Health Care Jobs Up– Again

Photo by bjmccray via Flickr

“Health Care Jobs Up,” a tried and true headline that has been capable of use every month in the last decade, and one I’ve used a time or two in one form or another here at HRW. Although the Bureau of Labor Statistics’ latest employment report showed a slowdown in private sector hiring, ambulatory care settings added 8,700 jobs while health care as a whole added 13,100 jobs.

In an article entitled “The Health Care Economy: Where the Jobs Are,” Merril Goozner over at the Fiscal Times writes:

The health care industry is bulletproof when it comes to increasing spending or creating jobs. Growth rates that are often double the rest of the economy have allowed the nation’s hospitals and physician offices to add nearly 1.5 million jobs over the past decade, a period when other private sector employers were shedding 2.8 million jobs, largely the result of the banking and financial crisis. In fact, there hasn’t been a single month in the past decade when health care providers as a group didn’t increase employment opportunities for job-hungry Americans.

The employment gains experienced in the health care sector are prodigious, in January of 2009 The Wall Street Journal reported that in an otherwise bleak economy

“Health care saw a net gain of 419,000 jobs in 2008 and its growth outlook continues to be strong through 2016, according to the Bureau of Labor Statistics.”

And for health law practitioners?  What I wrote back in March of this year seems no less true now:

What might one expect to be the effect of this relatively sanguine state of affairs for Health Care employment on Health Law practitioners?

In the well written and informative words of Professor Jennifer Bard, J.D., M.P.H (I highly recommend the article,  “I’m Interested in Health Law- Now Where Can I Get a Job?” to anyone who may be considering a career in Health Law),

Health care is a trillion-dollar industry[1]that has grown exponentially over the past 10 years with very little sign of slowing. The demand for legal services has tracked the growth of the industry,[2] and, as a result, attorneys calling themselves “health lawyers” have grown from a small core of specialists to a large and diverse group of individuals who are as likely to specialize in bond issuance and tax planning as in torts or food and drug law. Moreover, the increasing regulation of health care has created substantial need for lawyers specializing in compliance with a vast array of federal, state and local regulations. Where 15 years ago most health law was done by small, specialized law firms, today many of the nation’s biggest law firms have thriving health law practices.

Significantly, although officially published in the Winter of 2009 (14 New York State Bar Association Health Law Journal 73 (2009)), Professor Bard first published those words to SSRN in February of 2008-prior to the onset of the Obama Administration and the rising priority of Health Care Reform and regulatory enforcement. Because of these rising priorities, her words are no less true than when they were written, and have arguably gained an even greater currency since.

In an article this month in The American Lawyer, “Drug Supplement.  New federal regs demand more health care lawyers,” Rachel Breitman points out the following:

Ever since President Barack Obama gave health care reform a prime spot on his agenda, hospital, pharmaceutical, medical device, and insurance interest groups have been digging in, with the expectation of a battle to come-the kind that requires lawyers.

Changes have already begun. New federal regulations like a genetic discrimination shield law and new digital privacy security standards have been enacted. The U.S. Department of Justice and Health and Human Services launched a healthcare task force in May. “There’s going to be more oversight about how companies spend government grant funds for research and clinical trials,” says Frederick Robinson, the head of Fullbright & Jaworski’s Washington, D.C., health law practice, which advises clients like Zimmer, Inc., and Walgreen Company. “Also, as health care providers apply for stimulus funds, there will be new compliance challenges to get the money.”

As a result, law firms have a new appetite for health care lawyers.

Health Care Jobs Up & Expected to Stay That Way

The sickness of one is the work of the other. The Wall Street Journal reports that “Health care saw a net gain of 419,000 jobs in 2008 and its growth outlook continues to be strong through 2016, according to the Bureau of Labor Statistics.”

According to WSJ, Dennis Damp, “the Pittsburgh, Pa.-based author of ‘Healthcare Job Explosion’ and editor of Healthcarejobs.org, a free recruiting Web site,” said that “about half of the BLS’ 30 fastest-growing occupations through 2016 are health-related.”

An examination of the latest BLS report (p. 25) shows that employment numbers were up in every category of health care jobs tracked. WSJ reports that “among specific occupations, the number of registered nurses grew the most, adding 168,000 jobs through November as hospitals and agencies tried to address a nationwide nursing shortage.”

The Journal also reports that “The number of home care aides grew by 64,000 in 2008, the BLS said. Office and administrative support workers such as medical-records clerks accounted for 14% of the overall increase in health-care jobs year over year.” That 14% increase would be equivalent to approximately 59,000 jobs.

John Challenger, chief executive of outplacement consulting firm Challenger, Gray & Christmas in Chicago is reported by WSJ to have said that in health care, “Long-term forces are outweighing the short-term recessionary forces.” Mr. Challenger cited “the aging of the baby boomers, rapid product development in biotechnology and increased momentum for comprehensive national health-care reform” as being “likely to drive job growth this year.”

Mr. Challenger also noted that “There’s strong demand for geriatricians, physical therapists and nurses of all kinds….noting support work is hot as well, especially as the incoming Obama administration takes up health reform. ‘A commitment to a new kind of more universal health-care system is going to create a new structure and consequently new jobs.”

Read the full WSJ article here.

Physician Compensation II

Yesterday’s post displayed recent Bureau of Labor Statistic figures concerning physician compensation, and offered a link to recent median physician compensation data approved for use by Centers for Medicare and Medicaid Services (CMS) for calculations regarding direct graduate medical education under 42 CFR 413.78(f). The producer of this data, AMGA, also offers an interactive physician compensation survey which shows “average” and “starting” compensation for various specialties. A click on the arrow underneath “average” will sort from lowest to highest.

Here below is a list of a few of the CMS approved median physician compensation figures for a number of different specialties. The numbers are taken from the 2008 report.

The median compensation for a practitioner:

• Pediatric & Adolescent, Internal 161,444
• Pediatric & Adolescent, Infect. Disease 174,154
• Family Medicine, w/out Obstetrics 176,280
• Family Med., w/out Obst., Branch* 190,182
• Geriatrics 179,344
• Podiatry: 180,080
• Transplant Surgery, Kidney 368,750
• Dermatology, Branch* 301,111
• Dermatology, Mohs 423,848
• Not neural, Non-Interventionist, Radiology 420,858
• Mammography 540,028
• Orthopedic Surgery, Spine 611,670

*Branch is defined by AMGA as: These specialties have the same basic definition as the main specialty. These physicians located in small satellite or branch offices at least five miles from the main campus. The branch office practices primarily as its own separate entity, and often has different compensation and/or performance expectations than its main campus colleagues, there would be no teaching responsibilities at these locations.

With these numbers, over the course of ten career years, if calculated at a constant rate without regard to future increases in compensation, the median paid “Family Doctor, Branch” will have earned $1,900,182. During those same static ten years, a “Mammographer” will have earned $5,400,280. If the Family Doctor were to consult with the Mammographer at the end of those ten years, she would be doing so with someone who had made $3,500,098 more than she–nearly 3 times as much. If that same Family Doctor were to then consult with someone from the lowest paid of the three categories of Radiologist, Not neural, Non-Interventionist, she would be doing so with someone who had made $4,208,580 during that time-which would be $2,308,398 more than she–or more than twice as much.

Perhaps by way of consolation for the PCP, the Geriatrics specialist and the Pediatric Infectious Disease specialist would have fared worse, and even the Kidney transplant specialist who consults with the radiologist would be speaking with someone who had made a half of a million dollars more than he did.

But perhaps it is not consolation enough; the AMA has reported that the nation faces a shortage of 35,000 to 40,000 Primary Care Physicians.

Physician Compensation

The Bureau of Labor Statistics, U.S Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, publishes the data shown immediately below regarding physician compensation. The BLS report lists Primary Care Physicians under “Family practice.” The Handbook states:

.
Total compensation for physicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bonus and incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation.

Footnotes:
(NOTE) Source: Medical Group Management Association, Physician Compensation and Production Report, 2005.
Self-employed physicians-those who own or are part owners of their medical practice-generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement.

The American Medical Group Association (AMGA) offers a 2008 Physician Compensation Survey which is more comprehensive than the BLS data and has been approved for use in conjunction with the Centers for Medicare and Medicaid (CMS) regulations at 42 CFR 413.78(f) pertaining to calculations of physician pay (median) in reference to Graduate Medical Education. It features a wide range of specialist compensation data.

Health Benefit Costs Over Time

The U.S Bureau of Labor Statistics (BLS) offers a report: “Program Perspectives, On Health Benefits, recent data on employers’ costs and employees’ access.” The report (which also appears in the “Resources” section of this weblog) is user friendly and well worth the moment or two it would take to peruse it. It offers some interesting information on both relative cost and access. Of particular note, however, is “Chart 1,” which is a graphic representation of the “Employment Cost Index, private industry, 12 month percent change, health benefits and total benefits, 1982-2008.” Although BLS offers a caveat on the numbers, it cuts both ways.

BLS characterizes the data thus: “Over the last 25 years, health benefit costs for employers has moved in fits and starts.” The chart shows rapid accelerations in cost accompanied by periods of deceleration. In March1983 the cost of health benefits spiked 23.5% over the year prior; a similar (but not as large) rise may be seen from mid-1987 to mid-1988, and a protracted ascent may be seen from 1996 to 2002. BLS juxtaposes the health benefit costs with the costs of “total benefits;” in comparison, the movement of “health benefit costs” is precipitous.

BLS does not offer an explanation. It would be interesting to see charts which juxtaposed the cost of health benefits during this time period with the Inflation Rate, Interest Rates, Avg. ROI in the Stock and Bond Markets–and of course, the reported profit of the major commercial Health Insurance providers.