Health Care
The numbers don't lie: Providing 13.5 million jobs and 8 out of the 20
fastest growing occupations, health care is the country’s largest industry.
Compared to other industries, the health-care industry as a whole is
expected to realize a relative increase in the number of career
opportunities across the spectrum of its many specialties.
People are living longer and thus demand more and higher quality preventive
and long-term care. The demand for health-care workers is expected to grow
faster than the average rate for all occupations between 2000 and 2010. In
particular, the demand for home care aides, registered nurses, physician
assistants, nurse practitioners, physical therapists, nontraditional health
aides, and physicians will continue to increase at a healthy pace. This
trend also applies to technical and administrative jobs, as hospitals
continue to focus their energies on more efficient management and
profitability.
Many people are attracted to the health-care industry for its human touch
and service-oriented aspects. However, the harsh reality is that the
industry as a whole is all business these days. Hospitals, nursing homes,
home health care, specialized clinics—and even to some extent organizations
that provide alternative medical treatments—are being run increasingly like
any other major for-profit organization. Simply put, health care today is
all about big business—with its focus sharpening on driving profits higher.
The health-care industry provides diagnostic, healing, rehabilitation, and
preventive services. The individual physician is often the consumer's
(or patient's) primary point of contact with the system. However, it is
the health-care organization itself—that is, the hospital or health
management organization (HMO)—that finances much of the industry today; it
represents the preponderance of the physician's revenues. The
lion's share of these revenues, in turn, comes from employee health
insurance plans, Medicare (health insurance for Americans over the age of
65), and Medicaid (health insurance for Americans on welfare). Health-care
organizations (with the exception of county hospitals) are generally run
for profit. This disconnect between organizations based on the profit
motive and those operating as nonprofits creates tension among doctors and
other health-care professionals intent on prescribing the most
cost-effective treatments and conducting diagnostic tests. Health-care
organizations are increasingly driven to cut costs across the board.
Alternative Medicine
A growing segment of the population is turning to a wider, more diverse set
of techniques and therapies to meet health-care needs. The catchall
category of alternative medicine refers to any practice outside of
conventional medical treatments, including homeopathy, acupuncture, massage
therapy, and chiropractic. The granddaddy of the movement is Dr. Andrew
Weil, who preaches the benefits of treating a patient holistically, serving
the body, mind, and spirit.
Americans are increasingly turning to herbal remedies to treat ailments,
spending over 4 billion dollars a year on herbs and other botanical
remedies. Health-care providers and insurance companies are beginning to
recognize the legitimacy of some of these alternatives and to accept some
nontraditional techniques for treating chronic health issues.
Runaway Costs
Doctors and hospitals have been grappling with rising costs for a long
time—and each year the problem seems to get worse. Malpractice insurance
premiums, soaring prescription-drug prices, and the increasing numbers of
uninsured Americans are all factors leading to ever-higher costs for
caregivers. At the same time, revenues for doctors and hospitals keep
falling, as insurers are doing everything in their power to lower payments
for claims.
Meanwhile, insurers are not feeling the squeeze nearly as much as the
caregivers. The reason: They make sure that revenue from premiums rises at
a higher rate than claims payments.
The Uninsured Nation
Currently, some 43.6 million Americans have no health insurance. The number
of uninsured Americans continues to grow like an epidemic. Why? Insurance
premiums continue to skyrocket as health insurers consolidate their
businesses through frequent mergers and acquisitions. The result of this
trend is a continued decline in competition among health insurers—and
higher premiums are one of the results. Indeed, employers are facing
double-digit percentage increases in health premium costs each year. The
upshot: More and more of the cost of health insurance is being passed on to
employees, meaning many people simply can no longer afford health-care
coverage—considered a necessity (indeed even a birthright, many argue) in
any industrialized nation.
Hospitals
Despite the increased outsourcing (not uncommon in any industry today) of
medical records, housekeeping, lab testing, and clinical services (e.g.,
orthopedics and radiology), hospitals remain the biggest employers in the
health-care industry. The huge networks such as HCA and Tenet demand a
steady supply of doctors, nurses, administrators, medical technicians,
therapists, and other support staff. In areas where competition from HMOs
is mounting and cost-cutting is a priority, former staff may move outside
the immediate confines of a hospital. However, close and important links
remain—particularly for any type of surgery or specialized treatment such
as chemotherapy.
HMOs and PPOs
Health maintenance organizations (HMOs) and preferred provider
organizations (PPOs) are hybrids—basically, a cross between a hospital and
an insurance company. Each type of managed care plan covers primary care
visits, preventive services, and copayments for prescription drugs, whereas
only PPOs allow the enrollee to choose his or her physician (HMOs maintain
a list of plan-approved doctors). Some of the largest organizations have
their own medical staffs and facilities where they treat patients; smaller
ones may simply access networks of private providers and hospitals.
Competition is fierce in this arena—M&A and internal strife often
destabilize the job market. Coventry Health Care, Humana, Harvard Pilgrim
Health Care, and PacifiCare Health Systems (one of the leading Medicare
HMOs) are a few of the better-known players.
Specialty Providers
As hospitals have attempted to cut costs, they have turned to firms that
can provide specialized services at rock-bottom prices. These include
everything from nursing homes (Beverly Enterprises) to home infusion
therapy providers (Apria Healthcare) to diabetes treatment providers
(American Healthways). Clinics that focus on special treatments such as
chemotherapy, MRI and other scanning techniques, and physical therapy are
also proliferating. Most are small and locally run; however, Gambro and
Fresenius Medical Care are two enormous service companies that focus on
this type of care; others will undoubtedly emerge as their popularity
increases.
Home Care
Advances in technology have done much to improve efficiency and reduce
costs for both patients and home care staff. Today, home care nurses and
aides can administer complex treatments previously available only in
hospitals and clinics to the elderly and severely disabled in their own
homes. And because almost all hospitals and HMOs now release patients
before they are self-sufficient, home care is often the most cost-effective
choice. Most jobs in this sector don't require much training (they are
closely supervised by RNs, NPs, or physicians)—just deep reserves of
patience and kindness. The pay is low—often less than $10 an hour—and the
work is arduous. The rewards? In addition to extremely flexible hours and
plenty of personal contact with patients, there is the satisfaction of
helping people when they are most in need.
The various health-care positions require varying levels of education and
training. Registered nurses (RNs) are trained at the undergraduate level,
whereas nurse practitioners (NPs) have received master’s degrees in their
specialties. Physician assistants (PAs) are licensed to practice medicine
under the supervision of a physician. Doctors of osteopathy and medical
doctors both complete 4 years of postgraduate work to earn the titles of DO
and MD, enabling them to prescribe medicine and perform surgery. To qualify
for some positions (including doctor, nurse, tech), technical training is
required—and to actually land a job, you often need a strong network in a
given area and practical experience in the industry.
RNs, pharmacists, and radiological technicians are currently in very high
demand and will continue to be in the decade ahead. Why? The Baby Boomer
population is maturing into retirement, the elderly population in the
United States is growing, and health-care spending is being cut wherever
possible—which means that today, whenever a nurse can do something a doctor
used to be responsible for, that's exactly what's going to happen.
Employers are looking to attract people to these in-demand professions by
offering signing bonuses, tuition reimbursement or loan repayment, flexible
scheduling, and incentives for voluntary overtime shifts.
The good news doesn't end there: Opportunities will also grow at a
healthy clip for just about every other health-care function, including
doctors, optometrists, occupational therapists, audiologists, medical
record technologists, medical transcriptionists, and speech pathologists.
The highest demand will be for physician assistants, physical therapists,
lab clinicians, dental hygienists, respiratory technicians, substance abuse
counselors, and especially home health-care workers.
Hospitals and HMOs offer jobs in management in addition to
medicine—particularly if you have a background in information technology
(IT) and data system development. As a job seeker, you should be aware that
HMOs have been the catalysts for many of the efficient business practices
adopted throughout the health-care industry in recent years. Technical and
administrative support positions are in high demand as the industry evolves
in an intensely competitive market. Health-care IT is a steadily growing
sector; although the industry has been a late adopter of IT, it is catching
up now. There will be lots of opportunity in this area for the tech-savvy.
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Feels Good to Make Others Feel Good
Even if your medical career has only gone as far as plumping pillows and
soothing a fevered brow, you can probably sense why the many dedicated
people in this industry continue to selflessly perform often menial labor
for scant compensation and recognition. Recent studies have shown that HMO
technicians and doctors rate their job satisfaction significantly lower
than that of nurses, aides, and therapists who care for the sick—often with
significantly less pecuniary reward.
Need Flexibility?
One former teacher recalls arriving in a small town in Florida with little
chance of finding work in the local schools. Finally, in desperation, she
took a part-time job at a nursing home and discovered a whole new career.
"I really love my work," she says. With five years'
experience under her belt, she says, "I make my own hours, and I'm
earning very good money." Many people who fall into this field stay
put because they can better balance the demands of family, school, and
other commitments—both with more ease and associated emotional rewards than
is the case with most other kinds of part-time work.
Goodbye, Rusty Saw
Advances in medical technology over the last 30 years have been truly
phenomenal. The same patients who were once read their last rites are now
routinely patched up and returned to healthy, productive lives—often with
procedures that can be handled on an outpatient basis. Whether or not
you're a researcher at heart, playing an integral role in the ongoing
medical revolution can be immensely personally rewarding and intellectually
stimulating.
Care for Profit?
Most people pursue a career in health care because they want to help people
in need. Increasingly, however, the business side of health care has come
between patients and providers. "At my hospital, we're supposed to
call the patients 'customers,'" says one insider. "I keep
telling my boss this is not Lord & Taylor!" or "All I can say
is it stinks, and corporate America has no business in the system,"
says another. Lots of strong emotions emerge in this discussion, and these
days are certainly not easy or happy ones in this industry. The higher up
the ladder you go, the more bruising and harsh the politics and economics
tend to become.
The 15-Minute Consultation
With or without the capable assistance of a PA or NP, about 15 minutes is
about how much time most physicians are allocated per patient these days.
Think about it. If a patient showed up with searing pains in her legs, and
two previous doctors apparently were not providing immediate assistance,
how would you feel about giving yet another cursory inspection and
diagnosis? Everyone's complaints, no matter how seemingly routine,
deserve focus and attention. Most health-care professionals feel this even
more strongly than their patients do. Physician practice management groups
(PPMs) are proliferating and becoming increasingly vocal in their angry
opposition to the heavy, restrictive hand of managed care. This is a
problem that will likely get worse before it gets better.
Survival of the Fattest
Insiders readily acknowledge the fact that the poor receive a different
standard of health care. Some would argue that for the richest nation in
the world to be without a federally subsidized health program, particularly
for the indigent, is unconscionable. Others insist that a rigorous level of
medical excellence can only be maintained as a well-run, competitive
business. It's troubling to everyone, though, that those most
vulnerable to both chronic and emergency illness are those with fewer and
fewer available avenues of recourse to fairly priced quality health care.
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Top 10 Health Care Players, by 2005 Revenue
|
|
Rank
|
Company
|
Revenue ($M)
|
1-Year Change (%)
|
Employees
|
|
1
|
Blue Cross and Blue Shield Association
|
238,900*
|
10.2*
|
150,000*
|
|
2
|
UnitedHealth Group, Inc.
|
45,365
|
21.9
|
55,000
|
|
3
|
WellPoint, Inc.
|
45,136
|
116.8
|
42,000
|
|
4
|
Medco Health Solutions, Inc.
|
37,871
|
7.1
|
15,300
|
|
5
|
Caremark Rx, Inc.
|
32,991
|
27.9
|
13,628
|
|
6
|
Kaiser Permanente
|
25,300**
|
12.4**
|
147,000**
|
|
7
|
HCA Inc.
|
24,455
|
4.1
|
191,100
|
|
8
|
Aetna Inc.
|
22,492
|
13.0
|
26,700
|
|
9
|
CIGNA Corp.
|
16,684
|
-8.2
|
28,000
|
|
10
|
Express Scripts
|
16,266
|
7.6
|
14,020
|
*2004 numbers. **2003 numbers.
Sources: Hoover's; WetFeet analysis.
|
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Physician
Although most medical students today will tell you that the industry has
changed for the worse and that (in their opinion) new doctors will be lucky
if they can pay back their school loans, physicians still enjoy the most
pay and are accorded the greatest respect in the health care field today.
Undeniably, however, they also have to do the most preparation; typically a
doctor must complete seven years of schooling and residency before earning
certification to practice medicine—and often much more in the case of
specialties such as cardiac surgery or psychiatry.
Of the more than half a million physicians actively practicing in the
United States, about one-third are primary-care physicians. Most of the
rest are specialists: for example, surgeons, neurologists,
anesthesiologists, and radiologists. The demands of the work, the pay, and
the lifestyle vary considerably from one specialty to another. Salary
range: starting as low as $32,000 for residents; from $110,000 to $205,000
for general practitioners; $160,000 to $400,000 or more for hospital-based
doctors such as radiologists and anesthesiologists; $160,000 to $700,000 or
more for surgeons, depending on specialty.
Registered Nurse (RN)
The United States is facing a fairly severe nursing shortage, due in part
to declining nursing school enrollments and an aging workforce. It's a
job seeker's market, which means that you have more leverage, for
example, in the way of signing bonuses. On the other hand, the diminished
quality of care for patients and the heavier workload for those entering
this profession are bad.
Finally, however, nurses have proof to back up their contention that staff
cuts and replacement of RNs with medical assistants and licensed practical
nurses translates into harm to patients—something usually dismissed by
managers and executives as anecdotal or as just complaints. The Journal of
the American Medical Association documents the link between the increased
risk to patients with decreases in nurse staffing as well as nurse burnout
and job dissatisfaction. Investigators found that, when nurse caseloads
exceeded four patients, the risk of patient death increased by some 7
percentage points per additional patient. That means that if eight patients
are under the care of one nurse, those patients are 31 percent more likely
to die. The prognosis for the improvement in working conditions for nurses
in the future is unclear. Salary range: $30,000 to $65,000.
Licensed Practical Nurse (LPN)
LPNs represent the second-largest occupational title in the health-care
industry and are projected to be the fourth fastest-growing employment
category of positions requiring postsecondary or associate degrees. As with
RNs, there is a shortage of LPNs, and employers report that recruiting
candidates for this position is taking longer now—translating into more
leverage and greater choice for the job seeker. In addition to jobs in
hospitals, good job prospects can be found in nursing homes, home
health-care services, medical centers, and ambulatory surgi-centers.
Physicians' offices are also popular, particularly as more and more
become outpatient clinics for orthopedics and other specialties. Salary
range: $28,000 to $47,000.
Nurse Practitioner (NP)
NP is a good career target for those of you who have a master's degree
and training in pediatrics or family health, but either can't afford or
don't want to go to medical school. In many states, NPs can prescribe
medicine and are increasingly allowed primary-care status for basic health
problems. Oxford Health and Columbia-Presbyterian Hospital pioneered these
new responsibilities for NPs in the New York area, and HMOs elsewhere are
following suit. Salary range: physician's rates for primary care;
$50,000 to $80,000.
Medical Technician
The medical technician position is a solid career choice, particularly for
those with computer skills or an IT background. Med techs are in high
demand everywhere in the country, particularly on the West Coast and in the
Rockies, and in every type of facility—hospitals, medical labs, and
anywhere else special tests such as EEG, MRI, and CT are administered.
Budget cuts may come and go, but as is the case with so many other aspects
of modern life, technical expertise commands its own price. Moreover, this
is knowledge based on experience, not academic credentials; many
technicians have only high school or college degrees, plus several years of
specialized training. Salary range: $25,000 to $55,000; the best pay is in
nuclear medicine technology.
Physical Therapist
As the general population ages and athletes—weekend warriors or
otherwise—continue to get injured, physical therapy becomes ever more
popular. One unexpected drawback is that PT master's programs are in
such demand that, according to one insider, "those interested in PT
should start early, because it may take a few attempts to get accepted into
a program—and you need a master's to get a job." For communities
where managed care predominates, home care and nursing homes are better
long-term bets; their focus is on the benefit, not the cost, of physical
therapy for their patients. Salary range: $42,000 to $72,000. PT assistants
can expect to make between $25,000 and $40,000.
Health Care Manager
These are the jobs where an MBA comes in handy and a background in
accounting (and experience with cost-cutting), marketing, and information
systems management will give you an edge over the competition. Lots of
people want these jobs, and though industry observers predict that the
number of managerial slots in hospitals and HMOs will shrink to perhaps
half the current number, the need for qualified executive staff in home
health care, nursing homes, and clinics is expected to more than make up
the difference. Salary range: $50,000 and up. Experienced managers with an
impressive track record in meeting and maintaining strict budgets can earn
well into the six-figure range.
Home Health Care Aide
This category runs the gamut from the high school student with minimal
training who shops, cleans, and cooks part-time for an elderly or infirm
patient to a full-time nurse who can perform many of the procedures
available in a hospital and be on call 24 hours a day. Many states now
require brief training and some form of certification for all such workers,
but these regulations are difficult to enforce. Demand for these
professionals is expected to grow as the population ages and hospital
facilities become less available, especially for long-term care. But
bathing, dressing, feeding, and ministering to the disabled and the gravely
ill is difficult work. Not surprisingly, the greatest demand will be at the
bottom end of the pay scale. Salary range: $9 to $14 per hour—lowest for
those without formal training or state certification—up to $25 to $50 per
hour for aides with a BS in nursing.
Medical Secretary
Mergers, budget cuts, financial and insurance misdeeds: Neither these nor
any of the other more permanent structural changes in the industry have
decreased the demand for medical secretaries. They have been counted on for
years to dutifully answer the phones, juggle those canceled and emergency
appointments, and comfort the tearful and frightened. Computer networking
and sophisticated record-keeping skills are necessary these days, but even
without much formal training, medical secretaries will remain essential in
every doctor's office, clinic, outpatient center, and hospital. As with
secretarial positions in other industries, training is generally done on
the job, though classes in computer skills and administrative tasks will
give you a leg up on the competition. Salary range: $25,000 to $40,000.
Much depends on the aspect of this diverse and changing industry that you
choose to pursue. For a position demanding a particularly high level of
medical aptitude or technical skill, you're going to need substantial
training and equal amounts of personal dedication. For the growing home
care sector, training is less important than stamina, patience, and empathy
for the sick and elderly. Here are some things to consider before starting
your job search:
-
Many health-care professionals now see an MBA as a vital career boost,
and combined degrees in business and pharmacology or business and nursing
are becoming quite common. A facility with technology is also a big plus
on your resume, and degrees in such areas as computer science or even
electrical engineering, coupled with some aspect of medical training,
will become an increasingly useful job-hunting tool.
-
Whether you're caring for the ill directly or managing an office or
business that looks after their needs, your bedside manner matters. This
is not an industry for the impatient, the abrasive, or the
weak-stomached. You may be working in front of a computer terminal all
day and see very few patients, but don't expect to succeed or be
happy in this field in the long-term if you tend to be squeamish.
-
You'll want to consider carefully what means most to you in a job.
Start by talking to people in the field. In addition to inside
information on job possibilities others don't know about, it will
also help you choose the types of workplace that are right for you.