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Health Services

Nature of the Industry  |  Working Conditions  |  Employment  |  Occupations in the Industry
Training and Advancement  |  Job Outlook  |  Earnings

Significant Points

• Health services is one of the largest industries in the country, with more than 11 million jobs, including the self-employed.
• About 13 percent of all wage and salary jobs created between 2000 and 2010 will be in health services.
• Nine out of 20 occupations projected to grow the fastest are concentrated in health services.
• Most jobs require less than 4 years of college education.

Nature of the Industry

More than 469,000 establishments make up the health services industry; all vary greatly in terms of size, staffing patterns, and organizational structures. Two-thirds of all private health services establishments are offices of physicians or dentists. Although hospitals constitute less than 2 percent of all private health services establishments, they employ nearly 40 percent of all workers (table 1). When government hospitals are included, the proportion rises to 45 percent of the workers in the industry.
 

Table 1. Percent distribution of wage and salary employment and establishments in private health services, 2000
Establishment type	Establishments	Employment
Total, health services	100.0	100.0
Hospitals, private	1.6	39.3
Offices of physicians including osteopaths	41.1	19.7
Nursing and personal care facilities	4.5	17.9
Offices and clinics of dentists	23.8	6.8
Home healthcare services	3.1	6.3
Offices of other health practitioners	19.2	4.4
Health and allied services, not elsewhere classified	3.3	3.5
Medical and dental laboratories	3.5	2.1

 
The health services industry includes establishments ranging from small-town private practice physicians who employ only one medical assistant to busy inner city hospitals that provide thousands of diverse jobs. More than half of all non-hospital health services establishments employ fewer than 5 workers (see chart). On the other hand, almost two-thirds of hospital employees were in establishments with more than 1,000 workers (see chart).

The health services industry consists of the following eight segments:

Hospitals. Hospitals provide complete healthcare, ranging from diagnostic services to surgery and 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 also expanded into long-term and home healthcare services, providing a continuum of care for the communities they serve.

Nursing and personal care facilities. Nursing facilities provide inpatient nursing, rehabilitation, and health-related personal care to those who need continuous healthcare, 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.

Offices and clinics of physicians, including osteopaths. Physicians and surgeons practice privately or in groups of practitioners who have the same or different specialties. Group practice has become the recent trend, including clinics, freestanding emergency care centers, and ambulatory surgical centers. Physicians and surgeons are increasingly working as salaried employees of group medical practices, clinics, or integrated healthcare systems.

Home healthcare services. Skilled nursing or medical care is sometimes provided in the home, under a physician’s supervision. Home healthcare 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 make this once small segment of the industry into one of the fastest growing in the U.S. economy.

Offices and clinics of dentists. Almost 1 out of every 4 healthcare establishments is a dentist’s office. Most employ only a few workers, who provide general or specialized dental care, including dental surgery.

Offices and clinics of other health practitioners. This segment includes offices of chiropractors, optometrists, and podiatrists, as well as occupational and physical therapists, psychologists, audiologists, speech-language pathologists, dietitians, and other miscellaneous health practitioners. Demand for the services of this industry 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 industry also includes alternative-medicine practitioners, such as acupuncturists, homeopaths, hypnotherapists, and naturopaths.

Health and allied services, not elsewhere classified. Among the diverse establishments in this group are kidney dialysis centers, drug treatment clinics and rehabilitation centers, blood banks, and providers of childbirth preparation classes.

Medical and dental laboratories. Medical 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, or perform other clinical tests. In dental laboratories, workers make dentures, artificial teeth, and orthodontic appliances. Medical and dental laboratories provide the fewest number of jobs in health services.

In the rapidly changing health services 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 longevity and improve the quality of life for many Americans. Advances in medical technology also have improved the survival rates of trauma victims and the severely ill, who then need extensive care from therapists and social workers, among other support personnel.

Advances in information technology also 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 electronically transferred to a main database, eliminating paper and reducing record-keeping errors.

Cost containment also is shaping the healthcare 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 that reduces the eventual cost of undiagnosed, untreated medical conditions. Enrollment in managed healthcare programs—predominantly Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), and hybrid plans such as Point-of-Service (POS) 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 (IDS). An IDS combines two or more segments of the industry to increase efficiency through the streamlining of functions, primarily financial and managerial. According to a 2000 Deloitte & Touche survey, only 48 percent of surveyed hospitals expect to be stand-alone, independent facilities in 2005, as compared with 61 percent in 2000. These changes will continue to reshape not only the nature of the health services workforce, but also the manner in which health services are provided.

Working Conditions

Nonsupervisory workers in private health services averaged 33.1 hours per week in 2000, compared with 34.5 for all private industry. Hours varied somewhat among the different segments of the industry. Workers in home healthcare averaged only 29.5 hours per week; those in nursing and personal care facilities worked 32.6 hours; and hospital workers averaged 35.0 hours. 

Many workers in the health services industry are on part-time schedules. Part-time workers made up 15.3 percent of the workforce as a whole in 2000, but accounted for 36.8 percent of workers in offices and clinics of dentists and 18.8 percent of those in offices of physicians. Students, parents with young children, dual jobholders, and older workers make up much of the part-time workforce. 

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

In 1999, the incidence rate for occupational injury and illness in hospitals was 9.2 cases per 100 full-time workers, compared with an average of 6.3 for the private sector. Nursing and personal care facilities had a much higher rate, 13.5. Healthcare workers involved in direct patient care must take precautions to guard against back strain from lifting patients and equipment, exposure to radiation and caustic chemicals, and 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

The health services industry provided more than 11 million wage and salary jobs in 2000. Almost one-half of all salaried health services jobs were in hospitals; another one-third were in either nursing and personal care facilities or offices of physicians including osteopaths. About 91 percent of wage and salary jobs were in the private sector; the remainder, in State and local government hospitals. 

In 2000, there were about 383,000 self-employed workers in the health services industry. Of these, more than two-thirds were in offices of physicians, dentists, and other health practitioners. Health services jobs are found throughout the country, but are concentrated in large States, specifically California, New York, Florida, Texas, and Pennsylvania. 

Workers in health services tend to be older than workers in other industries. They are also 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. 

Occupations in the Industry

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. They may supervise other workers or conduct research, as well as provide services.

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 these positions; these 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. This group includes nursing aides, home health aides, maids and housekeeping cleaners, dental assistants, medical assistants, and personal and home care aides. Service workers may advance to higher level positions or transfer to new occupations, with experience and, in some cases, further education and training.

Most jobs in health services provide clinical services, but there also are many in occupations with other functions as well. 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 services administration, some enter these jobs with a general business education.

Each segment of the health services industry employs a different mix of health-related occupations and other workers.

Hospitals. Hospitals employ workers with all levels of education and training to provide a wider variety of services than other segments of the health services industry. About 1 in 4 hospital workers is a registered nurse. Hospitals also employ many physicians and surgeons, therapists, and social workers. About 1 in 5 jobs is in a service occupation, such as nursing, psychiatric, and home health aide, or building cleaning worker. Hospitals also employ large numbers of office and administrative support workers.

Nursing and personal care facilities. More than three-fifths of all nursing facility jobs are in service occupations, primarily nursing, psychiatric, and home health aides. Professional and administrative support occupations are a much smaller percentage of employment in nursing facilities than in other parts of the health services industry. Federal law requires nursing facilities to have licensed personnel on hand 24 hours a day, and to maintain an appropriate level of care.
 

Table 2. Employment of wage and salary workers in health services by occupation, 2000 and projected change, 2000-10 (Employment in thousands)
Occupation	Employment, 2000		Percent change, 2000-10
	Number	Percent
All occupations	11,065	100.0	25.5
Management, business, and financial occupations	546	4.9	27.3
Medical and health services managers	167	1.5	34.9
Business operations specialists	87	0.8	19.2
Professional and related occupations	4,975	45.0	26.9
Social workers	110	1.0	37.2
Dentists	86	0.8	13.7
Physicians and surgeons	459	4.1	27.8
Registered nurses	1,774	16.0	25.3
Physical therapists	109	1.0	36.7
Medical and clinical laboratory technologists	133	1.2	18.0
Medical and clinical laboratory technicians	121	1.1	18.9
Dental hygienists	142	1.3	37.1
Radiologic technologists and technicians	159	1.4	23.5
Health diagnosing and treating practitioner support technicians	210	1.9	23.9
Licensed practical and licensed vocational nurses	552	5.0	18.8
Medical records and health information technicians	118	1.1	54.1
Service occupations	3,275	29.6	29.5
Dental assistants	237	2.1	37.8
Home health aides	261	2.4	59.6
Nursing aides, orderlies, and attendants	1,053	9.5	21.7
Medical assistants	301	2.7	59.8
Medical transcriptionists	87	0.8	30.3
Food preparation workers	98	0.9	15.4
Food and beverage serving workers	97	0.9	3.9
Janitors and cleaners, except maids and housekeeping cleaners	93	0.8	21.9
Maids and housekeeping cleaners	245	2.2	12.4
Personal and home care aides	160	1.4	66.8
Office and administrative support occupations	1,987	18.0	16.0
First-line supervisors/managers of office and administrative support workers	147	1.3	3.3
Billing and posting clerks and machine operators	166	1.5	29.0
Bookkeeping, accounting, and auditing clerks	96	0.9	15.6
Receptionists and information clerks	288	2.6	26.6
Office clerks, general	264	2.4	12.2
Medical secretaries	280	2.5	20.0
Secretaries, except legal, medical, and executive	144	1.3	2.1
Installation, maintenance, and repair occupations	80	0.7	9.8
Production occupations	118	1.1	13.7
NOTE: May not add to totals due to omission of occupations with small employment.

 
Offices and clinics of physicians, including osteopaths. Many of the jobs in offices of physicians are in professional and related occupations, primarily physicians and surgeons and registered nurses. A large number of jobs, however, are in office and administrative support occupations, such as receptionists and information clerks, who comprise one-third of the workers in physicians’ offices.

Home health care services. More than half of the jobs in home health care 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 industry.

Offices and clinics of dentists. More than one-third of the jobs in this segment are in service occupations, mostly dental assistants. The typical staffing pattern in dentists’ offices consists of one professional with a support staff of dental hygienists and dental assistants. Larger practices are more likely to employ office managers and administrative support workers, as well as dental laboratory technicians.

Offices and clinics of other health practitioners. Professional and related occupations accounted for about 2 in 5 jobs in this segment, including physical therapists, occupational therapists, dispensing opticians, and chiropractors. Office and administrative support occupations also accounted for a significant portion of all jobs, almost one-third.

Medical and dental laboratories. Professional and related workers account for more than one-third of all jobs in this industry segment, primarily clinical laboratory and radiologic technologists and technicians. Unlike the case in other segments of the health services industry, many jobs also are in production occupations—most notably, dental laboratory technicians.

Health and allied services, not elsewhere classified. This segment of the health services industry employs the highest percentage of professional and related workers, including counselors, social workers, and registered nurses.

Training & Advancement

A variety of programs after high school provide specialized training for jobs in health services. Students preparing for healthcare careers can enter programs leading to a certificate or a degree at the associate, baccalaureate, professional, 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; physicians and surgeons, optometrists, and podiatrists have significant additional education and training beyond college. Persons considering careers in healthcare should have a strong desire to help others, genuine concern for the welfare of patients and clients, and an ability to deal with diverse people and stressful situations. 

The health services industry provides many job opportunities for people without specialized training beyond high school. In fact, 56 percent of the workers in nursing and personal care facilities have a high school diploma or less, as do 25 percent of the workers in hospitals. 

Some health services 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 segments of the industry to have the resources and incentive to provide training programs and advancement opportunities to their employees. In other segments, staffing patterns tend to be more fixed and the variety of positions and advancement opportunities 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 for a particular length of time in the hospital 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. 

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. 

Job Outlook

Many of the occupations projected to grow fastest are concentrated in the health services industry. For example, by 2010, employment within the health services industry of personal and home care aides is projected to increase by 67 percent, medical assistants by 60 percent, physician assistants by 57 percent, and medical records and health information technicians by 54 percent.

Employment in health services will continue to grow for a number of reasons. The elderly population, a group with much greater than average healthcare needs, will grow faster than the total population between 2000 and 2010, increasing the demand for health services, especially for home healthcare and nursing and personal care. 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. In addition, new technologies enable the identification and treatment of conditions not previously treatable. Medical group practices and integrated healthcare systems will become larger and more complex, increasing the need for office and administrative support workers. Also contributing to industry growth will be the shift from inpatient to less expensive outpatient care, made possible by technological improvements and Americans’ increasing awareness of and emphasis on all aspects of health. Various combinations of all these factors will ensure robust growth in this massive, diverse industry.

Employment growth in the hospital segment will be the slowest within the health services industry, as the segment consolidates to control costs and as clinics and other alternate care sites become more common. Hospitals will streamline healthcare delivery operations, provide more outpatient care, and rely less on inpatient care. Job opportunities, however, will remain plentiful because hospitals employ a large number of people. Besides job openings due to employment growth, additional openings will result as workers leave the labor force or transfer to other occupations. Occupations with the most replacement openings are usually large, with high turnover due to low pay and status, poor benefits, low training requirements, and a high proportion of young and part-time workers, such as nursing, psychiatric, and home health aides. Occupations with relatively few replacement openings, on the other hand, are those with high pay and status, lengthy training requirements, and a high proportion of full-time workers, such as physicians and surgeons.

The fastest growth is expected for workers in occupations concentrated outside the inpatient hospital sector, such as medical assistants and personal and home care aides. Because of cost pressures, many healthcare facilities will adjust their staffing patterns to lower bottom-line labor costs. Where patient care demands and regulations allow, healthcare facilities will substitute lower-paid providers and cross-train their workforce. Many facilities have cut the number of middle managers, while simultaneously creating new managerial positions as they diversify. Because traditional inpatient hospital positions are no longer the only option for many future healthcare workers, persons seeking a career in the field must be flexible and forward-looking (see chart).

The demand for dental care will increase due to population growth, greater retention of natural teeth by middle-aged and older persons, and greater awareness of the importance of dental care and ability to pay for services.

For some management, business, and financial operations occupations, rapid growth will be countered by restructuring to reduce administrative costs and streamline operations. The effects of 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 have job openings due to replacement needs.

Technological changes, such as increased laboratory automation, will negatively affect the demand for other occupations as well. For example, the use of robotics in blood analysis may limit job growth of medical and clinical laboratory technologists and technicians, although the nature of healthcare precludes wholesale productivity gains in many instances.

Health services workers at all levels of education and training will continue to be in demand. In many cases, it may be easier for job seekers with health-specific training to obtain jobs and advance. Specialized clinical training is a requirement for many jobs in health services and is an asset even for many administrative jobs that do not specifically require it.  

Earnings

As in most industries, professionals and managers working in health services typically earn more than other workers do. Earnings in individual health services occupations vary as widely as their duties, level of education and training, and amount of responsibility (table 4). Some establishments offer tuition reimbursement, paid training, child daycare services, and flexible work hours. Healthcare establishments that must be staffed around the clock to care for patients and handle emergencies often pay premiums for overtime and weekend work, holidays, late shifts, and time spent on call. Bonuses and profit-sharing payments also may add to earnings.

Earnings vary not only by type of establishment and occupation, but also by size. Salaries are often higher in larger hospitals and group practices. Geographic location also can affect earnings.
 

Table 4. Median hourly earnings of the largest occupations in health services, 2000
Occupation	Health services	All industries
Medical and health services managers	$27.12	$27.10
Dental hygienists	24.70	24.68
Registered nurses	21.56	21.56
Radiologic technologists and technicians	17.25	17.31
Licensed practical and licensed vocational nurses	13.96	14.15
Dental assistants	12.47	12.49
Medical assistants	11.07	11.06
Receptionists and information clerks	10.15	9.63
Nursing aides, orderlies, and attendants	8.83	8.89
Home health aides	8.10	8.23

 
Unionization is more common in hospitals, although most segments of the health services industry are not heavily unionized. In 2000, 13.8 percent of hospital workers and 10.1 percent of workers in nursing and personal care facilities were members of unions or covered by union contracts, compared with 13.5 percent of all workers in private industry.

Source: Career Guide to Industries, Bureau of Labor Statistics

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