Low-Skilled, Low-Wage Workers in Health Care Bianca K. Frogner, PhD, Associate Professor, Department of Family Medicine & Director, Center for Health Workforce Studies, University of Washington Setting the Stage Selected Findings Conclusions Greater need for supply of health care workers as demand for health services increases due to: Expanding needs for aging population with multiple chronic conditions Expansion of health insurance (e.g., Medicaid) Shift towards greater use of primary care Health care has been and projected to be fastest growing employment sector In 2013, health care was 12% of total labor force in US Occupation by Health Care Setting Jobs with entry requirements with high school degree or less tend to be at higher financial risk Workers in ambulatory care settings tend to be at higher financial risk compared to workers in hospitals Not shown: Long-term care workers also tend to be at much higher financial risk than hospital workers Concern is that health care labor has a weak financial foundation that may result in high turnover and low supply especially as health reform leads to: Team-based care with greater reliance on lower skilled workers Task shifting towards low skilled workers to achieve lower costs Are compensated appropriately for higher skilled tasks? Reliance on Federal Assistance Poverty Rates Background Among top 20 fastest growing health care occupations over next decade:1 Top two fastest jobs (personal care aides and home health aides) are expected to grow over 70%, which is two to three times as fast as any other occupation Over 25% of these jobs require less than a high school degree Long-term care job leavers:2 Half leave unemployed or exit the labor force Have higher disability and poverty rates than entrants or stayers Age by Occupation References Frogner B and Spetz J. (2013) “Affordable Care Act of 2010: Creating Job Opportunities for Racially and Ethnically Diverse Populations.” Report and presentation prepared for and published by Joint Center for Political and Economic Studies Report Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry-and-exit-workers-long-term-care Insurance Status Study Design Funding Other Selected Demographics Research Question: In which health care jobs are workers at highest financial risk? To what extent are workers relying on federal support? Data and Methods: Data: Current Population Survey, Annual Social and Economic Supplement (“March Supplement”) [2011-2013] Annual cross-sectional survey of approximately 100,000 households (200,000 individuals) weighted for national representation Sample: individuals employed in 10 allied health jobs, 18-75 years old Less than Bachelor’s level education entry requirements Excluded self-employed workers Health care jobs defined using 2009 Standard Occupation Classification System Minority Single Child under 18 Part-time All employed 20.1 44.9 43.6 18.8 Less than high school Personal and home care aides 32.6 60.6 47.2 43.5 Nursing, psychiatric and home health aides 43.7 61.1 50.4 30.9 High school Pharmacy aides 18.1 64.2 30.2 36.1 Medical assistants 21.8 52.4 52.2 21.0 Post-secondary Emergency medical technicians and paramedics 8.3 46.5 45.7 10.4 Massage therapiasts 15.3 58.6 42.7 57.6 Dental assistants 17.6 38.5 52.9 34.8 Medical records and health information technicians 45.2 49.8 13.3 Phlebotomists 32.8 44.7 56.1 18.9 Licensed practice and vocational nurses 33.7 45.4 55.9 17.8 This study was supported by the National Center for Health Workforce Analysis (NCHWA), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement # U81HP27844. The information, conclusions and opinions expressed in this presentation are those of the authors and no endorsement by NCHWA, HRSA or HHS is intended or should be inferred. For more information Bianca K. Frogner, PhD Associate Professor, Department of Family Medicine Director, Center for Health Workforce Studies University of Washington bfrogner@uw.edu 206.616.9657 http://depts.washington.edu/uwchws/