California Health Care Employment Outlook: 2010-20 Richard Holden Regional Commissioner U.S. Bureau of Labor Statistics CHWA/CHPC Meeting September 6, 2012

Employment Projections Background 10-year projections made every 2 years 2010-20 projections cover over 700 occupations and 300 industries Projections are used to produce the Occupational Outlook Handbook—which has been published since 1949 The BLS Employment Projections Program produces a new set of 10-year projections every 2 years. The 2010-20 National Employment Matrix covers over 700 detailed occupations and 300 detailed industries. (Exact numbers are 749 occupations and 328 industries.) The projections form the basis for data and outlook information in the Occupational Outlook Handbook, with a new edition of the Handbook released shortly after each new set of projections is published. (The 2012-13 edition of the Handbook, prepared using 2010-20 projections, is expected to be released in late March 2012.) Other users of the projections include: Career counselors and students making career choice decisions Mid-career jobseekers looking to switch occupations State educational program planners reviewing curriculum

Other Uses of Employment Projections Data Career counselors and students making career choice decisions Mid-career jobseekers looking to switch occupations Education and training officials to make decisions on policy, funding, and program offerings Researchers interested in how the economy is changing A wide variety of people use employment projections data. This includes but is not limited to: Career counselors and students making career choice decisions Mid-career jobseekers looking to switch occupations State educational program planners reviewing curriculum Researchers interested in how the economy is changing

Employment Projections Process Labor Force Total and by age, sex, race and ethnicity Aggregate Economy GDP, total employment, and major demand categories Demographics Fiscal policy Foreign economies Energy prices Monetary policy Population Labor force participation rate trends Occupational Employment Job openings due to growth & replacement needs Industry Final Demand Sales to consumers, businesses, government, and foreigners Staffing patterns Staffing pattern ratio analyses Staff expertise Replacement rates Economic censuses Annual economic surveys Other data sources The BLS projections are developed in a series of six steps- Size and demographic composition of the labor force The labor force is the number of people available to fill job openings. The projected labor force is based on estimates from the Census Bureau of the future population by age, sex, race, and ethnicity. BLS projects the percent of the population who will participate in the labor force in the coming decade. The growth of the aggregate economy A macroeconomic model is used to project Gross Domestic Product, consumer spending, investment, government spending, imports and exports, and other major economic measures. Final demand by industry sector The projected final demand categories are disaggregated to project the final demand, in sales to consumers, for each industry sector. Industry output Input-Output tables from the Bureau of Economic Analysis are used to determine the relationships between industries and project the output that will be needed from each industry to satisfy the final demand from the previous step, including outputs which are used by other industry sectors as an input towards satisfying their final demand. Industry employment The BLS models industry employment as a function of industry output, wages, prices, and time. Together with the industry output projections, employment results provide a measure of labor productivity. BLS analysts examine the implied growth rates in projected productivity for consistency with historical trends. At the same time, analysts attempt to identify industries that may deviate from past behavior because of changes in technology or other factors. Where appropriate, changes to the employment estimates are made by modifying either the employment demand itself or the results from earlier steps in the projections process. Occupational employment Occupational demand is projected by applying each industry’s unique staffing pattern to industry employment estimates. BLS analysts consider changes in technology, business practices, and other factors to project how staffing patterns will evolve over the coming decade. Occupational replacement needs are also projected to help determine the total number of job openings projected to be available in each occupation. Industry Employment Labor productivity, average weekly hours, wage & salary employment Industry Output Use and Make Relationships, Total Requirements Tables Industry output Sector wage rates Technological change Input-Output Tables 4 4

Population and Labor Force Millions of persons Population projections shown here are for the civilian non-institutional population aged 16 and over, which excludes members of the Armed Forces and the institutional population. Fertility, mortality and most importantly, immigration are the main drivers of population growth. Immigrants have high labor force participation rates that, in addition to their increasing numbers, impacts the growth of the labor force. Population growth and changes in labor force participation rates are the main factors of labor force growth. To be in the civilian labor force, one must be part of the civilian, non-institutional population, 16 years or older, and either working or actively looking for a job. The number of persons working or looking for work is projected to increase by 10.5 million over the 2010-20 period, compared to 16.7 million from 1990-2000 and 11.3 million from 2000-2010. BLS labor force projections are made for 136 age, race, sex and Hispanic origin groups. 2000 2010 Projected 2020 2000 2010 Projected 2020 Population Data Source: U.S. Census Bureau

Population Growth Rate Annual rates of change The growth of the civilian non-institutional population, 16 and over is projected to slow over the 2010-20 period. Since 2000, the labor force has experienced a significant slow down replacing the higher rates of growth experienced from 1970-1990. Labor force growth rates have been and will continue to be greatly impacted by the baby boom generation (persons born between 1946 and 1964). The labor force growth over the 1970-80 period mainly reflected the entry of the baby boomers into the labor force. This period also coincided with a huge increase in the labor force participation of women. The projected slowing of the labor force is mainly attributable to the retiring of the earliest baby boomers. By 2020, all baby boomers will be in the 55+ age group, which has distinctively lower labor force participation rates. As a greater share of the boomers reach retirement age, the labor force growth rates are expected to decline more rapidly. However, this group is expected to stay in the labor force longer than previous generations. Population Data Source: U.S. Census Bureau

Labor Force Participation Rates Percent Men Total This chart shows the convergence of men’s and women’s labor force participation rates throughout the decades. The rise of women’s participation rates seems to have leveled. From the 1950s until 2000, men and women’s labor force participation rates were converging with declines in men’s participation rate and increases in women’s. Since 2000, men’s labor force participation rate has continued to decline. Women’s labor force participation rate has also declined, but more slowly. Men’s participation rates have declined since the late 1940’s. The decline is due in part to the increased availability of disability and Social Security benefits. Women’s participation rate peaked in 1999 at 60 percent and has been declining since then. The BLS is projecting a slight decline in women’s participation rates. BLS is projecting a decline in overall participation rates for 2020. The decline is due in large part to baby boomers leaving the labor force. Women

Labor Force Change by Age Group: Projected 2010-20 In thousands of people As baby boomers age, the labor force will also get older. The 55 to 64 age group in the labor force will grow significantly. The labor force of the 65 and older age group will also grow as more baby boomers enter this age group. The large increase of 25-34 year olds is the result of more workers from the baby boom echo generation reaching this age group. The decline in the 16 to 24 age group of the labor force is the result of the significant decreases in the labor force participation rate of the younger workforce, which is a result of increased school attendance. The largest drop is in the 45-54 year old group, as baby boomers age out of this group.

Labor Force Growth by Race and Ethnicity Change in millions, projected 2010-20 The four yellow bars to the left of the vertical line represent all race groups and the two blue bars to the right of the vertical line represent all ethnicity groups. When you add the bars shown in yellow or the bars shown in blue, they equal total growth in population. The “Other” category includes 1) those of multiple racial origin 2) American Indians and Alaskan Natives 3) Native Hawaiian and other Pacific Islanders. Although white people are projected to have the slowest rate of growth, they are still adding more workers to the labor force than any other group. Unlike the changes in race where the white population is projected to add more workers to the labor force than other races despite slow growth, the increase in the number of Hispanic workers is expected to exceed that of Non-Hispanic workers. The classification of Hispanic ethnicity applies to people of every race.

Unemployment Rate Based on literature reviews and forecasts by other agencies and firms, BLS set the unemployment rate in 2020 associated with a full-employment economy at 5.2 percent. Due to the unpredictability of the business cycle over a ten-year period, BLS assumes the economy will be at full employment in the projection year (2020). (For clarification if questions are asked.) Labor supply in the projection year is assumed to be equivalent to labor demand except for a small amount of assumed frictional unemployment, generally estimated by the non-accelerating inflation rate of unemployment (NAIRU). Given the severity of labor market impacts related to the recent recession, there has been much discussion regarding impacts on NAIRU. Based on literature reviews and forecasts by other agencies and firms, BLS set the unemployment rate in 2020 associated with a full-employment economy at 5.2 percent.

Historic Data Source: U.S. Bureau of Economic Analysis Inflation Rate Annual rate of change The inflation rate represented here is measured by GDP price. Inflation is a monetary phenomenon that is influenced mostly by monetary policy, and to a lesser degree by exchange rates and global monetary flows. The BLS projections assume the Federal Funds rate will average 4.5% and the 10-year Treasury is projected to reach 5.5% in 2020. Historic Data Source: U.S. Bureau of Economic Analysis

Housing Starts: 1960 to 2010 and Projected 2020 (Thousands of units) Recession year Housing starts had not fallen below 1 million units before 2008, but were below 600,000 in both 2009 and 2010. The timing and magnitude of the housing recovery at this time is highly uncertain. Housing starts are a target variable in the 2020 projections.  The result was carefully analyzed and a target range was set through research including external model analysis, extensive literature review, and discussion with industry experts.  BLS expects that by 2020, the excess supply of housing will clear, including the overhang of shadow inventory.  The market will be based largely on demographic and economic trends. Housing starts are projected to reach 1.5 million units in 2020, much improved from just under 600,000 in 2009 and 2010, but considerably lower than the 2.1 million units started in 2005. Historic Data Source: U.S. Census Bureau

Nonagricultural Wage and Salary Employment Millions of jobs Employment on this graph includes non-farm payroll employment, which excludes agricultural, self employed and unpaid family workers. Employment is expected to grow by 1.4% a year, reversing the 0.2% annual rate decline experienced during the previous decade. The decline from 2000-10 reflects the December 2007-June 2009 recession, and the fact that employment had not fully recovered by 2010. Nonagricultural Wage and Salary Employment

The “Lost” Decade In 2000, total of 132.4 million jobs 2000-2010 Projection: 152 million total jobs in 2010 2000-2010 Actual: 130.4 million jobs in 2010 2020 Projected Employment: 150.2 million

Employment by Industry Sector: 2010 Thousands of wage and salary jobs State and local government, which includes public education and public hospitals, is the largest in terms of jobs by industry sector. Manufacturing is sixth in terms of jobs, despite being first by a large margin in terms of nominal output, because the sector has very high productivity. Educational services and health care and social assistance include only private organizations. Service providing Goods producing

Employment Change by Industry Sector: Projected 2010-20 Thousands of wage and salary jobs Service providing Goods producing Health care and social assistance is expected to add the most jobs, despite being the third largest sector by jobs in 2010. The projected change in demographics is largely driving the growth in the number of jobs being added in this sector. The increasing number of people 65 years and older will require more health care. Of the goods-producing sectors, only construction is projected to have a significant gain in employment. Despite this projected growth, the construction industry is still projected to be below the number of jobs the industry had in 2006. Federal government is the sector projected to see the largest declines. The increased pressure to reduce the government budget deficit will be one of the major contributors to the loss of employment. The Postal Service is expected to be responsible for almost half of the decrease in employment in the federal government sector. With wider spread use of e-mail, online bill pay, and the decrease circulation of magazines, consumers are moving away from services provided by the Postal Service industry. State and local government includes public education and hospitals.

Percent Change in Employment by Industry Sector: Projected 2010-20 Annual rate of change for wage and salary employment Total nonagricultural wage and salary growth= 1.4% Health care and social assistance, which is made of private institutions, is the fastest growing industry in addition to being the largest in terms of projected employment gains. Construction employment is projected to grow fast, but the construction industry in 2020 is still projected to be below the number of jobs the industry had in 2006. Educational services, which is made of private educational institutions, is the third fastest growing sector in terms of employment. However, it is ranked ninth in terms of the number of jobs added. Federal government is the sector projected to see the largest declines. The increased pressure to reduce the government budget deficit will be one of the major contributors to the loss of employment. The Postal Service is expected to be responsible for almost half of the decrease in employment in the federal government sector. With wider spread use of e-mail, online bill pay, and the decrease circulation of magazines, consumers are moving away from services provided by the Postal Service industry. State and local government includes public education and hospitals. Service providing Goods producing

Employment Change by Major Occupational Group Thousands of jobs, projected 2010-20 The largest occupational group with over 22.6 million jobs in 2010, office and administrative support occupations are also projected to add the most new jobs: 2.3 million through 2020, despite the group growing slower than average at 10.3 percent. The majority of projected job growth will be recovery from the recession, which caused the loss of 1.7 million jobs for this group from 2006 to 2010. Healthcare practitioners and technical occupations are projected to add 2.0 million new jobs from 2010 to 2020, the second most of any group. The fast growth for this occupational group is driven by increased spending on healthcare services, particularly from an aging population. Older individuals spend more on healthcare than those who are younger, so as the share of the population aged 65 and older grows, healthcare spending is expected to increase. Sales and related occupations are projected to add 1.9 million new jobs from 2010 to 2020 as this large occupational group grows at a slightly below average 12.5 percent rate. This follows the loss of 1.1 million jobs from 2006 to 2010. (Continued on next slide.) (Continued on next slide)

Employment Trends for Occupational Groups whose Employment Increased 2006-10 Percent of 2006 employment This graph shows occupational groups which grew by at least 2 percent from 2006 to 2010; all of these groups are projected to see continued growth through 2020. The two groups with the fastest growth from 2006 to 2010 were healthcare practitioners and technical occupations, and healthcare support occupations. These two groups are projected to continue to see strong growth, adding a combined 3.5 million jobs from 2010-20 after gaining 1.1 million from 2006-10. NOTE: BLS does not project specific data for years to 2020. The interim years between 2010 and the 2020 projection point are expressed by a straight dashed line only.

Employment Growth vs. Replacement Needs The new few slides look at job openings for occupations. This combines openings due to growth and openings from the need to replace workers who leave the occupation. Many replacement openings will be due to retirements. However, many replacement openings occur in occupations, such as cashiers, that have large numbers of young workers, such as high school or college students, who need to be replaced when they leave to find permanent employment. Compare: Numeric employment change- the number of jobs an occupation is projected to add Registered nurses are the occupation projected to add the most new jobs—711.9 thousand from 2010-20. Job openings- job openings result both from growth and from the need to replace workers who leave the occupation Replacement needs often create more job openings than employment growth. The vast majority of the 1.8 million projected job openings for cashiers are from replacement needs, not employment growth. Job openings can give a different picture than just looking at projected growth. Despite registered nurses being projected to add the most new jobs, cashiers are projected to have over 500,000 more projected job openings due to the large number of replacement needs. 1.8 M

Job Openings by Major Occupational Group Thousands of job openings, projected 2010-20 This slide couples job openings due to growth and job openings from the need to replace workers who leave the occupation. Many of these replacement openings will be due to retirements. However, many replacement openings occur in occupations, such as waiters and waitresses, that have large numbers of young workers, such as high school or college students, who need to be replaced when they leave to find permanent employment. For most occupational groups, job openings from replacement needs outnumber job openings due to growth. (Continued on next slide.) (Continued on next slide)

Job Openings by Major Occupational Group (Continued) Thousands of job openings, projected 2010-20 (Continued from previous slide.) This slide couples job openings due to growth and job openings from the need to replace workers who leave the occupation. Many of these replacement openings will be due to retirements. However, many replacement openings occur in occupations, such as waiters and waitresses, that have large numbers of young workers, such as high school or college students, who need to be replaced when they leave to find permanent employment. For most occupational groups, job openings from replacement needs outnumber job openings due to growth. As seen with the farming, fishing, and forestry occupations, job openings will be created through replacement needs even for occupations (or occupational groups) which are projected to decline in employment.

Fastest Growing Occupations Median annual wages, May 2010 $19,640 $20,560 $81,540 $27,780 $25,760 $29,710 $38,430 $49,690 $26,740 $45,260 Percent change, projected 2010-20 This slide shows the top ten fastest growing detailed occupations (the largest projected percentage increase from 2010 to 2020). The increase in health care employment is reflected here with three of the ten in either the healthcare practitioner and technical occupations group or the healthcare support occupations group. (Note, in case of question: following the SOC structure, this includes veterinary technologists and technicians, in addition to home health aides and physical therapist assistants.) Four of the ten are construction and extraction occupations, which are projected to grow as the construction industry begins to recover from the recent recession. The two fastest growing occupations, personal care aides and home health aides, will be affected by demographic changes. Both assist the elderly, convalescents, and persons with disabilities in the person’s home or in a care facility. Home health aides provide health services such as administering medications, while personal care aides provide general services, such as cooking meals. The growing elderly population will require some care and assistance in their own homes or health care facilities, which should lead to increased demand for these occupations. Although biomedical engineers and reinforcing iron and rebar workers are on this list, they are expected to add relatively few jobs, adding 9,700 and 9,300 respectively. Six of these occupations make less than median annual wage for May 2010 of $33,840.

Occupations with the Largest Job Growth Median annual wages, May 2010 $64,690 $20,670 $20,560 $19,640 $26,610 $17,950 $30,460 $37,770 $23,460 $45,690 Thousands of jobs, projected 2010-20 This slide show the ten occupations expected to add the most jobs from 2010-20. Many of the occupations listed in the table are very large and will create many new jobs despite lower growth rates. The expected growth in health care will drive the demand for registered nurses, which are projected to add the most new jobs, and home health aides. Two office and administrative support occupations appear on this list as well (office clerks, general; and customer service representatives), primarily because they are large occupations that are employed across many industries. Both had more than two million jobs in 2010. Only two of these occupations, home health aides and personal care aides, are also amongst the fastest growing occupations. Seven of these occupations make less than median annual wage for May 2010 of $33,840.

Occupations with the Most Job Openings Median annual Wages, May 2010 $20,670 $18,500 $18,330 $64,690 $17,950 $26,610 $23,460 $30,460 $20,560 $22,210 Thousands of job openings, projected 2010-20 This slide shows the ten occupations expected to have the most total job openings due to both employment growth and replacement needs. Registered nurses and home health aides are the only occupations on the chart expected to add more jobs due to employment growth than replacement needs. Of these occupations, only registered nurses make more than the median annual wage for May 2010 of $33,840. For some of the occupations, such as retail salespersons and cashiers, the replacement needs will be the result of the large number of young workers that leave this occupation permanently. For other occupations, such as registered nurses, the replacement needs will be due to a number of older workers’ retirement.

Percent Change in Employment by Typical Entry-level Education Category Average, all occupations = 14.3% Percent change, projected 2010-20 When grouped by typical entry-level education, all education categories that typically need some postsecondary education are projected to have faster-than-average employment growth. Those occupations assigned to the high school or less than high school categories will grow slower than the average. (Note: These data reflect the sum of base-year and projected year employment for occupations assigned to each category. Some detailed occupations which typically require postsecondary education are projected to grow slower than average, and some detailed occupations which typically require a high school diploma or less are projected to grow faster than average.)

Employment Change by Typical Entry-level Education Category Thousands of jobs, projected 2010-20 Despite being the only two education categories projected to grow slower than average, occupations that typically need a high school diploma or equivalent or less than high school are projected to add the most and second most new jobs, respectively, due to their large size. (Note: These data reflect the sum of projected employment change from 2010-20 for occupations assigned to each category. This is not the same as a projection of the number of workers with each of these education levels. Workers may have educational attainment that is either higher or lower than that typically needed for entry into the occupation in which they are employed.)

Graduate Degree Occupations with the Largest Job Growth Median annual wages, May 2010 N $62,050 I/R ≥$166,400 $76,310 $112,760 $111,570 $53,380 $47,230 $38,150 $32,350 $72,320 Thousands of jobs, projected 2010-20 These are the ten occupations that have the largest projected job growth and typically need a graduate degree (Master’s, Doctoral, or Professional degree) to enter the occupation. Most high-growth occupations in these educational categories are related to healthcare, education, and social services. The projected increase in the number of postsecondary teachers reflects expanding college enrollments. ‘W’ indicates whether WORK EXPERIENCE IN A RELATED OCCUPATION is also typically needed for entry into the occupation. Assignments are more than 5 years (5+), 1-5 years (1-5), less than 1 year (<1), or none (N). ‘T’ indicates whether ON-THE-JOB TRAINING is typically needed to attain competency in the occupation. Assignments are internship/residency (I/R), apprenticeship (A), long-term (L), moderate-term (M), short-term (S), or none (N).

Associate’s Degree or Postsecondary Non-degree Award Occupations with the Largest Job Growth Median annual wages, May 2010 N $64,690 $24,010 $40,380 $25,700 $22,760 $33,470 L $42,530 5+ $83,860 1-5 $94,400 $30,360 Thousands of jobs, projected 2010-20 These are the ten occupations that have the largest projected job growth and typically need an Associate’s degree or postsecondary non-degree award to enter the occupation. At these levels of education, occupations that are projected to gain the most jobs are largely related to healthcare, reflecting the growing medical needs of an aging population. ‘W’ indicates whether WORK EXPERIENCE IN A RELATED OCCUPATION is also typically needed for entry into the occupation. Assignments are more than 5 years (5+), 1-5 years (1-5), less than 1 year (<1), or none (N). ‘T’ indicates whether ON-THE-JOB TRAINING is typically needed to attain competency in the occupation. Assignments are internship/residency (I/R), apprenticeship (A), long-term (L), moderate-term (M), short-term (S), or none (N).

Less Than High School Occupations with the Largest Job Growth Median annual wages, May 2010 N S $20,670 $20,560 $19,640 $17,950 $23,460 $18,500 $22,210 $23,400 $29,280 $18,330 Thousands of jobs, projected 2010-20 These are the ten occupations that have the largest projected job growth and typically do not need a high school diploma to enter the occupation. While workers might not need a high school diploma to enter these occupations, they typically need on-the-job training to attain competency. ‘W’ indicates whether WORK EXPERIENCE IN A RELATED OCCUPATION is also typically needed for entry into the occupation. Assignments are more than 5 years (5+), 1-5 years (1-5), less than 1 year (<1), or none (N). ‘T’ indicates whether ON-THE-JOB TRAINING is typically needed to attain competency in the occupation. Assignments are internship/residency (I/R), apprenticeship (A), long-term (L), moderate-term (M), short-term (S), or none (N).

U.S. Health care Overview

Health Care Employment and Annual Rate of Change 2000-2010, 2010-2020 Employment, in thousands

Employment, in thousands Ambulatory Health Care Services Employment Annual Rate of Change 2000-2010, 2010-2020 Employment, in thousands

Healthcare Occupations with the Largest Projected Job Growth in the U Healthcare Occupations with the Largest Projected Job Growth in the U.S., 2010-2020 Job growth number (in thousands) Job growth percent increase Job openings due to growth and replacements (in thousands) Registered Nurses 711.9 26.0 1,207.4 Home Health Aides 706.3 69.4 837.5 Nursing Aides, Orderlies, and Attendants 302.0 20.1 496.1 Licensed Practical and Licensed Vocational Nurses 168.5 22.4 369.2 Physicians and Surgeons 168.3 24.4 305.1 Medical Assistants 162.9 30.9 243.8 Pharmacy Technicians 108.3 32.4 166.3 Dental Assistants 91.6 30.8 154.0 Physical Therapists 77.4 39.0 100.6 Emergency Medical Technicians and Paramedics 75.4 33.3 120.8

Healthcare Occupations with the Fastest Projected Job Growth in the U Healthcare Occupations with the Fastest Projected Job Growth in the U.S., 2010-2020 Job growth number (in thousands) Job growth percent increase Job openings due to growth and replacements (in thousands) Home Health Aides 706.3 69.4 837.5 Veterinary Technologists and Technicians 41.7 52.0 55.7 Physical Therapist Assistants 30.8 45.7 41.2 Diagnostic Medical Sonographers 23.4 43.5 31.7 Occupational Therapy Assistants 12.3 43.3 16.8 Physical Therapist Aides 20.3 43.1 27.6 Physical Therapists 77.4 39.0 100.6 Dental Hygienists 68.5 37.7 104.9 Audiologists 4.8 36.8 5.6 Veterinarians 22.0 35.9 34.2

Healthcare Occupations with the Most Projected Job Openings in the U.S., 2010-2020 Job growth number (in thousands) Job growth percent increase Job openings due to growth and replacements (in thousands) Registered Nurses 711.9 26.0 1,207.4 Home Health Aides 706.3 69.4 837.5 Nursing Aides, Orderlies, and Attendants 302.0 20.1 496.1 Licensed Practical and Licensed Vocational Nurses 168.5 22.4 369.2 Physicians and Surgeons 168.3 24.4 305.1 Medical Assistants 162.9 30.9 243.8 Pharmacy Technicians 108.3 32.4 166.3 Dental Assistants 91.6 30.8 154.0 Pharmacists 69.7 25.4 139.6 Emergency Medical Technicians and Paramedics 75.4 33.3 120.8

Percent of total employment Employment in Hospitals by Detailed Occupation (includes Private, State, and Local Government Hospitals – May 2011) Detailed Occupation Employment Percent of total employment Annual mean wage (May 2011) All Occupations 5,648,820 100.00% $55,180 Registered Nurses 1,642,900 29.08% $69,880 Nursing Aides, Orderlies, and Attendants 410,690 7.27% $27,220 Licensed Practical and Licensed Vocational Nurses 153,450 2.72% $41,170 Medical Secretaries 137,830 2.44% $32,490 Radiologic Technologists and Technicians 133,750 2.37% $56,910 Maids and Housekeeping Cleaners 119,320 2.11% $23,590 Medical and Health Services Managers 119,020 $101,920 Office Clerks, General 100,080 1.77% $30,730 Medical and Clinical Laboratory Technologists 98,750 1.75% $58,650 May 2011 Occupational Employment Statistics

Employment per thousand jobs Top Paying Metropolitan Areas for Registered Nurses, Nationwide (May 2011 - Top 10 Metropolitan Areas are All Located in California) Metropolitan area Employment Employment per thousand jobs Location quotient Annual mean wage Vallejo-Fairfield, CA 3,370 28.72 1.35 $120,540 San Jose-Sunnyvale-Santa Clara, CA 12,120 13.82 0.65 $117,590 Oakland-Fremont-Hayward, CA Metropolitan Division 20,090 21.10 0.99 $106,730 San Francisco-San Mateo-Redwood City, CA Metropolitan Division 18,400 19.17 0.90 $105,670 Salinas, CA 2,670 17.57 0.83 $103,310 Sacramento--Arden-Arcade--Roseville, CA 14,850 18.44 0.87 $99,230 Napa, CA 1,370 22.16 1.04 $98,870 Hanford-Corcoran, CA 970 26.65 1.25 $96,950 Santa Cruz-Watsonville, CA 1,690 20.35 0.96 $96,760 Modesto, CA 3,300 22.04 $95,530

Percent of Total Employed Black or African American Employed Persons by Detailed Industry, Sex, Race, and Hispanic or Latino Ethnicity Industry Total Employed (in thousands) Percent of Total Employed Women Black or African American Asian Hispanic or Latino Total, all industries, 16 years and over 139,869 46.9 10.8 4.9 14.5 Health care and Social Assistance Sector 18,902 78.5 16.0 5.5 11.1 Hospitals 6,315 75.8 15.3 7.2 8.7 Health services, except hospitals 9,367 78.1 15.9 5.1 11.2

California Population and Labor force Overview

Labor Force Share by Sex 2010

Labor Force Share by Race 2010

Labor Force Share by Race 2010

Labor Force Share by Race 2010

Labor Force Share by Ethnicity 2010

California Counties with the Largest Population Growth, 2010-2050 Bubble size represents 2010 population

California health care industry projections

Employment Change by Industry Sector: Projected 2010-20, California Source: California Employment Development Department, 2010-2020 Industry Projections

Percent Change in Employment by Industry Sector: Projected 2010-20, California Source: California Employment Development Department, 2010-2020 Industry Projections

Employment Change in Healthcare and Social Assistance Sector 2008 – 2018 by County Includes Ambulatory Healthcare Services, Hospitals (private), Nursing and Residential Care Facilities, and Social Assistance Source: California Employment Development Department, 2008-2018 Industry Projections

Percent Change in Healthcare and Social Assistance Employment 2008 – 2018 by County Includes Ambulatory Healthcare Services, Hospitals (private), Nursing and Residential Care Facilities, and Social Assistance Source: California Employment Development Department, 2008-2018 Industry Projections

Projected Employment in Ambulatory Health Care Services, 2008-2018 Percent Growth Bubble size represents 2018 projected total employment Source: California Employment Development Department, 2008-2018 Industry Projections

Projected Employment in Private Hospitals, 2008-2018 Percent Growth Bubble size represents 2018 projected total employment Source: California Employment Development Department, 2008-2018 Industry Projections

Bubble size represents 2018 projected total employment Projected Employment in Nursing and Residential Care Facilities, 2008-2018 Percent Growth Bubble size represents 2018 projected total employment Source: California Employment Development Department, 2008-2018 Industry Projections

California health care occupational projections

Employment by Major Occupational Group in California Occupational Title Annual Average Employment Employment Change 2012 First Quarter Wages 2010 2020 Numerical % Median Annual Food Preparation and Serving Related Occupations 1,248,500 1,572,000 323,500 25.9 $19,451 Office and Administrative Support Occupations 2,487,000 2,789,700 302,700 12.2 $35,914 Sales and Related Occupations 1,581,400 1,880,800 299,400 18.9 $28,164 Personal Care and Service Occupations 730,300 933,100 202,800 27.8 $22,808 Business and Financial Operations Occupations 821,000 983,500 162,500 19.8 $68,837 Transportation and Material Moving Occupations 936,700 1,096,500 159,800 17.1 $29,524 Healthcare Practitioners and Technical Occupations 735,600 893,100 157,500 21.4 $77,945 Management Occupations 1,099,900 1,214,400 114,500 10.4 $108,870 Construction and Extraction Occupations 607,900 721,800 113,900 18.7 $50,489 Computer and Mathematical Occupations 468,800 576,600 107,800 23.0 $88,960 Education, Training, and Library Occupations 983,700 1,089,600 105,900 10.8 $53,909 Source: California Employment Development Department, 2010-2020 Occupational Projections

Employment by Major Occupational Group in California Occupational Title Annual Average Employment Employment Change 2012 First Quarter Wages 2010 2020 Numerical % Median Annual Healthcare Support Occupations 388,200 483,600 95,400 24.6 $29,066 Building and Grounds Cleaning and Maintenance Occupations 556,500 647,900 91,400 16.4 $24,350 Installation, Maintenance, and Repair Occupations 498,700 574,200 75,500 15.1 $45,887 Arts, Design, Entertainment, Sports, and Media Occupations 407,400 461,800 54,400 13.4 $55,770 Community and Social Service Occupations 230,300 274,300 44,000 19.1 $47,446 Production Occupations 815,700 858,900 43,200 5.3 $29,378 Architecture and Engineering Occupations 316,500 358,000 41,500 13.1 $88,008 Protective Service Occupations 366,100 405,000 38,900 10.6 $47,055 Life, Physical, and Social Science Occupations 185,600 224,200 38,600 20.8 $70,470 Legal Occupations 137,400 152,500 15,100 11.0 $102,580 Farming, Fishing, and Forestry Occupations 315,100 319,800 4,700 1.5 $18,816 (cont…..) Source: California Employment Development Department, 2010-2020 Occupational Projections

Healthcare Occupations with the Largest Job Growth in California Occupational Title Annual Average Employment Employment Change 2010 2020 Numerical Percent Registered Nurses 251,800 306,100 54,300 21.6 Home Health Aides 61,100 93,100 32,000 52.4 Nursing Aides, Orderlies, and Attendants 109,500 134,100 24,600 22.5 Medical Assistants 80,900 99,000 18,100 22.4 Licensed Practical and Licensed Vocational Nurses 64,500 79,000 14,500 Pharmacy Technicians 29,000 38,600 9,600 33.1 Emergency Medical Technicians and Paramedics 15,900 22,600 6,700 42.1 Pharmacists 23,600 29,900 6,300 26.7 Dental Assistants 43,700 49,000 5,300 12.1 Physicians and Surgeons, All Other 34,600 4,700 15.7 Source: California Employment Development Department, 2010-2020 Occupational Projections

Fastest Growing Healthcare Occupations in California Occupational Title Annual Average Employment Employment Change 2010 2020 Numerical Percent Home Health Aides 61,100 93,100 32,000 52.4 Emergency Medical Technicians and Paramedics 15,900 22,600 6,700 42.1 Diagnostic Medical Sonographers 5,300 7,300 2,000 37.7 Occupational Therapy Assistants 2,700 700 35.0 Pharmacy Technicians 29,000 38,600 9,600 33.1 Pharmacy Aides 8,100 10,700 2,600 32.1 Veterinary Technologists and Technicians 8,400 11,000 31.0 Physical Therapist Assistants 4,600 6,000 1,400 30.4 Athletic Trainers 1,000 1,300 300 30.0 Physical Therapist Aides 6,400 8,300 1,900 29.7 Source: California Employment Development Department, 2010-2020 Occupational Projections

Average Annual Job Openings Average Annual Job Openings (Growth + Replacement Needs) California Healthcare Occupations Occupational Title Average Annual Job Openings New Jobs Replacement Needs Total Jobs Registered Nurses 5,420 4,560 9,980 Home Health Aides 3,200 790 3,990 Nursing Aides, Orderlies, and Attendants 2,470 1,410 3,880 Licensed Practical and Licensed Vocational Nurses 1,450 1,720 3,170 Medical Assistants 1,810 1,240 3,050 Pharmacy Technicians 960 500 1,460 Dental Assistants 530 920 Pharmacists 630 600 1,230 Physicians and Surgeons, All Other 470 590 1,060 Emergency Medical Technicians and Paramedics 670 320 990 Source: California Employment Development Department, 2010-2020 Occupational Projections

Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations Los Angeles County Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 1,820 1,079 2,899 $80,890 Licensed Practical and Licensed Vocational Nurses 580 628 1,208 $48,007 Nursing Aides, Orderlies, and Attendants 877 321 1,198 $24,275 Medical Assistants 634 242 876 $28,940 Home Health Aides 560 125 685 $21,130 Dental Assistants 263 210 473 $29,523 Pharmacy Technicians 181 161 342 $35,499 Physicians and Surgeons, All Other 118 129 247 N/A Pharmacists 103 138 241 $120,616 Healthcare Support Workers, All Other 141 75 216 $32,324 Source: California Employment Development Department, 2008-2018 Occupational Projections

Riverside/San Bernardino Counties Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations Riverside/San Bernardino Counties Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 518 373 891 $76,486 Licensed Practical and Licensed Vocational Nurses 122 187 309 $43,502 Nursing Aides, Orderlies, and Attendants 91 278 $24,475 Medical Assistants 192 76 268 $26,101 Dental Assistants 97 79 176 $30,013 Home Health Aides 133 37 170 $21,024 Pharmacy Technicians 77 153 $34,754 Emergency Medical Technicians and Paramedics 49 38 87 $32,123 Pharmacists 28 44 72 $121,830 Physicians and Surgeons, All Other 35 34 69 N/A Source: California Employment Development Department, 2008-2018 Occupational Projections

Marin/San Francisco/San Mateo Counties Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations Marin/San Francisco/San Mateo Counties Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 181 266 447 $101,345 Licensed Practical and Licensed Vocational Nurses 18 101 119 $58,255 Home Health Aides 66 30 96 $23,281 Nursing Aides, Orderlies, and Attendants 28 63 91 $33,368 Medical Assistants 52 37 89 $39,056 Dental Assistants 50 87 $40,344 Pharmacy Technicians 43 42 85 $41,504 Massage Therapists $28,486 Pharmacists 17 31 48 $124,787 Dental Hygienists 16 24 40 $112,881 Source: California Employment Development Department, 2008-2018 Occupational Projections

Sacramento/Placer/Yolo/El Dorado Counties Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations Sacramento/Placer/Yolo/El Dorado Counties Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 393 261 654 $92,678 Nursing Aides, Orderlies, and Attendants 124 64 188 $28,765 Home Health Aides 125 32 157 $21,471 Licensed Practical and Licensed Vocational Nurses 93 $54,611 Dental Assistants 100 51 151 $38,335 Medical Assistants 101 31 132 $29,365 Dental Hygienists 67 36 103 $94,088 Pharmacy Technicians 46 82 $38,867 Massage Therapists 19 50 $35,985 Pharmacists 22 28 $126,985 Source: California Employment Development Department, 2008-2018 Occupational Projections

Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations San Diego County Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 452 374 826 $80,734 Licensed Practical and Licensed Vocational Nurses 94 159 253 $47,797 Medical Assistants 170 75 245 $30,303 Nursing Aides, Orderlies, and Attendants 160 85 $24,250 Home Health Aides 152 40 192 $21,607 Dental Assistants 93 72 165 $36,143 Pharmacy Technicians 71 64 135 $37,262 Physicians and Surgeons, All Other 47 54 101 N/A Pharmacists 33 48 81 $120,859 Dental Hygienists 37 30 67 $93,723 Source: California Employment Development Department, 2008-2018 Occupational Projections

Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations Orange County Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 500 365 865 $77,209 Nursing Aides, Orderlies, and Attendants 232 83 315 $26,371 Home Health Aides 246 52 298 $23,605 Licensed Practical and Licensed Vocational Nurses 123 170 293 $51,053 Medical Assistants 184 84 268 $31,572 Dental Assistants 112 92 204 $32,566 Pharmacy Technicians 75 65 140 $35,432 Veterinary Technologists and Technicians 54 37 91 $31,102 Physicians and Surgeons, All Other 38 41 79 N/A Pharmacists 33 44 77 $118,547 Source: California Employment Development Department, 2008-2018 Occupational Projections

Alameda/Contra Costa Counties Average Annual Job Openings Top Average Annual Job Openings for Healthcare and Social Service Occupations Alameda/Contra Costa Counties Average Annual Job Openings 2010-1st Quarter Wages New Jobs Replacement Needs Total Jobs per Year Median Annual Registered Nurses 453 316 769 $99,961 Nursing Aides, Orderlies, and Attendants 236 89 325 $30,466 Home Health Aides 225 44 269 $20,344 Licensed Practical and Licensed Vocational Nurses 111 150 261 $58,735 Medical Assistants 144 49 193 $34,140 Dental Assistants 83 50 133 $45,088 Dental Hygienists 73 48 121 $102,055 Pharmacy Technicians 52 47 99 $40,596 Healthcare Support Workers, All Other 36 21 57 $37,979 Pharmacists 32 53 $123,018 Source: California Employment Development Department, 2008-2018 Occupational Projections

U. S. Bureau of Labor Statistics Western Information Office www. bls U.S. Bureau of Labor Statistics Western Information Office www.bls.gov/ro9 415-625-2270 BLSinfoSF@bls.gov

Resources for Additional Information Employment Outlook: 2010-20 Resources for Additional Information The next few slides present some resources for additional information about the BLS projections.

Occupational Outlook Handbook www.bls.gov/ooh The Occupational Outlook Handbook includes job descriptions, education and training requirements, salary data and job outlook information. The 2012-13 edition is expected to be published online in later March 2012, and will include nearly 350 occupational profiles covering more than 500 detailed occupations. (Many profiles cover multiple similar occupations.) Information about an occupation can be found by: Using the A to Z index on the homepage (it can’t be seen on the screenshot, but it’s below the “Ways to use the OOH” box Using the “Search the OOH” function on the left hand side Navigating major occupational categories on the left hand side

Occupational Outlook Quarterly www.bls.gov/ooq The “Occupational Outlook Quarterly” includes articles about education, careers and BLS data. There are four editions of the OOQ each year. Every two years the OOQ puts out a “Chartbook,” that coincides with the release of the Projections. The Chartbook presents the results of the employment projections graphically. Examples of past articles: “Focused jobseeking: A measured approach to looking for work” “Mapping out a career: An analysis of geographic concentration of occupations” “Informational interviewing: Get the inside scoop on careers” Many articles profiling occupations or occupational groups, such as: “Work for play: Careers in video game development” “Helping those in need: Human service workers” “Medical physicists and health physicists: Radiation occupations” “Paid to persuade: Careers in sales” To subscribe: http://www.bls.gov/opub/ooq/subscrib.htm

Employment Projections Program www.bls.gov/emp The Employment Projections homepage provides access to the detailed projections data and information about replacement rates and education and training categories.

January 2012 Monthly Labor Review Overview of projections to 2020 The U.S. economy to 2020: recovery in uncertain times Labor force projections to 2020: a more slowly growing workforce Industry employment and output projections to 2020 Occupational employment projections to 2020 The Monthly Labor Review (MLR) is principal journal of fact, analysis, and research from the Bureau of Labor Statistics. With each biennial release of new employment projections data, the MLR devotes an issue to summarizing the projections. The 2010-20 projections are covered in the January 2010 MLR, in a series of five articles: "Overview of projections to 2020" by Dixie Sommers and James C. Franklin "The U.S. economy to 2020: recovery in uncertain times" by Kathryn J. Byun and Christopher Frey "Labor force projections to 2020: a more slowly growing workforce" by Mitra Toossi "Industry employment and output projections to 2020" by Richard L. Henderson "Occupational employment projections to 2020" by C. Brett Lockard and Michael Wolf

Useful Employment Projections Sites Technical documentation of Employment Projections Program methods and data http://www.bls.gov/emp/ep_tech_documentation.htm Other Employment Projections Program publications, including five Monthly Labor Review articles http://www.bls.gov/emp/publications.htm Frequently asked questions http://www.bls.gov/emp/ep_faq_001.htm A few pages on the Employment Projections site may be particularly useful. The technical documentation presents projections methodology, information on classification and crosswalks, and definitions and concepts used in the Employment Projections Program. The publications page lists publications (in addition to the Occupational Outlook Handbook and Occupational Outlook Quarterly), including links to the five Monthly Labor Review articles referenced on the previous slide. A Frequently Asked Questions page presents answers to some of the most common projections-related questions.

State and Local Area Projections BLS prepares projections only for the nation as a whole Projections of industry and occupational employment are prepared by each state, using input from the BLS national projections State projections data, and links to each state’s projections site, are available http://www.projectionscentral.com/ While the BLS projections are only for the nation as a whole, each state government makes projections for their state, and some make projections for local areas. State projections data is available at www.projectionscentral.com. Because the BLS national projections are an input to state projections, publication of the state projections lags behind publication of BLS’s national projections.

Projections Evaluation Last performed for 1996-2006 projections Comparisons were difficult due to classification changes BLS projections outperformed naïve models Direction of employment change was generally correct The last evaluation of BLS projections was performed for the 1996-2006 projections. Comparisons of the projections to actual results were difficult due to changes in occupational and industry classifications and other definitional changes. Comparisons were made between BLS projections and naïve models. (Naïve models—based entirely on extrapolation of historical data, with no qualitative input—were used because there are no other widely-published projections for the 1996-2006 period to compare BLS’s accuracy against.) On the whole, BLS projections outperformed the naïve models, but not projecting the housing bubble or the rise in oil prices did cause some inaccuracies in the BLS projections. BLS correctly projected the direction of employment change (i.e. growth or decline) for 72% of industries and 66% of occupations evaluated. (Not all industries and occupations could be evaluated due to classification changes.) More information can be found in the September 2010 edition of the Monthly Labor Review.