The health care industry added 312,500 new jobs in 2011, continuing the trend of increasing demand for workers in home health care, clinics, hospitals and group practices, according to the Bureau of Labor Statistics (BLS). Physicians, registered nurses, and workers in every part of the health care sector will see new opportunities, but the most dramatic growth is in jobs for the frontline workforce.
“Home health aide is probably the job that’s increasing the fastest, in terms of employment opportunities. Though there are concerns about people taking these positions because they are not covered by the Fair Labor Standards Act in many states. That’s changing slowly,” says Bob Konrad, PhD, the co-director of the national evaluation office of the Robert Wood Johnson Foundation (RWJF) Jobs to Careers (J2C) program. “The U.S. Department of Labor has proposed ending the ‘companionship exemption’ for home care workers. This could ensure that these workers—employed directly by consumers or by agencies—will receive the protection of the Fair Labor Standards Act,Bureau of Labor Statistics including minimum wage and overtime protections. This might attract more workers to these positions.”
“Other strong trends include the Affordable Care Act’s (ACA) emphasis on expanded primary care in group practices; a factor that will increase job opportunities for physician extenders—such as nurses and physician assistants,” Konrad adds.
“I agree that we will continue to see an increasing demand for health care across the board, especially as 80 million baby boomers grow older,” adds Peter Buerhaus, PhD, RN, professor of nursing at Vanderbilt University, chair of the National Health Care Workforce Commission and a former RWJF fellow in health care finance. “We also have growing numbers of people with multiple chronic health problems and, soon the ACA will provide health care insurance for an additional 32 million people. All of these factors will increase the demand for health care workers.”
Barriers to Training
While BLS data does an excellent job of reporting what employers want, it does not reflect the concerns that many industry experts have about how potential health care workers will obtain the training needed to take advantage of new opportunities.
In order for there to be a rich pool of workers to fill the frontline and allied health care worker slots trumpeted in the job growth figures, “we’ve got to create more effective career ladders and opportunities for advancement for entry level people in health care,” Konrad says. “We also have to allow more lateral movement among jobs and create a general health care skills curriculum that can begin in high school and carry through college, nursing and medical school. Teaching core skills would allow people to be more prepared to fill this pipeline.”
But in many communities, the educational institutions that could train the small army of care coordinators, laboratory technicians, medical billing and IT administrators, nurses and others who provide the bulk of direct patient care or keep clinics, hospitals and physician practices running smoothly are cutting, rather than adding, student slots. Citing financial pressures, state, community, and technical colleges in Nebraska, Nevada, South Dakota, Colorado, Florida, Texas, and North Carolina—states that have reported nursing shortages—have cut programs in science, engineering, and nursing.
“We do have an issue here,” explains Randall Wilson, PhD, who is part of the building economic opportunities group at Jobs for the Future, the national program office for Jobs to Careers, and author of the 2010 report, Rx for the Health Care Workforce. “Giving people the opportunity to train at the workplace [the Jobs to Careers model] means that hospitals and other health care institutions can share part of the cost of training these workers.”
“The partnership formed between Owensboro Community and Technical College and Owensboro Medical Health System (OMHS), in Kentucky, is a near perfect example of the multiple rewards—and problems—institutions may encounter when attempting to meet health care workforce needs,” Wilson says. OMHS projected a shortage of 600 registered nurses so they developed one of the first J2C programs, an accelerated path to a nursing degree designed to help full-time workers—including nurse’s aides, pharmacy techs, and unit clerks—to obtain associates degrees in nursing in three years using online instruction, in-hospital learning, and other innovative tools.
The program operated for five successful years, but the current version will close this year after graduating three cohorts. The program is not continuing because, “once the economy slowed, experienced nurses stayed at OMHS longer or returned to work so the shortage just did not occur, “explains Cindy Fiorella, a vice president at Owensboro Community and Technical College who specializes in workplace-based learning.
“The program was also very expensive to run at a time when our college’s student body has nearly doubled, but our state funding has been cut to 1998 levels,” Fiorella says. “Still, it was one of the most exciting and rewarding programs I’ve worked on. We definitely got some people through the pipeline that would not have made it otherwise and we learned a great deal about how to train frontline workers using the workplace. Given the opportunity, I’d do the program again in a Texas minute. We hope the program will evolve into a new model to train people for frontline and allied positions that we will institute after the economy recovers.”
Diverse Populations Still Struggling for Inclusion
Frontline and allied health positions are also seen as a gateway for diversifying the health care workforce, but barriers remain. “In community colleges with high percentages of minority students, the attrition rate is extremely high. There’s a great deal of financial pressure on these students,” says Ebbin Dotson, PhD, a 2011-2013 RWJF New Connections: Increasing Diversity of RWJF Programming grantee who is conducting research on the business case for diversifying the health care workforce. “The other issue is that we still do not have a high number of minority administrators in schools of health and technology to serve as mentors or role models for students choosing these careers.”
“I do think that the job growth in health care will help to diversify the profession, but it’s a very, very slow process. In my research, I do see—in hospitals for example—a larger emphasis on training people from a range of cultural backgrounds. It’s not as well thought out as it should be, but it’s improving,” Dotson adds.
In addition, says Dotson, an assistant professor of management at the University of Texas Health Sciences Center, this is not just an issue of creating more equitable opportunities for workers from all backgrounds. “I argue that health care institutions will benefit financially from having employees that reflect our nation’s increasingly diverse patient base.”
As the country moves forward in the effort to redefine the way health care is managed and delivered, “we will also see a heightened demand for people who coordinate care,” Wilson says. “New occupations may be created but financial factors such as the cost of care and the possible repeal of all or parts of the ACA, may have a negative impact on job demand going forward.”
Jobs to Careers helps frontline health care workers access the skills and credentials they need to advance their careers through work-based learning—at little to no cost to the workers. This program was sponsored by the Robert Wood Johnson Foundation, in collaboration with The Hitachi Foundation and the U.S. Department of Labor.
New Connections: Increasing Diversity of RWJF Programming is a national program of the Robert Wood Johnson Foundation which works to develop and retain a diverse, well-trained leadership and workforce in health and health care to meet the needs of all Americans. Created in 2005, New Connections is designed to expand the diversity of perspectives that inform RWJF program strategy.