There will be more jobs. That much we can say when it comes to the Patient Protection and Affordable Care Act -- the healthcare reform law enacted in March 2010. In its 1,000-plus pages, the historic legislation's broad-stroke system changes will create healthcare jobs and could impact the career paths of many experienced or aspiring health professionals as the system lumbers toward universal healthcare with an emphasis on primary care.
But what jobs will be created in which health occupations, and when? Much won't be known for a few years, as the law's many provisions make their staged entrances. Still, the legislation's major emphases will have somewhat predictable effects on the healthcare labor economy.
And what will be the magnitude of job creation? Perhaps not as enormous as some headline healthcare-reform numbers suggest.
Because Medicare today covers virtually the entire population age 65 and older, nearly all of the estimated 32 million people who will become covered under the law by 2014 are younger Americans who require less healthcare. As it is, "uninsured Americans already receive about 50 percent of the care they will receive when insured," says Charles Roehrig, director of the Altarum Institute's Center for Studying Health Spending, a research and consulting organization with government and private-sector clients. For that reason, the total increase in provided healthcare will be about 3 percent, Roehrig says. And since younger patients use more ambulatory care, outpatient services will see the greatest increase in demand.
A Greater Mix of Providers for Preventive, Primary Care
The law's emphasis on primary care will have cascading effects on several clinical occupations. "Physicians can't be trained overnight, so healthcare employers will leverage their MDs with nurse practitioners and physician assistants," Roehrig says. "Everything will be pushed so that everyone is performing right up to their education level." Along with these licensed providers, demand for medical assistants will see a boost, he adds.
And the pressure to move some tasks off the plates of physicians won't stop at hospitals. "You'll probably see more nurse practitioners and physician assistants in physicians' offices, and more states will license them to practice on their own," says John Salerno, DO, a family physician at Patients Medical in New York City. As the demand for advanced practice nurses rises, the perennial shortage of bedside RNs will likely intensify, Salerno says.
Cynthia Lord, director of the physician assistant program at Quinnipiac University, notes that the new law promotes patient-centered medical homes, which often make use of licensed medical providers other than physicians, such as nurse practitioners and physician assistants.
"Our [physician assistant] graduates get the attention of physicians in private practice as well as hospitals," Lord says. Every physician assistant in Quinnipiac's class of 2009 who sought a full-time job found one, she says.
Outlook for Pharmacists and Diagnostic Technicians
Pharmacy is also likely to gain jobs under health reform, though the interplay of supply and demand is complex.
"The current situation is that the job market has tightened up a bit -- there's not as much of a shortage of registered pharmacists," says Ken Schafermeyer, professor of pharmacy administration at the St. Louis College of Pharmacy. "But when 32 million people get insurance in 2014, there will be a boost in demand, and we'll need more pharmacists and pharmacy technicians. Still, there are more than 100 pharmacy schools today, which is too many schools turning out too many pharmacists."
The reform measure's emphasis on primary care is also likely to boost jobs for diagnostic technicians, among other allied-health occupations. "The law's prevention measures require that any health plan pay 100 percent [for screenings], such as mammograms," says Fred Goldstein, president of US Preventive Medicine, which provides health programs to employer groups. "There's also $200 million in the law for grants to smaller employers to provide prevention programs."
Community Health Initiatives Will Jump-Start Healthcare Jobs
The demand for healthcare professionals created by the addition of 32 million Americans to insurance rolls is likely to be the biggest labor-market effect of the new law, but it won't be the first.
"Community health funding will hit in 2011, and this may be the initial source of new jobs," Roehrig says. The legislation also increases funding for the National Health Service Corps; authorizes a grant for school-based health centers; and provides funding for nurse-family home-visit partnerships, which serve low-income new mothers. The reform law also creates a grant program for nurse-managed clinics, which are primary- and preventive-care facilities run by nurse practitioners in medically underserved regions.
Finally, the legislation's healthcare workforce initiatives bolster scholarship and loan-repayment programs in fields including primary care, dentistry, pediatrics, nursing and mental health. The goal of the funding is to bring students into the education pipeline in time to keep the big promises that healthcare reform has made to millions of Americans.
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