Los Angeles Daily News. April 6, 2014.
Pasadena resident Nathaniel Furnanz knows the statistic well: the number of nursing jobs in the U.S. is expected to grow by 19 percent over the next 10 years, nearly twice the average of other occupations, according to the U.S. Bureau of Labor Statistics.
And with more than 7 million people signing up for the Affordable Care Act at last week’s deadline, other experts predict even stronger job growth in nursing and the healthcare industry as a whole.
That’s one reason Furnanz, 30, turned to nursing when he lost his job during the recession.
“With the unstable economy, a lot of people are looking for something with decent pay that is stable, dependable,” he said.
But now that Furnanz is months away from graduating from Cal State L.A. with a nursing degree, the reality of the job market is hitting him.
“It’s a little bit scary. I talked to a major hospital in L.A. County recently and they told me last year they had 50 new grad positions and … over 1,900 people applied,” Furnanz said. “We hear about all these jobs that are coming, but we also hear stories about people with R.N. licenses waiting tables at Chili’s.”
Experts say jobs in the healthcare industry are indeed growing much faster than other sectors, and will continue to do so with millions more people insured. But opportunities may be easier to find in some parts of the country than others. And the types of jobs may not be what seekers expect.
REASONS FOR OPTIMISM
Healthcare jobs are generally divided into two types: professional and technical jobs such as doctors and nurses that earn high wages and require at least a college degree, and low-wage, low-skill support jobs.
Both sectors are growing quickly.
Professional and technical occupations will add 1 million jobs by 2018, according to a 2012 report by the Georgetown University Center on Education and the Workforce. Nursing will see the largest growth, at 26 percent.
Part of the boost in nursing comes from efforts to increase efficiency and tame healthcare spending by shifting the distribution of workers toward nurses and other support personnel. The idea is not to have a costly doctor doing what less expensive staff could be doing.
“For health care to become more efficient, doctors, nurses — everyone — has to practice toward the higher end of their training,” said Ralph Henderson, president of healthcare staffing for AMN Healthcare Services, a San Diego-based healthcare staffing company.
“If nurses can provide a certain treatment, it doesn’t make sense to have a doctor do it.”
Nurses, particularly those with more education, will increasingly be allowed to write prescriptions and make referrals.
“We know there is going to be less doctors, and if we are going to require less doctors, we are going to need more nurses,” said economist Nicole Smith, one of the authors of the Georgetown report.
Even before the effects of the Affordable Care Act are felt, the healthcare workforce has seen growing demand for years. As baby boomers get older, demand for health care is growing. New government requirements for digital records means new jobs in that field. And the population of doctors and nurses is aging, meaning many are close to retirement.
Healthcare-related employment has been growing steadily at around 2 percent a year for many years, even during the recession, according to Ani Turner, deputy director of the Altarum Institute’s Center for Studying Health Spending, a research and consulting organization.
But in 2013, that growth started to slow, particularly in hospitals and nursing homes, Turner said.
The slowdown is a response to a drop in use of hospital services during the recession and a result of lower reimbursement rates paid through Medicare for services, Turner said.
“There is a general trend toward needing to constrain the growth in healthcare costs,” she said.
Those pressures could impact the longer-term healthcare job market.
“There are forces moving in both directions. I think there is a difference between a short-term bump and a long-term ongoing trend after that,” Turner said. “Certainly in the next few years … there will be an increased demand with the Affordable Care Act.”
But it won’t be as big a demand as some may think, Turner said. Approximately 32 million more people are expected to be insured under ACA, including people who signed up for private coverage and people newly covered by Medicaid or their employer, under the law’s new requirements. Though that amounts to about 10 percent of the U.S. population, they won’t use 10 percent of the services. People over age 65 and people who are disabled — populations that use more health services — already have government coverage.
“These are mostly adults, mostly young men. They don’t require as many services. So research suggests a bump in demand of between 2 and 3 percent, spread out over a couple of years,” Turner said. “And it will be felt in some parts of the country more than others.”
Furnanz and other students say, so far, it doesn’t look good for L.A.
“L.A. County and its surrounding areas are saturated. There are a lot of nursing schools here and it has some of the highest pay in the country,” Furnanz said.
Like her classmate, Cal State L.A. student Cheyanne Punsal said she has heard of many students who graduated last year but still don’t have jobs.
“There are too many nurses and the actual availability of jobs is not enough,” said Punsal, who is president of the Student Nurses Association.
Both Furnanz and Punsal said recent grads have to be open to jobs outside of traditional hospitals.
Jobs in home health care are growing particularly fast.
“Care in the home is preferable in a lot of situations. It is so expensive to treat a patient in a hospital. And in the long-term, more patients at home means you don’t have to build a hospital. Patients at home are more comfortable, they get healthier feaster,” Henderson said.
This means more positions for not only skilled nurses willing to work in home health care, but also less skilled aides. Job growth for home health aides is expected to reach 49 percent in the coming years, Henderson said.
“These are some of the easier careers to get into,” he said. “They are on the lower end of the pay scale, but they pay better than your average admin or childcare-type jobs.”
Home health aides, like nurse assistants, typically have to go through a certification process, but they are not required to have extensive college-level training. The average home health aide in California makes $10.52 an hour. The average nursing assistant makes $13.42, according to theBureau of Labor Statistics.
Henderson says the push to contain healthcare costs doesn’t mean fewer jobs, but it does mean where the jobs are could shift.
“And the ACA calls for better diagnosis of disease, so there will be growth in jobs in diagnostic and lab testing,” he added. “It calls for electronic medical records, so there is growth in IT jobs, as well as jobs in medical coding and billing.”
Henderson also sees fast job growth for nurse practitioners, physician’s assistants and primary care doctors.
The biggest demand for additional services will likely be in primary care and addressing chronic conditions that have gone untreated, Turner said.
WHERE TO BEGIN
The first hurdle facing healthcare job seekers, particularly those seeking higher wage positions, is finding a program.
While medical schools have expanded their capacity in recent years,responding to a threatened doctor shortage, there is still a severe lack of residency programs for them to continue their training in, according to Turner
Meanwhile, nursing schools across L.A. are overwhelmed with applicants.
San Bernardino Valley College has one student who has been on the waiting list for its nursing program for seven years, and she still won’t get into the program until next year, according to Associate Dean Carol Wells, director of the nursing program.
The school is phasing out its wait list and switching to a point system. Last year it has 90 applicants for 10 spots in the point system.
Mount St. Mary’s College in Los Angeles sees three applicants for every position in its nursing program, according to Dean of Nursing Diane Vines.
Part of the problem is that nursing schools have had a hard time finding professors to teach nursing students because working in nursing pays much more than teaching it, Vines and others said.
And training nurses doesn’t come cheap.
“It costs a lot to create a nurse, for the training, the equipment. It’s a lot more expensive than educating a literature major,” Smith said.
Finding training for lower-wage health-care positions is easier — technical schools, vocational high schools, the Red Cross and other organizations offer certification programs, which are approved by the state.
But Smith warns aspiring nurses against starting in low-wage healthcare support jobs with the hope of moving up.
“It is rare to find a lot of upward mobility in health care. There is no vertical ladder,” she said.
And two-year nursing programs aren’t cutting it anymore, the experts said. Hospitals are increasingly requiring their nurses to have four-year bachelor’s degrees.
“There is a lot of movement in upscaling, in requiring more education,” Smith said.
Wells recommends students interested in careers in health care start on the career path in high school.
“They should work hard in their sciences, in math. And they should be persistent. They’ll get into a program, eventually,” she said.