Nature of the Industry
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.
Industry organization. About 580,000 establishments make up the health care industry; they vary greatly in terms of size, staffing patterns, and organizational structures. Nearly 77 percent of health care establishments are offices of physicians, dentists, or other health practitioners. Although hospitals constitute only 1 percent of all health care establishments, they employ 35 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 2006, almost half of non-hospital health care establishments employed fewer than five workers (chart 1). 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:
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.
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.
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.
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 preventative, cosmetic, or emergency care. Some offices specialize in a single field of dentistry such as orthodontics or periodontics.
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.
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.
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.
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.
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.
Recent developments. 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 infection control, less invasive surgical techniques, advances in reproductive technology, 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. Enrollment in managed care programs—predominantly preferred provider organizations, health maintenance organizations, and hybrid plans such as point-of-service programs—continues to grow. These prepaid plans provide comprehensive coverage to members and control health insurance costs by emphasizing preventive care. 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.
Hours. 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 27.1 hours per week in 2006, while those in psychiatric and substance abuse hospitals averaged 35.7 hours, compared with 33.9 hours for all private industry.
Many workers in the health care industry are on part-time schedules. Part-time workers made up about 19 percent of the health care workforce as a whole in 2006, but accounted for 38 percent of workers in offices of dentists and 31 percent of those in offices of other health practitioners. 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.
Work environment. In 2006, the incidence of occupational injury and illness in hospitals was 8.1 cases per 100 full-time workers, compared with an average of 4.4 for private industry overall. Nursing care facilities had a higher rate of 9.8. 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.
As the largest industry in 2006, health care provided 14 million jobs—13.6 million jobs for wage and salary workers and about 438,000 jobs for self-employed and unpaid family workers. Of the 13.6 million wage and salary jobs, 40 percent were in hospitals; another 21 percent were in nursing and residential care facilities; and 16 percent were in offices of physicians. 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 295,000 out of the 438,000 total self-employed.
Health care jobs are found throughout the country, but they are concentrated in the largest States—in particular, California, New York, Florida, Texas, and Pennsylvania.
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, in part because of the high level of education and training required for many health occupations.
Occupations in the Industry
Health care firms employ large numbers of workers in professional and service occupations. Together, these two occupational groups account for 3 out of 4 jobs in the industry (table 2). The next largest share of jobs, 18 percent, is in office and administrative support. Management, business, and financial operations occupations account for only 4 percent of employment. Other occupations in health care made up only 2 percent of the total.
Professional occupations, such as physicians and surgeons, dentists, registered nurses, social workers, and physical therapists, usually require at least a bachelor’s degree in a specialized field or higher education in a specific health field, although registered nurses also enter through associate degree or diploma programs. Professional workers often have high levels of responsibility and complex duties. In addition to providing services, these workers may supervise other workers or conduct research.
Other health professionals and technicians work in many fast growing occupations, such as medical records and health information technicians and dental hygienists. These workers may operate technical equipment and assist health diagnosing and treating practitioners. Graduates of 1- or 2-year training programs often fill such positions; the jobs usually require specific formal training beyond high school, but less than 4 years of college.
Service occupations attract many workers with little or no specialized education or training. For instance, some of these workers are nursing aides, home health aides, building cleaning workers, dental assistants, medical assistants, and personal and home care aides. Nursing or home health aides provide health-related services for ill, injured, disabled, elderly, or infirm individuals either in institutions or in their homes. By providing routine personal care services, personal and home care aides help elderly, disabled, and ill persons live in their own homes instead of in an institution. Although some of these workers are employed by public or private agencies, many are self-employed. With experience and, in some cases, further education and training, service workers may advance to higher level positions or transfer to new occupations.
Most workers in health care jobs provide clinical services, but many also are employed in occupations with other functions. Numerous workers in management and administrative support jobs keep organizations running smoothly. Although many medical and health services managers have a background in a clinical specialty or training in health care administration, some enter these jobs with a general business education.
Each segment of the health care industry provides a different mix of wage and salary health-related jobs.
Hospitals. Hospitals employ workers with all levels of education and training, thereby providing a wider variety of services than is offered by other segments of the health care industry. About 3 in 10 hospital workers is a registered nurse. Hospitals also employ many physicians and surgeons, therapists, and social workers. About 1 in 5 hospital jobs are in a service occupation, such as nursing, psychiatric, and home health aides, or building cleaning workers. Hospitals also employ large numbers of office and administrative support workers.
Nursing and residential care facilities. About 2 out of 3 nursing and residential care facility jobs are in service occupations, primarily nursing, psychiatric, and home health aides. Professional and administrative support occupations make up a much smaller percentage of employment in this segment, compared to other parts of the health care industry. Federal law requires nursing facilities to have licensed personnel on hand 24 hours a day and to maintain an appropriate level of care.
Offices of physicians. Many of the jobs in offices of physicians are in professional and related occupations, primarily physicians, surgeons, and registered nurses. About two-fifths of all jobs, however, are in office and administrative support occupations, such as receptionists and information clerks.
Offices of dentists. Roughly one-third of all jobs in this segment are in service occupations, mostly dental assistants. The typical staffing pattern in dentists’ offices consists of one dentist with a support staff of dental hygienists and dental assistants. Larger practices are more likely to employ office managers and administrative support workers.
Home health care services. About 3 in 5 jobs in this segment are in service occupations, mostly home health aides and personal and home care aides. Nursing and therapist jobs also account for substantial shares of employment in this segment.
Offices of other health practitioners. About 2 in 5 jobs in this industry segment are professional and related occupations, including physical therapists, occupational therapists, dispensing opticians, and chiropractors. Healthcare practitioners and technical occupations and office and administrative support occupations also accounted for a significant portion of all jobs—34 percent and 32 percent, respectively.
Outpatient care centers. This segment of the health care industry employs a high percentage of professional and related workers, including counselors, social workers, and registered nurses.
Other ambulatory health care services. Because this industry segment includes ambulance services, it employs about 2 out of every 5 emergency medical technicians and paramedics and ambulance drivers and attendants.
Training and Advancement
Most workers have jobs that require less than 4 years of college education, but health diagnosing and treating practitioners are among the most educated workers.
A variety of programs after high school provide specialized training for jobs in health care. Students preparing for health careers can enter programs leading to a certificate or a degree at the associate, baccalaureate, or graduate level. Two-year programs resulting in certificates or associate degrees are the minimum standard credential for occupations such as dental hygienist or radiologic technologist. Most therapists and social workers have at least a bachelor’s degree. Health diagnosing and treating practitioners—such as physicians and surgeons, optometrists, and podiatrists—are among the most educated workers, with many years of education and training beyond college.
The health care industry also provides many job opportunities for people without specialized training beyond high school. In fact, more than half of workers in nursing and residential care facilities have a high school diploma or less, as do a fifth of workers in hospitals.
Some health care establishments provide on-the-job or classroom training, as well as continuing education. For example, in all certified nursing facilities, nursing aides must complete a State-approved training and competency evaluation program and participate in at least 12 hours of in-service education annually. Hospitals are more likely than other facilities to have the resources and incentive to provide training programs and advancement opportunities to their employees. In other segments of health care, the variety of positions and advancement opportunities are more limited. Larger establishments usually offer a broader range of opportunities.
Some hospitals provide training or tuition assistance in return for a promise to work at their facility for a particular length of time after graduation. Many nursing facilities have similar programs. Some hospitals have cross-training programs that train their workers—through formal college programs, continuing education, or in-house training—to perform functions outside their specialties.
Persons considering careers in health care should have a strong desire to help others, genuine concern for the welfare of patients and clients, and an ability to deal with people of diverse backgrounds in stressful situations.
Health specialists with clinical expertise can advance to department head positions or even higher level management jobs. Medical and health services managers can advance to more responsible positions, all the way up to chief executive officer.
Health care will generate 3 million new wage and salary jobs between 2006 and 2016, more than any other industry. Seven of the twenty fastest growing occupations are health care related. Job opportunities should be good in all employment settings.
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 2006 and 2016; 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 of the occupations projected to grow the fastest in the economy are concentrated in the health care industry. For example, over the 2006-16 period, total employment of home health aides—including the self-employed—is projected to increase by 49 percent, medical assistants by 35 percent, physical therapist assistants by 32 percent, and physician assistants by 27 percent.
Rapid growth is expected for workers in occupations concentrated outside the inpatient hospital sector, such as pharmacy technicians and personal and home care 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. Hospitals will be the slowest growing segment 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.
Job prospects. Job opportunities should be good 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 United States.
Occupations with the most replacement openings are usually large, with high turnover stemming from low pay and status, poor benefits, low training requirements, and a high proportion of young and part-time workers. Nursing aides, orderlies and attendants, and home health aides are among the occupations adding the most new jobs between 2006 and 2016, about 647,000 combined. By contrast, occupations with relatively few replacement openings—such as physicians and surgeons—are characterized by high pay and status, lengthy training requirements, and a high proportion of full-time workers.
Another occupation that is expected to have many openings 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. Imbalances between the supply of and the demand for qualified workers should spur efforts to attract and retain qualified registered nurses. For example, employers may restructure workloads and job responsibilities, improve compensation and working conditions, and subsidize training or continuing education.
Health care workers at all levels of education and training will continue to be in demand. In many cases, it may be easier for jobseekers with health-specific training to obtain jobs and advance in their careers. Specialized clinical training is a requirement for many jobs in health care and is an asset even for many administrative jobs that do not specifically require it.
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.
Industry earnings. Average earnings of nonsupervisory workers in most health care segments are higher than the average for all private industry, with hospital workers earning considerably more than the average and those employed in nursing and residential care facilities and home health care services earning less (table 4). Average earnings often are higher in hospitals because the percentage of jobs requiring higher levels of education and training is greater than in other segments. Those segments of the industry with lower earnings employ large numbers of part-time service workers.
Earnings vary not only by type of establishment and occupation, but also by size; salaries tend to be higher in larger hospitals and group practices. Geographic location also can affect earnings.
Benefits and union membership. Health care workers generally receive standard benefits, such as health insurance, paid vacation and sick leave, and pension plans. However, benefits can vary greatly by occupation and by employer.
Although some hospitals have unions, the health care industry is not heavily unionized. In 2006, only 10 percent of workers in the industry were members of unions or covered by union contracts, compared with about 13 percent for all industries.
Sources of Additional Information
Disclaimer:Links to non-JA Internet sites are provided for your convenience and do not constitute an endorsement.
For additional information on specific health-related occupations, contact:
American Medical Association/Health Professions Career and Education Directory, 515 N. State St., Chicago, IL 60610. Internet: http://www.ama-assn.org/go/alliedhealth
For information on physician careers and applying to medical school, contact:
Association of American Medical Colleges, 2450 N St. NW., Washington, DC 20037. Internet: http://www.aamc.org/students
General information on health careers is available from:
Bureau of Health Professions, Parklawn Rm. 8A-09, 5600 Fishers Lane, Rockville, MD 20857. Internet: http://bhpr.hrsa.gov/kidscareers
For a list of accredited programs in allied health fields, contact:
Commission on Accreditation of Allied Health Education Programs, 1361 Park St., Clearwater, FL 333756. Internet: http://www.caahep.org
A wealth of information on health careers and job opportunities also is available through the Internet, schools, libraries, associations, and employers.
Information on the following occupations may be found in the 2008-09 Occupational Outlook Handbook:
Cardiovascular technologists and technicians
Clinical laboratory technologists and technicians
Diagnostic medical sonographers
Dietitians and nutritionists
Emergency medical technicians and paramedics
Licensed practical and licensed vocational nurses
Medical and health services managers
Medical, dental, and ophthalmic laboratory technicians
Medical records and health information technicians
Nuclear medicine technologists
Nursing, psychiatric, and home health aides
Occupational therapist assistants and aides
Personal and home care aides
Physical therapist assistants and aides
Physicians and surgeons
Radiologic technologists and technicians
Receptionists and information clerks
Social and human service assistants
Bureau of Labor Statistics, U.S. Department of Labor, Career Guide to Industries, 2008-09 Edition, Health Care