a career in rehabilitation, one must complete a critical analysis of his/her personal and professional expectations. Rehabilitation encourages independent thinking, flexibility, and innovation. Rehabilitation requires continuous learning. In choosing a career in rehabilitation, a person is making a decision to pursue lifelong learning in order to remain current, relevant, and effective. Quality and productivity are required simultaneously. Quality in services is an essential element in rehabilitation. Productivity, as a measure of performance, is essential. As economic resources remain finite and human needs geometrically expand, productivity and efficiency will continue to be critical. The balance between quality and productivity is an inherent factor within rehabilitation and an expectation of all rehabilitation personnel.
The provision of services in rehabilitation must be based on both information and intuition. The balance of information with intuition and personal caring is the essence of the rehabilitation relationship. A person choosing a career in rehabilitation must be committed to flexibility and working effectively with a client to assist in modifying his/her environment to maximize individual independence and abilities. The ability to establish and maintain a one-to-one relationship as a service provider, supervisor, or administrator is essential. Active participation in work groups (i.e., patient treatment teams, support services, transition planning, employment planning, etc.) is equally critical. The ability to work cooperatively among organizational units of rehabilitation services with consumers and other professionals is an inherent requirement for a rehabilitation professional. The interdependence of disciplines within rehabilitation mandates cooperation and integration. The concept of understanding transferability of skills across independent living and occupational settings is increasingly critical. The relationship of each of these factors to rehabilitation service delivery is extremely important.
Finally, when examining a career in rehabilitation, one must demonstrate a positive philosophy of the human condition, a set of professional values, ethical principles, a knowledge of human conditions, a knowledge of community and work expectations, and an effective grounding in inquiry skills that reflect quantitative and qualitative investigation. In essence, the person entering a career in rehabilitation must be inherently inquisitive, willing to take risks, able to provide services based on accepted ethical principles, and demonstrate a commitment to improving the quality of life for each client.
There are many occupational specializations within the field of rehabilitation. Each contains the inherent characteristics cited above, regardless of the chosen occupation. These specializations include rehabilitation medical services such as rehabilitation medicine and the allied health services such as occupational therapy, physical therapy, speech pathology and audiology, and prosthetics and orthotics. Other specializations include rehabilitation engineering, independent living, orientation and mobility instruction, interpreter training for people with hearing impairments, and vocational evaluation. In the field of rehabilitation counseling there are specializations such as deafness, blindness, mental health, and alcohol and drug abuse.
Each person must make a career decision that relates to his/her own personal and professional expectations. The field of rehabilitation is entering an age of tremendous growth and development. What was once a specialized area of human and social services has expanded into the mainstream of society. Current legislation, future advances in technologies and medical services, an aging population, and other innovations which have not even been conceptualized will provide an exciting array of options.
Because a career decision impacts a person's entire adult life and, ultimately, the quality of that life, choosing a career is a critical decision. The field of rehabilitation is challenging and demanding. It presents professional and personal demands. The rewards of a career in rehabilitation are extrinsic and intrinsic. A career in a rehabilitation discipline requires continuous learning and development. The essence of a career in rehabilitation is the willingness to understand and acknowledge individual diversity and support individual change from dependence to independence.
1. The Department of Commerce (1990) considered related care homes as nursing homes, skilled care facilities for chronically disabled and developmentally disabled and/or longterm nursing (49-4).
2. These indicators are related to the work site and job responsibilities, not necessarily individual demographic characteristics.
Agor, W. (1989, November-December). Intuition and strategic planning. The Futurist 23(6), 20-23.
Brand, L. (1990). Occupational staffing patterns within industries through the year 2000. Occupational Outlook Quarterly, 34(2), 40-52.
Jacobs, J. (1989, August-September). Training the workforce of the future. Technology Review, 92(6), 66-72.
Johnston, W., & Packer, A. (1987). Workforce 2000: Work and workers for the twenty-first century. Indianapolis: Hudson Institute.
Murphy, J., (1988). The unheroic side of leadership: Notes from the swamp. Phi Delta Kappan.
Sargent, J., & Pfleeger, J. (1990). The job outlook for college graduates to the year 2000: A 1990 update. Occupational Outlook Quarterly, 34 (2), 2-9.
17th Institute on Rehabilitation Issues. (1991). Assistive technology: Planning for the future. University of Arkansas.
Spencer, G. (1989). Projections of the population of the United States by age, sex, and race: 1988 to 2080. Bureau of the Census, U.S. Department of Commerce.
Tofler, A. (1990). Powershift: Knowledge, wealth, and violence at the edge of the 21st century. New York: Bantam Books.
U.S. Department of Commerce. (1990, January). 1990 U.S. Industrial Outlook.
U.S. Department of Labor. (1988, March )Projections 2000.
Dr. McFarlane is a professor and Chairperson for the Department of Administration, Rehabilitation and Postsecondary Education at San Diego State University (SDSU). A professor in Rehabilitation Counseling at SDSU since 1972, Dr. McFarlane has been involved in pre-service and continuing education efforts in rehabilitation as a planner, educator, researcher, and administrator. He has served as principle investigator on various rehabilitation grants, contracts and services since 1972. His special areas of interest include leadership, management and assessment. TABULAR DATA OMITTED