Looking Into the Career Crystal Ball Part 1:

(This is part 1 of ADVANCE's new 3 part series on the future of health care career opportunities.)

Ten years ago, very few could have imagined the current state of the U.S. economy. Did anyone predict that the technology stock bubble would burst - or that health care personnel shortages across the country would be coupled with increasing demand? While no one can tell exactly what the future holds, this article, and the next two in this series, will look at the factors influencing the present - and the future - of health care careers. The first article will look at the causes of health care shortages, from declining program enrollment to increased demand for services. Following this is a look at recruitment efforts, including where the greatest need will be and efforts to meet it. Finally, we'll conclude by looking at the ways managed care and government may affect shortages and what's done about them. ADVANCE spoke with academic leaders and leaders in the field, gaining their insight into the future of health care jobs. To begin to piece together this puzzle, we looked at some employment estimates from the government. The Bureau of Labor Statistics publication Career Guide to Industries, states "employment in the health services industry is projected to increase more than 25 percent through 2010, compared with an average of 16 percent for all industries." 1 This will account for 13 percent of all wage and salary jobs added over the same period, the report concludes. Home health care services may experience the largest increases - a predicted 68 percent employment growth. But, the numbers are only one side of the story, as there are many reasons behind this anticipated growth. Population Factors Several population factors working in tandem will create the growth in career opportunities. The Baby Boom generation is approaching retirement age-meaning that aging workers will be leaving the field just as their peers will start requiring the most health care. At the same time, more older people are surviving into later life, says Alan Jette, PhD, dean of Boston University's Sargent School of Health and Rehabilitation Sciences. This means an increased prevalence of chronic and potentially disabling illnesses to deal with, he says. Accompanying the aging population, the diversity within the nursing field will take on a different view, says Martin Ford, dean of Cooperative Education and Career Services at Drexel University in Philadelphia. "We have nurses that are primarily working in health care facilities, but we're going to see increased need for trained nurses in the areas of residential and specialty care as more of the population looks at the need for those kind of facilities." Coupled with an increased demand for services, there are fewer people entering into health careers. There are now more opportunities for people who would typically select nursing and allied health careers-which would be women-to look at other employment areas. While this has provided great opportunities for women, the same number of women haven't expressed interest in health fields, explains Pam Cipriano, PhD, RN, FAAN, chief clinical officer for the University of Virginia Health System. Along with the general population, the average age of a nurse is increasing steadily, notes Carlos Hagler, director of operations for CompHealth, a health care staffing firm. Fewer new workers are entering the health care system, he explains. National and Local Trends While professional and patient staffs are aging, geographical issues will also play a role in shaping job outlooks. The shortages-both current and predicted-won't necessarily happen the same way across the nation, our experts agreed. There will be some national trends but regional variations will play strongly into the overall picture. Most of the trends have been national, Dr. Jette observes, but flow regionally. "The coasts tend to be affected first and there tends to be more professional resources in those dense urban areas. More people want to live and work there, but there's more demand for services in other parts of the country." Larry Altman, vice president of Corporate Marketing Communications and Product Development for Horizon Blue Cross Blue Shield of New Jersey, explains that the general trend of the US population shift is to the southwest. This population shift will directly influence both the need for care, and the number of health care positions available. "Where there are larger populations of retirees, we'll see the demand continue to increase," notes Dr. Cipriano. The Baby Boom and the older generation tend to be higher consumers of health care and that creates a geographical difference, she continues. This will continue to affect care delivery. "As the Baby Boomers continue to age, where they tend to move will affect where the shortages are. As the next group retires, I think it's an open question as to where they're going to go," Altman affirms. Technology's Role Population and geographic changes alone won't create new positions; technology changes will dramatically change job outlooks. Innovation is a hallmark of health care, with rapid gains in technology bringing in new techniques, therapies and equipment. These advancements will continue to change the health care landscape. "Certainly to the extent that technology helps people survive major illness, it's going to increase the demand for care," Dr. Jette says. As we use technology to expand the life of those suffering from ongoing chronic disease, we create an intensified demand for services. On the other side of the coin, technology also provides opportunities for disabled people that they've never had before, Dr. Jette explains, and "opens up a whole new area of the use of technology to help people maintain meaningful lives in the face of major impairments." Advances in technology also extend the reach of health care - both within and outside traditional hospital settings. Looking at new technologies, Ford says, "we're bringing medicine-in particular specialty care-to people and parts of the country where it currently does not exist." As well, a universal effort exists to figure out how to use technology, Dr. Cipriano states-especially in the home. "We no longer need to keep people in the hospital," in order for them to receive a high level of care, she confirms. But how will new technology and equipment truly affect the future of health care careers? Ultimately, there may be just as many jobs created by technology as those that could potentially be changed or eliminated. "It's like anything dealing with technology," Ford states, "it's something new, we try it out and we realize that we still can't replace people because we need people to manage the technology." Technology may appear to reduce the number of people, he says, but those people must be well trained. Looking at available school and certification programs, the problem is training these people, he continues. "I do not think there are enough training programs to meet the need." "A similar need exists in terms of very specialized laboratory areas," says Dr. Cipriano. "As we have a lot of progress in the cellular genetics area and things like that, people just aren't being prepared fast enough for those fields." Because equipment is more technical, people must have better training and be more technical than they were a couple years ago, Hagler believes. "The manpower is so short right now, and while technology will help a little bit, the shortage is so huge that even with the technology it's going to be there for years." As in many areas of the economy, there is an increasing need for people who have the technological knowledge and skills. Professionals who can combine medical and health care knowledge with information and communication technology will be in demand. Conclusion The future of health care looks bright, holding a wealth of new job opportunities to attract diverse people into the field. Increasing technology from information systems to lab equipment, new focuses on chronic and holistic care and pushes for more diversity mean that the field is widening the pool of potential employees. Check back for the next part in this series, which will take a closer look at the fields and skills that will be most in demand - and the efforts underway to encourage and retain the next generation of health care professionals. Reference: 1. The 2002-03 Career Guide to Industries U.S. Department of Labor, Bureau of Labor Statistics http://stats.bls.gov/oco/cg/cgs035.htm. Accessed May 13, 2002 Nicole Benkert is on staff at ADVANCE.