Healthcare June 2012 Anthony P. Carnevale Nicole Smith Artem Gulish Bennett H. Beach 2 Healthcare Chapter 1: Growing Demand For Healthcare Workers Healthcare ii Healthcare Acknowledgements We would like to express our gratitude to the individuals and organization that have made this report possible. First, we thank Lumina Foundation and the Bill and Melinda Gates Foundation for their support of our research over the past few years. This report would not have been possible without the support of Jamie Merisotis, Holly Zanville, Elizabeth Gonzalez, Parminder Jassal as well as Hillary Pennington and Ann Person. We are honored to be partners in their mission to promote postsecondary access and completion for all Americans. We undertook this report to help advance the discussion and understanding of many contentious issues surrounding the healthcare workforce. We reached out to experts with a diverse array of perspectives in the healthcare dialogue to review our analysis. Their responses contributed enormously to our understanding of the healthcare data and forced us to address many empirical questions much more clearly. We especially want to thank the following experts for their in-depth review: • Ed Salsberg Director, National Center for Health Workforce Analysis Health Resources and Services Administration. • Emory Morrison Director, Policy Research Studies, Research and Data Programs Association of American Medical Colleges. • Douglas Grbic Senior Research Analyst, Research and Data Programs Association of American Medical Colleges. • Catherine Dower Associate Director of Research, Center for Health Professions University of California San Francisco • Linda Burnes-Bolten Vice President and Chief Nursing Officer Cedars-Sinai Medical Center • Bernard Galla Chief Information Officer, Health Sciences Howard University Hospital Special thanks to our own experts at Georgetown University’s Health Policy Institute for their input and critique throughout the process: Doreen Cavanaugh Mila Kofman Sabrina Corlette Laura Summer Jack Hoadley We also wish to thank Jeff Strohl, Megan Fasules and Ban Cheah for their strong data expertise and Tracy Thompson, who served as our editor. Finally, we wish to thank Ryan Clennan, Studio Grafik, for design, and Andrea Porter, Marilyn Downs and Andrew Hanson, who provided support to the project. That said, all errors remain the responsibility of the authors. Chapter 1: Growing Demand For Healthcare Workers Contents Chapter 1: Growing Demand For Healthcare Workers .................................................................................. 2 We spend twice as much as Europe ............................................................................................................ 2 Healthcare costs will continue to rise in spite of new legislation – reform is inevitable ............................... 5 Healthcare jobs will grow faster than any other sector ................................................................................ 6 Healthcare job openings will grow by 30% through 2020 – almost twice as fast as the national economy ............................................................................................. 8 Jobs in the industry are closer to 13 percent of all employment (if we include pharmaceuticals and medical equipment manufacturing) ..................................................... 8 Output in healthcare was $1.8 billion in 2010 and will rise to $3.1 billion in 2020 ....................................... 9 Productivity in the healthcare industry is fourth from the bottom in the nation compared to other industries, and slowest to grow over time.................................................................................................... 9 Demand for postsecondary education in healthcare professional and technical occupations is third to science, technology, engineering and mathematics (STEM) and education. ................................ 11 By 2020, 82% of all healthcare jobs will demand postsecondary education and training ........................ 12 Between 2010 and 2020 there will be 5.6 million job openings in healthcare occupations ...................... 12 The healthcare workforce is aging and “shortage” areas are still difficult to fill ......................................... 13 Box: New Emerging Models of Care .......................................................................................................... 19 Box: The Patient Protection and Affordable Care Act, (aka OBAMACare) ................................................ 19 Chapter 2: Healthcare, Growth and Opportunity by Occupational Group ................................................. 23 Persistence in healthcare occupations ...................................................................................................... 24 Doctors ....................................................................................................................................................... 25 Nurses ........................................................................................................................................................ 29 Box: What nurses do .................................................................................................................................. 32 Allied healthcare ......................................................................................................................................... 34 Healthcare support ..................................................................................................................................... 37 Box: Healthcare professions: Definitions and Characteristics ................................................................... 39 Chapter 3: Wages In Healthcare .................................................................................................................... 41 Summary .................................................................................................................................................... 42 Wage growth for healthcare occupations has been substantial over the past three decades. ................. 42 Healthcare support jobs pay better than the alternative ............................................................................ 44 Mid-level healthcare professional and technical workers workers earn extremely good wages ............... 45 Wages by sex ............................................................................................................................................. 45 Male nurses earn more than females at every level of education. ............................................................. 46 Chapter 4: Healthcare Competencies: Knowledge, Skills, Abilities, Values and Interests ....................... 48 Healthcare knowledge................................................................................................................................ 50 Healthcare skills ......................................................................................................................................... 51 Healthcare abilities ..................................................................................................................................... 54 Healthcare values ....................................................................................................................................... 55 Healthcare interests ................................................................................................................................... 57 Chapter 5: Diversity in Healthcare ................................................................................................................. 58 Gender ....................................................................................................................................................... 61 Age ......................................................................................................................................................... 62 Race ......................................................................................................................................................... 64 Socioeconomic status ................................................................................................................................ 69 Nativity ....................................................................................................................................................... 72 References ....................................................................................................................................................... 77 Appendices ...................................................................................................................................................... 86 Appendix 1: Forecast of detailed healthcare occupations, 2010-2020 ................................................... 87 Appendix 2: Forecast of detailed job openings in healthcare occupations by education, 2010 through 2020 ............................................................................................................... 89 Appendix 3: Wage premium by education attainment for healthcare professionals over support workers ........................................................................................................... 94 Appendix 4: Wages of detailed healthcare occupations by education .................................................... 94 Appendix