Healthcare

Related Profiles of Professionals

• Steven Calderone, Baystate Health Systems
• Urszula Tajchman, University of Iowa Hospitals and Clinics
• Carl Landis, Western Reserve Healthcare Corp.

Industry Overview
Combining medical technology and the human touch, the health care industry administers care around the clock, responding to the needs of millions of people -- from newborns to the critically ill.

About 545,000 establishments make up the health care industry; they vary greatly in terms of size, staffing patterns, and organizational structures. About 76 percent of health care establishments are offices of physicians, dentists, or other health practitioners. Although hospitals constitute only 2 percent of all health care establishments, they employ 40 percent of all workers.

The health care industry includes establishments ranging from small-town private practices of physicians who employ only one medical assistant to busy inner-city hospitals that provide thousands of diverse jobs. In 2004, about half of nonhospital health care establishments employed fewer than 5 workers. By contrast, 7 out of 10 hospital employees were in establishments with more than 1,000 workers.

The health care industry consists of the following nine segments:

1. Hospitals
Hospitals provide complete medical care, ranging from diagnostic services, to surgery, to continuous nursing care. Some hospitals specialize in treatment of the mentally ill, cancer patients, or children. Hospital-based care may be on an inpatient (overnight) or outpatient basis. The mix of workers needed varies, depending on the size, geographic location, goals, philosophy, funding, organization, and management style of the institution. As hospitals work to improve efficiency, care continues to shift from an inpatient to outpatient basis whenever possible. Many hospitals have expanded into long-term and home health care services, providing a wide range of care for the communities they serve.

2. Nursing and Residential Care Facilities
Nursing care facilities provide inpatient nursing, rehabilitation, and health-related personal care to those who need continuous nursing care, but do not require hospital services. Nursing aides provide the vast majority of direct care. Other facilities, such as convalescent homes, help patients who need less assistance. Residential care facilities provide around-the-clock social and personal care to children, the elderly, and others who have limited ability to care for themselves. Workers care for residents of assisted-living facilities, alcohol and drug rehabilitation centers, group homes, and halfway houses. Nursing and medical care, however, are not the main functions of establishments providing residential care, as they are in nursing care facilities.

3. Offices of Physicians
About 37 percent of all health care establishments fall into this industry segment. Physicians and surgeons practice privately or in groups of practitioners who have the same or different specialties. Many Physicians and surgeons prefer to join group practices because they afford backup coverage, reduce overhead expenses, and facilitate consultation with peers. Physicians and surgeons are increasingly working as salaried employees of group medical practices, clinics, or integrated health systems.

4. Offices of Dentists
About 1 out of every 5 health care establishments is a dentist's office. Most employ only a few workers, who provide general or specialized dental care, including dental surgery.

5. Home Health Care Services
Skilled nursing or medical care is sometimes provided in the home, under a physician's supervision. Home health care services are provided mainly to the elderly. The development of in-home medical technologies, substantial cost savings, and patients' preference for care in the home have helped change this once-small segment of the industry into one of the fastest growing parts of the economy.

6. Offices of Other Health Practitioners
This segment of the industry includes the offices of chiropractors, optometrists, podiatrists, occupational and physical therapists, psychologists, audiologists, speech-language pathologists, dietitians, and other health practitioners. Demand for the services of this segment is related to the ability of patients to pay, either directly or through health insurance. Hospitals and nursing facilities may contract out for these services. This segment also includes the offices of practitioners of alternative medicine, such as acupuncturists, homeopaths, hypnotherapists, and naturopaths.

7. Outpatient Care Centers
The diverse establishments in this group include kidney dialysis centers, outpatient mental health and substance abuse centers, health maintenance organization medical centers, and freestanding ambulatory surgical and emergency centers.

8. Other Ambulatory Health Care Services
This relatively small industry segment includes ambulance and helicopter transport services, blood and organ banks, and other ambulatory health care services, such as pacemaker monitoring services and smoking cessation programs.

9. Medical and Diagnostic Laboratories
Medical and diagnostic laboratories provide analytic or diagnostic services to the medical profession or directly to patients following a physician's prescription. Workers may analyze blood, take x rays and computerized tomography scans, or perform other clinical tests. Medical and diagnostic laboratories provide the fewest number of jobs in the health care industry.

In the rapidly changing health care industry, technological advances have made many new procedures and methods of diagnosis and treatment possible. Clinical developments, such as organ transplants, less invasive surgical techniques, skin grafts, and gene therapy for cancer treatment, continue to increase the longevity and improve the quality of life of many Americans. Advances in medical technology also have improved the survival rates of trauma victims and the severely ill, who need extensive care from therapists and social workers as well as other support personnel.

In addition, advances in information technology continue to improve patient care and worker efficiency with devices such as hand-held computers that record notes on each patient. Information on vital signs and orders for tests are transferred electronically to a main database; this process eliminates the need for paper and reduces recordkeeping errors.

Cost containment also is shaping the health care industry, as shown by the growing emphasis on providing services on an outpatient, ambulatory basis; limiting unnecessary or low-priority services; and stressing preventive care, which reduces the potential cost of undiagnosed, untreated medical conditions. Cost effectiveness also is improved with the increased use of integrated delivery systems, which combine two or more segments of the industry to increase efficiency through the streamlining of functions, primarily financial and managerial. These changes will continue to reshape not only the nature of the health care workforce, but also the manner in which health care is provided.

Working Environment 
Average weekly hours of nonsupervisory workers in private health care varied among the different segments of the industry. Workers in offices of dentists averaged only 26.9 hours per week in 2004, while those in psychiatric and substance abuse hospitals averaged 36.4 hours, compared with 33.7 hours for all private industry.

Many workers in the health care industry are on part-time schedules. Part-time workers made up about 20 percent of the workforce as a whole in 2004, but accounted for 39 percent of workers in offices of dentists and 33 percent of those in offices of other health practitioners. Students, parents with young children, dual jobholders, and older workers make up much of the part-time workforce.

Many health care establishments operate around the clock and need staff at all hours. Shift work is common in some occupations, such as registered nurses. Numerous health care workers hold more than one job.

In 2004, the incidence of occupational injury and illness in hospitals was 8.7 cases per 100 full-time workers, compared with an average of 5.0 for private industry overall. Nursing care facilities had a much higher rate of 10.1. Health care workers involved in direct patient care must take precautions to prevent back strain from lifting patients and equipment; to minimize exposure to radiation and caustic chemicals; and to guard against infectious diseases, such as AIDS, tuberculosis, and hepatitis. Home care personnel who make house calls are exposed to the possibility of being injured in highway accidents, all types of overexertion when assisting patients, and falls inside and outside homes.

Employment
As the largest industry in 2004, health care provided 13.5 million jobs -- 13.1 million jobs for wage and salary workers and about 411,000 jobs for self-employed and unpaid family workers. Of the 13.1 million wage and salary jobs, 41 percent were in hospitals; another 22 percent were in nursing and residential care facilities; and 16 percent were in offices of physicians. About 92 percent of wage and salary jobs were in private industry; the rest were in State and local government hospitals. The majority of jobs for self-employed and unpaid family workers in health care were in offices of physicians, dentists, and other health practitioners -- about 282,000 out of the 411,000 total self-employed.

Workers in health care tend to be older than workers in other industries. Health care workers also are more likely to remain employed in the same occupation, due, in part, to the high level of education and training required for many health occupations.

Industry Forecast
Job opportunities should be excellent in all employment settings because of high job turnover, particularly from the large number of expected retirements and tougher immigration rules that are slowing the numbers of foreign health care workers entering the U.S. Wage and salary employment in the health care industry is projected to increase 27 percent through 2014, compared with 14 percent for all industries combined. Employment growth is expected to account for about 3.6 million new wage and salary jobs -- 19 percent of all wage and salary jobs added to the economy over the 2004–14 period. Projected rates of employment growth for the various segments of the industry range from 13 percent in hospitals, the largest and slowest growing industry segment, to 69 percent in the much smaller home health care services.

Many of the occupations projected to grow the fastest in the economy are concentrated in the health care industry. For example, over the 2004–14 period, total employment of home health aides -- including the self-employed -- is projected to increase by 56 percent, medical assistants by 52 percent, physician assistants by 50 percent, and physical therapist assistants by 44 percent.

Employment in health care will continue to grow for several reasons. The number of people in older age groups, with much greater than average health care needs, will grow faster than the total population between 2004 and 2014; as a result, the demand for health care will increase. Employment in home health care and nursing and residential care should increase rapidly as life expectancies rise, and as aging children are less able to care for their parents and rely more on long-term care facilities. Advances in medical technology will continue to improve the survival rate of severely ill and injured patients, who will then need extensive therapy and care. New technologies will make it possible to identify and treat conditions that were previously not treatable. Medical group practices and integrated health systems will become larger and more complex, increasing the need for office and administrative support workers. Industry growth also will occur as a result of the shift from inpatient to less expensive outpatient and home health care because of improvements in diagnostic tests and surgical procedures, along with patients' desires to be treated at home.

Many job openings will result from a need to replace workers due to retirements and high job turnover.  Nursing aides, orderlies and attendants, and home health aides are among the occupations adding the most new jobs between 2004 and 2014, about 675,000 combined.

Another occupation that will add many new jobs is registered nurses. The median age of registered nurses is increasing, and not enough younger workers are replacing them. As a result, employers in some parts of the country are reporting difficulties in attracting and retaining nurses.

Fast growth is expected for workers in occupations concentrated outside the inpatient hospital sector, such as medical assistants and home health aides. Because of cost pressures, many health care facilities will adjust their staffing patterns to reduce labor costs. Where patient care demands and regulations allow, health care facilities will substitute lower paid providers and will cross-train their workforces. Many facilities have cut the number of middle managers, while simultaneously creating new managerial positions as the facilities diversify. Traditional inpatient hospital positions are no longer the only option for many future health care workers; persons seeking a career in the field must be willing to work in various employment settings. Employment growth in hospitals will be the slowest within the health care industry because of efforts to control hospital costs and the increasing use of outpatient clinics and other alternative care sites.

Demand for dental care will rise due to population growth, greater retention of natural teeth by middle-aged and older persons, greater awareness of the importance of dental care, and an increased ability to pay for services. Dentists will use support personnel such as dental hygienists and assistants to help meet their increased workloads.

In some management, business, and financial operations occupations, rapid growth will be tempered by restructuring to reduce administrative costs and streamline operations. Office automation and other technological changes will slow employment growth in office and administrative support occupations; but because the employment base is large, replacement needs will continue to create substantial numbers of job openings. Slower growing service occupations also will provide job openings due to replacement needs.

Related Degree Fields

• Dentist
• Nurse
• Optometrist
• Pharmacist
• Physical Therapist
• Physical Therapist Assistant
• Physician/Surgeon
• Physician Assistants
• Veterinarian
• Veterinary Technicians and Technologists

Professional Associations

• American Association for Homecare
• American Medical Association
• American Physical Therapy Association

Note: Some resources in this section are provided by the US Department of Labor, Bureau of Labor Statistics.