While employment within the health care sector has grown dramatically over the past 16 years, the composition of the workforce has undergone surprisingly few changes. Between 2000 and 2016, the number of people working in the health care space expanded by more than 40 percent, while the overall private sector grew less than 10 percent.1 Given the aging population, combined with Aadvancements in technology over the past 15 years, I’m a bit surprised there haven’t been more substantive shifts in occupational structures across the industry.
In 2016, health care services accounted for 12.6 percent of the nation’s overall employment – up from 9.8 percent in 2000. Five industries – hospitals, home health care services, physician offices, outpatient care facilities, and nursing care facilities – account for about 75 percent of the health sector’s employment, according to 2016 data. That percentage has slipped a bit from 77 percent in 2000.
But not all health care sectors have experienced robust employment growth. While employment among home health care agencies and outpatient centers more than doubled over the past 16 years, nursing care facilities saw their rosters grow by a modest 8.6 percent. With the exception of outpatient care centers, each segment experienced slower employment growth after the enactment of the Affordable Care Act (ACA) in 2010.2 Despite changes that followed the law’s implementation, the occupational makeup within each sector remained relatively consistent.
Here’s a look at some key employment trends within each health care sector:
Outpatient care centers: Between 2000 and 2016, outpatient centers saw their employment levels double, adding 431,100 jobs nationwide. Possibly driven by growth in joint replacements among aging baby boomers, outpatient centers are employing proportionally more physical therapists than they did in 2000. In 2015, physical therapists made up 5.8 percent of the workforce – up from 3.3 percent 15 years earlier. This group saw a slight uptick in the proportion of counselors, which accounted for 6.9 percent of staff in 2015 – up from 5.7 percent in 2000.
Hospitals: Collectively, the nation’s hospitals employed about 5 million people in 2016 – up 27 percent from 2000 – and represent the largest employer in the health care space. Of the 4.6 million health care jobs created between 2000 and 2016, nearly one-quarter of them were in hospitals. Hospitals, along with outpatient centers, also have the highest proportion of specialized and highly skilled workers (e.g., nurses, physicians, therapists, and technicians). Close to 70 percent of hospital employees are medical doctors, registered nurses or have other highly specialized training. Many home health agencies and nursing care facilities, by contrast, employ far fewer highly specialized employees, and instead rely more on lower-skilled aides.
Home health agencies: Although home health agencies have far fewer employees than hospitals, employment soared 115 percent between 2000 and 2016. In 2000, agencies employed about 600,000 people. That number more than doubled to 1.4 million in 2016. Agencies appear to be relying more on personal health aides, and less on health care aids and registered nurses than they have in the past. In 2015, personal care aides accounted for 25 percent of agency workers – an increase of 144 percent over 15 years.
Physician offices: The proportion of actual physicians working in doctors’ offices declined slightly over the past 15 years as doctor offices rely more on medical assistants. In 2000, one-in-five people working in a physicians’ office was a medical doctor. In 2015, physicians and surgeons made up 17.8 percent of the workforce, while medical assistants accounted for 13.3 percent – up from 10.3 percent 15 years earlier.
Skilled nursing facilities: Despite an expanding population of seniors, employment at skilled nursing facilities has remained relatively flat over the past decade and was the only health care sector examined with employment growth below the national average. Nursing, psychiatric and home health aides made up 33.3 percent of the workforce in 2015 – down from 37.4 percent in 2000. The percentage of both registered nurses and licensed practical nurses increased slightly.
Employment in the health care sector has far outpaced the overall job market since 2000. It’s a trend that isn’t likely to slow down over the next decade as the US population continues to age and patients demand more and different types of services. Given that the structure of the workforce has undergone little transformation over the past 15 years, future change will likely to be tied to increases in overall employment within each sector, rather than the staff composition.
For more on this analysis, check out the full report on dupress.com.
1. Calculations are based on Bureau of Labor Statistics, “Employment, Hours, and Earnings from the Current Employment Statistics survey,” extracted on February 24, 2017
2. Bureau of Labor Statistics