LowSkilled LowWage Workers in Health Care Bianca K
Low-Skilled, Low-Wage Workers in Health Care Bianca K. Frogner, Ph. D Associate Professor, Department of Family Medicine Director of Center for Health Workforce Studies AAMC Health Workforce Research Conference Thursday May 5, 2016
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
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
Industry and Occupation Transitions, 2003 -2013 Industry Entry from what industry? Home Health Care Services 14% Hospitals 14% Nursing care facilities Nursing Care Facilities 18% Hospitals 12% Leisure & hospitality Residential Care Services 14% Leisure & hospitality 8% Out of labor force Most common occupation of entrants 42% Nursing, psych & home health aides 23% Personal care aides 37% Nursing, psych & home health aides 10% Registered nurses Exit to what industry? 33% Out of labor force 18% Unemployed 27% Out of labor force 19% Unemployed 21% Personal care 25% Out of labor aides force 13% Food preparation 16% Unemployed 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-care
SES Characteristics of Transition Groups, 2003 -2013 Industry % not a citizen Home Health Care Services Entrants 10% Leavers 9% Stayers 11% Nursing Care Facilities Entrants 8% Leavers 7% Stayers 8% Residential Care Services Entrants 6% Leavers 7% Stayers 6% % rural residence % disabled % below poverty % fulltime Wages from past year 20% 19% 4% 10% 4% 18% 22% 14% 74% 59% 66% $19, 666 $15, 289 $19, 799 24% 25% 26% 2% 8% 2% 16% 8% 75% 72% 78% $20, 677 $17, 409 $22, 527 17% 19% 4% 8% 3% 14% 13% 5% 74% 73% 79% $19, 517 $16, 123 $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-care
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
High school Less than high school Distribution over Health Care Setting Nursing, psychiatric and home health aides (n=5, 962, 865) Personal and home care aides (n=3, 110, 356) Medical assistants (n=1, 345, 044) Pharmacy aides (n=155, 705) Medical records and health information technicians (n=310, 720) Post-secondary Phlebotomists (n=326, 451) Licensed practice and vocational nurses (n=1, 624, 840) Emergency medical technicians and paramedics (n=472, 093) Massage therapists (n=255, 343) Dental assistants (n=848, 727) 0% Hospital Ambulatory 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Long-term care Other
High school Less than high school Any Age Distribution by Occupation All employed Nursing, psychiatric and home health aides Personal and home care aides Pharmacy aides Medical assistants Massage therapiasts Post-secondary Dental assistants Phlebotomists Emergency medical technicians and paramedics Medical records and health information technicians Licensed practice and vocational nurses 0% Age 18 -22 10% 20% Age 23 -49 30% 40% 50% Age 50 -74 60% 70% 80% 90% 100%
Other Selected Demographics Minority Single 20. 1 44. 9 Child under 18 43. 6 32. 6 60. 6 47. 2 43. 5 43. 7 61. 1 50. 4 30. 9 Pharmacy aides 18. 1 64. 2 30. 2 36. 1 Medical assistants 21. 8 52. 4 52. 2 21. 0 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 Postsecondary Medical records and health information technicians Phlebotomists 17. 6 38. 5 52. 9 34. 8 30. 2 45. 2 49. 8 13. 3 32. 8 44. 7 56. 1 18. 9 Licensed practice and vocational nurses 33. 7 45. 4 55. 9 17. 8 All employed Less than Personal and home care aides high school Nursing, psychiatric and home health aides High school Part-time 18. 8
POVERTY RATES
Below 150% Poverty Level All employed Personal and home care aides Nursing, psychiatric and home health aides Massage therapiasts Phlebotomists Pharmacy aides Medical assistants Dental assistants Licensed practice and vocational nurses Medical records and health information technicians Emergency medical technicians and paramedics 0 All 5 Single 10 15 20 25 Percent (%) 30 35 40
Below 150% Poverty Level: Hospital v. Ambulatory All employed Massage therapiasts Dental assistants Personal and home care aides Nursing, psychiatric and home health aides Phlebotomists Medical assistants Medical records and health information technicians Licensed practice and vocational nurses Emergency medical technicians and paramedics Pharmacy aides 0 Hospital 5 10 Ambulatory 15 20 25 Percent (%) 30 35 40 45
Comparison of Poverty Levels: 150% v. 200% All employed Personal and home care aides Nursing, psychiatric and home health aides Massage therapiasts Phlebotomists Pharmacy aides Medical assistants Dental assistants Licensed practice and vocational nurses Medical records and health information technicians Emergency medical technicians and paramedics 0 Below 150% pov 10 20 Below 200% pov 30 Percent (%) 40 50 60
<$15 WAGE RATE
Wage Rate Below $15 Per Hour All employed Pharmacy aides Personal and home care aides Nursing, psychiatric and home health aides Phlebotomists Medical assistants Emergency medical technicians and paramedics Dental assistants Medical records and health information technicians Massage therapiasts Licensed practice and vocational nurses 0 All 5 Single 10 15 Percent (%) 20 25
Wage rate below $15 per hour: Hospital v. Ambulatory Care All employed Personal and home care aides Nursing, psychiatric and home health aides Pharmacy aides Phlebotomists Emergency medical technicians and paramedics Medical assistants Medical records and health information technicians Licensed practice and vocational nurses Massage therapiasts Dental assistants 0 Hospital 5 Ambulatory 10 15 Percent (%) 20 25
WELFARE AND FOOD STAMPS
Welfare Receipt among Individuals with Children All employed Personal and home care aides Pharmacy aides Nursing, psychiatric and home health aides Medical assistants Medical records and health information technicians Emergency medical technicians and paramedics Dental assistants Licensed practice and vocational nurses Massage therapiasts Phlebotomists 0 All 1 1 Single 2 2 3 3 4 Percent (%) 4 5 5 6
Food Stamp Receipt All employed Personal and home care aides Nursing, psychiatric and home health aides Medical assistants Phlebotomists Pharmacy aides Massage therapiasts Dental assistants Licensed practice and vocational nurses Medical records and health information technicians Emergency medical technicians and paramedics 0 5 10 15 Percent (%) 20 25 30
INSURANCE
Medicaid All employed Personal and home care aides Nursing, psychiatric and home health aides Massage therapiasts Pharmacy aides Medical assistants Phlebotomists Dental assistants Licensed practice and vocational nurses Medical records and health information technicians Emergency medical technicians and paramedics 0 2 4 6 8 10 12 Percent (%) 14 16 18 20
Medicaid: Hospital v. Ambulatory All employed Medical assistants Nursing, psychiatric and home health aides Phlebotomists Licensed practice and vocational nurses Personal and home care aides Massage therapiasts Medical records and health information technicians Dental assistants Emergency medical technicians and paramedics Pharmacy aides 0 Hospital 5 Ambulatory 10 15 Percent (%) 20 25
Uninsured All employed Personal and home care aides Massage therapiasts Nursing, psychiatric and home health aides Phlebotomists Dental assistants Medical assistants Licensed practice and vocational nurses Emergency medical technicians and paramedics Pharmacy aides Medical records and health information technicians 0 5 10 15 20 25 Percent (%) 30 35 40
Uninsured: Hospital v. Ambulatory All employed Personal and home care aides Dental assistants Phlebotomists Nursing, psychiatric and home health aides Medical assistants Licensed practice and vocational nurses Emergency medical technicians and paramedics Medical records and health information technicians Massage therapiasts 0 Hospital 5 10 Ambulatory 15 20 25 Percent (%) 30 35 40
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
Questions? Contact: Bianca K. Frogner, Ph. D 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
Food Stamp Receipt: Hospital v. Ambulatory Care All employed Massage therapiasts Medical assistants Nursing, psychiatric and home health aides Personal and home care aides Phlebotomists Medical records and health information technicians Licensed practice and vocational nurses Emergency medical technicians and paramedics Pharmacy aides Dental assistants 0 Hospital 5 10 Ambulatory 15 20 25 Percent (%) 30 35 40
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