Outpatient and Nursing Now Have Twice the Amount of Employees as Hospitals
Healthcare jobs are still being added at a healthy pace of 3.2% from June 2015 to June 2016. The pace of adding jobs slowed some from 46k being added in May to only adding 39k jobs in June. The section of healthcare with the largest amount of new jobs added continues to be outpatient services (ambulatory health care), with 19k new jobs created while hospitals added 15k jobs. Nursing and Residential Care facilities rounded out the remaining number of new jobs at 4k new jobs. These numbers are in line with the averages over the past 12 months. It is also worth noting that the offices of physicians and other health practitioners accounted for almost 11k out of the 19k outpatient care jobs created.
Outpatient and Nursing Have Twice the Amount of Employees
As we look back over the past year, both outpatient care and hospitals have grown at roughly the same pace, however an interesting thing happened. Outpatient care (7.1m) and nursing facilities (3.3m) combined employment numbers grew to 10.4m, which is twice the amount of employees working in hospitals (5.1m).
Outpatient care accounted for 50% of healthcare job growth while hospitals accounted for 39%. Other sectors of healthcare, including skilled nursing, added the remaining 11%.
I asked several healthcare executives and practitioners if they see any continuing or emerging trends, as well as, will these trends continue. Here were some of their answers:
Kim Walker, MSHHA, Healthcare executive and former Executive Director of LifePath Hospice in Tampa FL says, "Absolutely this trend will continue as the outpatient, ambulatory procedure and post-acute care networks grow. We will see the development of more comprehensive care organizations that have all components of the care spectrum, not just the acute care that has dominated our systems for so long."
Pallavi Aggarwal, a practicing physician at Elite Medical Clinic in Tulsa OK says that she feels the trend will definitely continue, however she hopes "that not before long it will be figured out that hired/acquired physicians are just instruments to capitalize on all the testing, procedures within the hospital." Dr Aggarwal further relates, "I suppose the reimbursement for the physicians will not be as competitive as it is now. It's on the rise now, but would definitely want to see what the future holds for this trend. Also hoping patients will take charge of making some choices and decisions regarding this trend. It is hard for physicians to bond with patients if they are pressurized to see a certain number of patients in the current situations. Patients and physicians get equally frustrated."
Pete Hague, Consulting Manager of Proposals & Contracts for Clinilabs in New York NY says, "I have worked for large institutions and many physicians get sucked up into large corporate conglomerates, they lose the sense that a patient is a real person and not just a number! Surveys can confirm this reality that in the end the patient suffers due to the inadequate or lack of care provided! Also another comparison is as practices are being bought up, the cost goes up, since the patient is no-longer paying for just that practice, but now for an entire hospital system, end statement: increased price per visit, soaring insurance rates and lack of Doctor patient personalization!"
Onyeka Abengowe MS, CNMT, Lead Nuclear Medicine Technologist for Dallas Regional Medical Center in Garland TX says that it is, "very likely" the trend will continue. "Especially for specialists who rely heavily on outpatient imaging or other outpatient procedures to stay profitable. Physicians are not taught how to run businesses and are having trouble keeping up with the numerous policy, regulatory and reimbursement changes that have become routine in the healthcare industry. A steady, guaranteed income is very attractive. Let the experts worry about the peripheral details while the physician focuses on patient care."
Sagarika Ramanan, Outcomes Executive for Allscripts (EHR Software) in New York NY says, "The trend of acquiring physician practices continues especially when some of these practices are not well run financially and operationally." Sagarika says that, "if they are faced with technology decisions, and (are) on older EHR (systems) that will not continue to be certified technology," this would play a part in their decision to be acquired. In addition, if they "were not able to fully report on metrics and capture incentive dollars, she says that this also plays a part in the decision. "If they are large enough to merge with another similar or larger group, they could go that route and possibly hold off being (acquired)."
Sagarika also cites that, "the geographic market they are in plays a role...in choosing to remain independent or get acquired." She cautions that the "practice will need to carefully evaluate their operating and survival strategy. Value based care models will require them to collaborate with other providers, care settings, hospitals and patients in very different ways and they will be paid for outcomes. (not volume)"
Peter Perdik MD MMM, Physician at AdvantageCare Physicians in Lake Success NY, says not to just look at hospital acquisitions. Dr Perdik sees, "health insurers are also aligning with physician groups as an alternative." Which he says, creates a "different focus and model."
John Daller, President of Strategic Illuminations Company in Exton PA, says, "Uniformity of care will bring both clinical and economic efficiencies. The issue becomes how the professional and business entities are integrated and how their core values are respected in the mergers." John continues, "This has been going on for a while. Hospital systems are continuing to look to grow to achieve market share of tertiary services."
Bill Fetke, Owner of Florida Pediatric Clinic and Candidate for Florida State Representative District 1 in Pensacola FL says, "Doctors need to be careful when selling out." He relates an example of when a physician agrees to be acquired, often they are required to "sign a non-compete clause." He said that the physician could sometimes "get fired if they don't produce the profits the hospitals demand." This can happen "even if the doctor is seeing the exact same amount of patients" before the acquisition. Bill says that some hospitals have chosen to "put in ARNPs and PAs in the doctors place, since they are a lot cheaper." This scenario can leave the physician no choice but "to leave the area and start fresh elsewhere." John Daller added that Bill's comment, "is a great example of the business side where the professional contribution is not respected."
Anthony Arreola, Imaging Services Supervisor for St Jude Medical Center in Los Angeles CA, says, "Look for new regulations to slow this growth quickly"
Debbie McManus, District Sales Manager for Lupin Pharmaceuticals in Birmingham AL, says that we should expect to see a "predicted shortage of physicians by 2020", and she also expects to see a large growth pattern in the "elderly care" sector of healthcare.
Rhonda Stroman, JD, Director of Compliance, Labor Compliance and CVA Administrator for Cuyahoga Metropolitan Housing Authority in Cleveland OH, says, "I believe it's happening but I don't know that it's yielding the cost savings hospitals envisioned."
We eagerly await to see how some of these trends unfold.
Below is the direct text of the report regarding healthcare jobs created in June 2016: "Health care and social assistance added 58,000 jobs in June. Health care employment increased by 39,000 over the month. Job gains occurred in ambulatory health care services (+19,000) and hospitals (+15,000), about in line with average monthly gains over the prior 12 months in each industry. Within social assistance, child day care services added 15,000 jobs in June."