Is anyone sad to see 2008 making its exit? I can't say I am, even though the year included some memorable moments; the Presidential election and the Olympics among them.

It also included, however, a fair share of what used to be called "downers." The economy was certainly the most conspicuous downer, but it had company-ongoing wars overseas, global warming and the usual array of natural disasters.

On the brighter side, a recently released study from the Centers for Disease Control showed a decline in cancer rates in the U.S. This is hopefully attributable at least in part to healthcare professionals encouraging patients to adopt more healthy behaviors, rather than to a drop in the number of people being screened.

From my perspective as a healthcare staffing professional, what I saw in 2008 was a job market in a holding pattern. Med Travelers conducts an annual survey of imaging department managers examining trends in temporary, i.e., traveling imaging technologist staffing. The survey, combined with other internal market data, indicates that the number of imaging departments using traveling technologists declined in 2008. As little as two years ago, 80 percent of imaging department managers we surveyed said their facilities had used traveling technologists sometime in the previous 12 months. That number decreased to 41 percent in 2007. Our 2008 numbers are not in yet, but a preliminary guesstimate suggests the number of imaging department managers reporting they used travelers this year will be no higher than it was last year.

A job market barometer

The market for traveling technologists is usually a good barometer of what is happening in the permanent technologist job market. Travelers are used in greater numbers as substitutes when permanent techs are hard to find. In 2008, the supply of permanent technologists was in relative balance with demand, so the use of travelers was essentially flat.

The lull in the imaging job market preceded the economic downturn of 2008, and I do not believe the recession was a major contributor to this year's soft employment picture. Nor do I believe that declining utilization of imaging services was to blame. The Deficit Reduction Act no doubt inhibited utilization in freestanding centers, but this was likely balanced by a corresponding increase in utilization at hospitals. According to a new study from the University of California, San Francisco research team, the use of CT and MRI nearly doubled over the last decade, rising from 260 to 478 tests per thousand patients. According to research firm Arlington Medical Associates, the number of X-ray procedures in the U.S. increased 22 percent from 2000 to 2004.

The main reason imaging jobs are currently not as abundant is that imaging technologist training programs have done a good job of keeping up with market demand. Enrollment in radiography training programs increased significantly from 1999 to 2005. In 1999, about 11,000 new enrollees entered radiography training programs, according to the ASRT. By 2005, that number had grown to 16,274, an increase of 48 percent. Enrollment also grew in radiation therapy, from 500 first-year enrollees in 1999 to about 1,400 in 2005. In nuclear medicine, enrollment increased from 1,000 enrollees in 1999 to about 1,600 in 2005.

It is important to note, however, that enrollment rates have flattened in the last few years. The ASRT attributes this not to declining applicants but to a lack of faculty. In 2005, 32,000 qualified applicants to imaging training programs were turned away, according to the ASRT, mostly due to lack of faculty. Rising utilization of imaging services combined with a flat supply of new trainees suggests it's only a matter of time before the job market becomes more robust.

Which brings us to 2009. Gulp.

Will techs shine in '09?

The economy is in rough shape, and it will take some time before it rebounds. I have been in the healthcare staffing business for more than 14 years and have experienced several economic downturns. None of these rough patches, however, significantly inhibited the physician, nurse or allied healthcare professional staffing business. People still get sick, and healthcare has been considered recession-proof for that reason.

This notion will be challenged in the early part of 2009, but I believe it ultimately will be proved correct. There are anecdotal reports that patients are foregoing elective, out-of-pocket procedures, particularly cosmetic surgery. There are also reports that some patients are putting off non-elective procedures in an effort to avoid co-pays or because they cannot afford to miss work. In addition, the credit crunch has prevented the start-up of new healthcare facilities and the expansion of others. Declines in imaging utilization- which I don't believe had much effect on the imaging job market for most of 2008-may have some effect in early 2009.

However, patients can only put off needed care for so long. Also, bad economic times breed stress, and stress breeds a

wide range of ills, many of them cardiac-related. What the struggling economy takes away in the form of elective procedures it may return in the form of a growing number of patients who need the services provided by imaging technologists, nurses, doctors and other healthcare professionals. 2009 is likely to bring many opportunities to help alleviate the ills of a highly-stressed patient population.

The economic picture also does nothing to change some of the other underlining drivers of healthcare utilization, i.e., a growing population, an aging population, and a population susceptible to obesity and other societal problems. One indicator of how aging drives demand for imaging services is conveyed by a Thomson PULSE healthcare survey. The survey shows that in 2006, 41 percent of people under 35 had an imaging procedure. By contrast, 63.5 percent of people 65 and over had an imaging procedure. The effects of obesity can be gauged by the fact that the rate of new diabetes cases nearly doubled over the last decade, from five per 1,000 adults in the mid-1990s to nine in the mid-2000s.

The imaging job market did have some bright spots in 2008, including an increase in demand for cardiac and vascular interventional technologists and for vascular technologists. Med Travelers' annual survey of the imaging tech staffing market indicates that in 2004 interventional techs represented only 4 percent of our imaging staffing assignments. That number increased to 16 percent in 2007. Similarly, only 11 percent of our assignments were for ultrasound/vascular in 2004, a number which grew to 24 percent in 2007. The numbers aren't in yet, but it's clear that demand for services relatedto cardiac and circulatory problems remained strong this year and is likely to stay strong in 2009. As suggested above, an aging and an obese population are the drivers of this trend.

The silver lining

President-elect Obama has made it clear that tackling the economy will be his main priority in 2009. It is already becoming obvious; however, that healthcare reform plays an important role in economic reform. This point is brought home by the struggles that Detroit automakers are experiencing, some of them directly related to the high cost of healthcare insurance provided to their employees. It will be hard to get the economy in shape and to enhance the competitiveness of U.S. industry unless changes are made to the way healthcare is delivered and paid for.

The goals and methods of the Obama health plan will become clearer in 2009, though whether a comprehensive health reform bill will pass next year is debatable. What has emerged so far is that Obama wants to expand Medicaid and SCHIP and create a government-subsidized insurance purchasing pool that will make insurance affordable to many who do not have it now. The net effect will be to significantly increase healthcare access to the point where coverage is close to universal.

The Lewin Group consulting firm projects that universal access would create the need for 35,000 additional physicians, 40,000 additional nurses, 15,000 additional pharmacists and 125,000 additional health aides and technicians. There is no specific projection for imaging techs, but the implication is clear that thousands of additional techs also would be needed.

While their methods may differ, both Democrats and Republicans now seem serious about doing something to expand healthcare access to more Americans. One of the positives going into 2009 is that for the first time in a long while we are likely to see some progress made on healthcare reform.

While 2009 no doubt will present challenges to many people, the good news is that healthcare is probably the best field to be in from the perspective of job security. Reports from late 2008 indicated that healthcare was one area of the economy that was still adding jobs. While both permanent and traveling imaging technologists may not have as many opportunities to choose from in 2009 as they did several years ago, the need for your services will still be there.

So there's reason for optimism as our focus shifts to what we hope will be a healthy, happy and prosperous New Year.

John Moberly is executive vice president of Med Travelers, a national allied healthcare staffing firm and a division of AMN Healthcare. He can be reached at john.moberly@medtravelers.com.