1. Low-Skilled, Low-Wage Workers in Health Care Bianca K. Frogner, PhD Associate Professor, Department of Family Medicine Director of Center for Health Workforce Studies AAMC Health Workforce Research Conference Thursday May 5, 2016

2. Setting the Stage Growing demand for health services will lead to greater need for health workers – Increasing needs for aging population with multiple chronic conditions – Insurance (e.g., Medicaid) expansion – Greater emphasis on primary care and team-based care Health care has been and will continue to be fastest growing employment sector – 12% of total labor force of the U.S. in 2013

3. Growth in the Largest Occupations, 2010-2020 Red=HS degree or less; Purple=some college; Blue=graduate degree Source; 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

4. IndustryEntry from what industry? Most common occupation of entrants Exit to what industry? Home Health Care Services 14% Hospitals 14% Nursing care facilities 42% Nursing, psych & home health aides 23% Personal care aides 33% Out of labor force 18% Unemployed Nursing Care Facilities 18% Hospitals 12% Leisure & hospitality 37% Nursing, psych & home health aides 10% Registered nurses 27% Out of labor force 19% Unemployed Residential Care Services 14% Leisure & hospitality 8% Out of labor force 21% Personal care aides 13% Food preparation 25% Out of labor force 16% Unemployed Industry and Occupation Transitions, 2003-2013 Source: 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-carehttp://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-care

5. SES Characteristics of Transition Groups, 2003-2013 Industry% not a citizen % rural residence % disabled% below poverty % full- time Wages from past year Home Health Care Services Entrants10%20%4%18%74%$19,666 Leavers9%20%10%22%59%$15,289 Stayers11%19%4%14%66%$19,799 Nursing Care Facilities Entrants8%24%2%16%75%$20,677 Leavers7%25%8%16%72%$17,409 Stayers8%26%2%8%78%$22,527 Residential Care Services Entrants6%17%4%14%74%$19,517 Leavers7%17%8%13%73%$16,123 Stayers6%19%3%5%79%$21,203 Source: 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-carehttp://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-care

6. Study Design Research Questions: In which allied healthcare jobs are workers at highest financial risk? To what extent are workers relying on federal support? Data and Methods: 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 job defined using 2009 Standard Occupation Classification

7. Distribution over Health Care Setting

8. Age Distribution by Occupation

9. Other Selected Demographics MinoritySingle Child under 18 Part-time All employed20.144.943.618.8 Less than high school Personal and home care aides32.660.647.243.5 Nursing, psychiatric and home health aides43.761.150.430.9 High school Pharmacy aides18.164.230.236.1 Medical assistants21.852.452.221.0 Post- secondary Emergency medical technicians and paramedics 8.346.545.710.4 Massage therapiasts15.358.642.757.6 Dental assistants17.638.552.934.8 Medical records and health information technicians 30.245.249.813.3 Phlebotomists32.844.756.118.9 Licensed practice and vocational nurses33.745.455.917.8

10. POVERTY RATES

14. <$15 WAGE RATE

17. WELFARE AND FOOD STAMPS

20. INSURANCE

25. Summary 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 high financial risk than workers in hospitals – Not shown: Long-term care workers also tend to be at much higher financial risk than hospital workers Concern that health care labor is built on a labor force with a weak financial foundation – May result in high turnover and low supply

26. Questions? Contact: Bianca K. Frogner, PhD Associate Professor, Department of Family Medicine Director, Center for Health Workforce Studies bfrogner@uw.edu UW Center for Health Workforce Studies https://depts.washington.edu/fammed/chws/ @uwchws