Careers in San Diego s Healthcare Sector: A Healthy Future

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3 Careers in San Diego s Healthcare Sector: A Healthy Future

4 This report is dedicated to the memory of DR. JO-ANN ROSSITTO, former Associate Dean of Nursing at San Diego City College, who helped guide its development.

5 Table of Contents TABLE OF CONTENTS INTRODUCTION...3 HEALTHCARE SECTOR PROFILE AND OUTLOOK...7 FACILITIES AND EMPLOYMENT...9 WAGES...14 SECTOR TRENDS...15 OCCUPATIONAL OVERVIEW...19 CAREER LADDER PATHWAYS...23 HEALTHCARE CAREER LADDERS...23 CAREER LADDER VIGNETTES...28 PRIMARY OCCUPATION PROFILES...33 CARDIOVASCULAR TECHNOLOGISTS AND TECHNICIANS...33 CLINICAL, COUNSELING, AND SCHOOL PSYCHOLOGISTS...37 DENTAL ASSISTANTS...42 DENTAL HYGIENISTS...46 DIETETIC TECHNICIANS...50 EMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS...54 HOME HEALTH AIDES...59 LICENSED PRACTICAL AND LICENSED VOCATIONAL NURSES...63 MEDICAL AND CLINICAL LABORATORY TECHNICIANS (CYTOTECHNOLOGISTS)...69 MEDICAL AND CLINICAL LABORATORY TECHNOLOGISTS...74 MEDICAL ASSISTANTS...79 MEDICAL RECORDS AND HEALTH INFORMATION TECHNICIANS...85 NURSING AIDES, ORDERLIES, AND ATTENDANTS...90 OCCUPATIONAL THERAPIST ASSISTANTS...94 PHARMACY AIDES...98 PHARMACY TECHNICIANS PHYSICAL THERAPIST AIDES PHYSICAL THERAPIST ASSISTANTS PHYSICAL THERAPISTS PHYSICIAN ASSISTANTS RADIOLOGIC TECHNOLOGISTS AND TECHNICIANS REGISTERED NURSES RESPIRATORY THERAPISTS RESPIRATORY THERAPY TECHNICIANS SPEECH-LANGUAGE PATHOLOGISTS SURGICAL TECHNOLOGISTS San Diego Workforce Partnership Page i

6 Table of Contents SECONDARY OCCUPATION PROFILES DENTAL LABORATORY TECHNICIANS DIAGNOSTIC MEDICAL SONOGRAPHERS DIETITIANS AND NUTRITIONISTS MASSAGE THERAPISTS MEDICAL EQUIPMENT PREPARERS MEDICAL TRANSCRIPTIONISTS MENTAL HEALTH AND SUBSTANCE ABUSE SOCIAL WORKERS NUCLEAR MEDICINE TECHNOLOGISTS OCCUPATIONAL THERAPISTS OPTICIANS, DISPENSING PSYCHIATRIC TECHNICIANS APPENDICES APPENDIX A: DATA SOURCES FOR OCCUPATIONAL PROFILES APPENDIX B: OCCUPATIONAL FORECASTING AND WAGE DATA METHODOLOGY Page ii San Diego Workforce Partnership

7 List of Tables LIST OF TABLES TABLE 1: SUB-SECTORS IN THE SAN DIEGO HEALTHCARE SECTOR...7 TABLE 2: HEALTHCARE SECTOR SEGMENTS...9 TABLE 3: HEALTHCARE SECTOR FACILITIES IN SAN DIEGO, TABLE 4: HEALTHCARE SECTOR EMPLOYMENT IN SAN DIEGO, TABLE 5: PROJECTED HEALTHCARE SECTOR EMPLOYMENT IN SAN DIEGO, TABLE 6: HEALTHCARE SECTOR AVERAGE WAGES IN SAN DIEGO, TABLE 7: HEALTHCARE OCCUPATIONS WITH THE GREATEST EMPLOYMENT IN SAN DIEGO, 2004 AND TABLE 8: HEALTHCARE OCCUPATIONS WITH THE HIGHEST MEDIAN ANNUAL WAGES IN SAN DIEGO, San Diego Workforce Partnership Page iii

8 List of Figures LIST OF FIGURES FIGURE 1: PATIENT HEALTHCARE CAREER LADDERS...24 FIGURE 2: TECHNICAL HEALTHCARE CAREER LADDERS...25 FIGURE 3: CLERICAL HEALTHCARE CAREER LADDERS...26 FIGURE 4: SALARY POTENTIAL: NURSING PROFESSION...29 FIGURE 5: SALARY POTENTIAL: RADIOLOGY TECHNOLOGY...30 FIGURE 6: CARDIOVASCULAR TECHNOLOGISTS AND TECHNICIANS EMPLOYMENT FORECAST...33 FIGURE 7: CARDIOVASCULAR TECHNOLOGISTS AND TECHNICIANS WAGE DISTRIBUTION...34 FIGURE 8: CARDIOVASCULAR TECHNOLOGISTS AND TECHNICIANS SKILL IMPORTANCE...35 FIGURE 9: CARDIOVASCULAR TECHNOLOGISTS AND TECHNICIANS EDUCATIONAL PROFILE...36 FIGURE 10: CLINICAL, COUNSELING, AND SCHOOL PSYCHOLOGISTS EMPLOYMENT FORECAST...37 FIGURE 11: CLINICAL, COUNSELING, AND SCHOOL PSYCHOLOGISTS WAGE DISTRIBUTION...38 FIGURE 12: CLINICAL, COUNSELING, AND SCHOOL PSYCHOLOGISTS SKILL IMPORTANCE...39 FIGURE 13: CLINICAL, COUNSELING, AND SCHOOL PSYCHOLOGISTS EDUCATIONAL PROFILE...40 FIGURE 14: DENTAL ASSISTANTS EMPLOYMENT FORECAST...42 FIGURE 15: DENTAL ASSISTANTS WAGE DISTRIBUTION...43 FIGURE 16: DENTAL ASSISTANTS EDUCATIONAL PROFILE...44 FIGURE 17: DENTAL HYGIENISTS EMPLOYMENT FORECAST...46 FIGURE 18: DENTAL HYGIENISTS WAGE DISTRIBUTION...47 FIGURE 19: DENTAL HYGIENISTS EDUCATIONAL TRAINING...48 FIGURE 20: DIETETIC TECHNICIANS EMPLOYMENT FORECAST...50 FIGURE 21: DIETETIC TECHNICIANS WAGE DISTRIBUTION...51 FIGURE 22: DIETETIC TECHNICIANS SKILL IMPORTANCE...52 FIGURE 23: DIETETIC TECHNICIANS EDUCATIONAL PROFILE...53 FIGURE 24: EMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS EMPLOYMENT FORECAST...54 FIGURE 25: EMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS WAGE DISTRIBUTION...55 FIGURE 26: EMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS SKILL IMPORTANCE...56 FIGURE 27: EMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS EDUCATIONAL PROFILE...57 FIGURE 28: HOME HEALTH AIDES EMPLOYMENT FORECAST...59 FIGURE 29: HOME HEALTH AIDES WAGE DISTRIBUTION...60 FIGURE 30: HOME HEALTH AIDES EDUCATIONAL PROFILE...61 FIGURE 31: LICENSED PRACTICAL AND LICENSED VOCATIONAL NURSES EMPLOYMENT FORECAST...64 FIGURE 32: LICENSED PRACTICAL AND LICENSED VOCATIONAL NURSES WAGE DISTRIBUTION...65 FIGURE 33: LICENSED PRACTICAL AND LICENSED VOCATIONAL NURSES SKILL IMPORTANCE...66 FIGURE 34: LICENSED PRACTICAL AND LICENSED VOCATIONAL NURSES EDUCATIONAL PROFILE...67 Page iv San Diego Workforce Partnership

9 List of Figures FIGURE 35: MEDICAL AND CLINICAL LABORATORY TECHNICIANS (CYTOTECHNOLOGISTS) EMPLOYMENT FORECAST...70 FIGURE 36: MEDICAL AND CLINICAL LABORATORY TECHNICIANS (CYTOTECHNOLOGISTS) WAGE DISTRIBUTION...71 FIGURE 37: MEDICAL AND CLINICAL LABORATORY TECHNICIANS (CYTOTECHNOLOGISTS) EDUCATIONAL PROFILE...72 FIGURE 38: MEDICAL AND CLINICAL LABORATORY TECHNOLOGISTS EMPLOYMENT FORECAST...74 FIGURE 39: MEDICAL AND CLINICAL LABORATORY TECHNOLOGISTS WAGE DISTRIBUTION...75 FIGURE 40: MEDICAL AND CLINICAL LABORATORY TECHNOLOGISTS SKILL IMPORTANCE...76 FIGURE 41: MEDICAL AND CLINICAL LABORATORY TECHNOLOGISTS EDUCATIONAL PROFILE...77 FIGURE 42: MEDICAL ASSISTANTS EMPLOYMENT FORECAST...80 FIGURE 43: MEDICAL ASSISTANTS WAGE DISTRIBUTION...81 FIGURE 44: MEDICAL ASSISTANTS SKILL IMPORTANCE...82 FIGURE 45: MEDICAL ASSISTANTS EDUCATIONAL PROFILE...83 FIGURE 46: MEDICAL RECORDS AND HEALTH INFORMATION TECHNICIANS EMPLOYMENT FORECAST...86 FIGURE 47: MEDICAL RECORDS AND HEALTH INFORMATION TECHNICIANS WAGE DISTRIBUTION...87 FIGURE 48: MEDICAL RECORDS AND HEALTH INFORMATION TECHNICIANS EDUCATIONAL PROFILE...88 FIGURE 49: NURSING AIDES, ORDERLIES, AND ATTENDANTS EMPLOYMENT FORECAST...90 FIGURE 50: NURSING AIDES, ORDERLIES, AND ATTENDANTS WAGE DISTRIBUTION...91 FIGURE 51: NURSING AIDES, ORDERLIES, AND ATTENDANTS EDUCATIONAL PROFILE...92 FIGURE 52: OCCUPATIONAL THERAPIST ASSISTANTS EMPLOYMENT FORECAST...94 FIGURE 53: OCCUPATIONAL THERAPIST ASSISTANTS WAGE DISTRIBUTION...95 FIGURE 54: OCCUPATIONAL THERAPIST ASSISTANTS SKILL IMPORTANCE...96 FIGURE 55: OCCUPATIONAL THERAPIST ASSISTANTS EDUCATIONAL PROFILE...97 FIGURE 56: PHARMACY AIDES EMPLOYMENT FORECAST...98 FIGURE 57: PHARMACY AIDES WAGE DISTRIBUTION...99 FIGURE 58: PHARMACY AIDES EDUCATIONAL PROFILE FIGURE 59: PHARMACY TECHNICIANS EMPLOYMENT FORECAST FIGURE 60: PHARMACY TECHNICIANS WAGE DISTRIBUTION FIGURE 61: PHARMACY TECHNICIANS EDUCATIONAL PROFILE FIGURE 62: PHYSICAL THERAPIST AIDES EMPLOYMENT FORECAST FIGURE 63: PHYSICAL THERAPIST AIDES WAGE DISTRIBUTION FIGURE 64: PHYSICAL THERAPIST AIDES EDUCATIONAL PROFILE FIGURE 65: PHYSICAL THERAPIST ASSISTANTS EMPLOYMENT FORECAST FIGURE 66: PHYSICAL THERAPIST ASSISTANTS WAGE DISTRIBUTION FIGURE 67: PHYSICAL THERAPIST ASSISTANTS EDUCATIONAL PROFILE FIGURE 68: PHYSICAL THERAPISTS EMPLOYMENT FORECAST FIGURE 69: PHYSICAL THERAPISTS WAGE DISTRIBUTION FIGURE 70: PHYSICAL THERAPISTS SKILL IMPORTANCE FIGURE 71: PHYSICAL THERAPISTS EDUCATIONAL PROFILE FIGURE 72: PHYSICIAN ASSISTANTS EMPLOYMENT FORECAST San Diego Workforce Partnership Page v

10 List of Figures FIGURE 73: PHYSICIAN ASSISTANTS WAGE DISTRIBUTION FIGURE 74: PHYSICIAN ASSISTANTS SKILL IMPORTANCE FIGURE 75: PHYSICIAN ASSISTANTS EDUCATIONAL PROFILE FIGURE 76: RADIOLOGIC TECHNOLOGISTS AND TECHNICIANS EMPLOYMENT FORECAST FIGURE 77: RADIOLOGIC TECHNOLOGISTS AND TECHNICIANS WAGE DISTRIBUTION FIGURE 78: RADIOLOGIC TECHNOLOGISTS AND TECHNICIANS EDUCATIONAL PROFILE FIGURE 79: REGISTERED NURSES EMPLOYMENT FORECAST FIGURE 80: REGISTERED NURSES WAGE DISTRIBUTION FIGURE 81: REGISTERED NURSES SKILL IMPORTANCE FIGURE 82: REGISTERED NURSES EDUCATIONAL PROFILE FIGURE 83: RESPIRATORY THERAPISTS EMPLOYMENT FORECAST FIGURE 84: RESPIRATORY THERAPISTS WAGE DISTRIBUTION FIGURE 85: RESPIRATORY THERAPISTS SKILL IMPORTANCE FIGURE 86: RESPIRATORY THERAPISTS EDUCATIONAL PROFILE FIGURE 87: RESPIRATORY THERAPY TECHNICIANS EMPLOYMENT FORECAST FIGURE 88: RESPIRATORY THERAPY TECHNICIANS WAGE DISTRIBUTION FIGURE 89: RESPIRATORY THERAPY TECHNICIANS EDUCATIONAL PROFILE FIGURE 90: SPEECH-LANGUAGE PATHOLOGISTS EMPLOYMENT FORECAST FIGURE 91: SPEECH-LANGUAGE PATHOLOGISTS WAGE DISTRIBUTION FIGURE 92: SPEECH-LANGUAGE PATHOLOGISTS SKILL IMPORTANCE FIGURE 93: SPEECH-LANGUAGE PATHOLOGISTS EDUCATIONAL PROFILE FIGURE 94: SURGICAL TECHNOLOGISTS EMPLOYMENT FORECAST FIGURE 95: SURGICAL TECHNOLOGISTS WAGE DISTRIBUTION FIGURE 96: SURGICAL TECHNOLOGISTS EDUCATIONAL PROFILE FIGURE 97: DENTAL LABORATORY TECHNICIAN EMPLOYMENT FORECAST FIGURE 98: DENTAL LABORATORY TECHNICIAN WAGE DISTRIBUTION FIGURE 99: DIAGNOSTIC MEDICAL SONOGRAPHERS EMPLOYMENT FORECAST FIGURE 100: DIAGNOSTIC MEDICAL SONOGRAPHERS WAGE DISTRIBUTION FIGURE 101: DIETITIANS AND NUTRITIONISTS EMPLOYMENT FORECAST FIGURE 102: DIETITIANS AND NUTRITIONISTS WAGE DISTRIBUTION FIGURE 103: MASSAGE THERAPISTS EMPLOYMENT FORECAST FIGURE 104: MASSAGE THERAPISTS WAGE DISTRIBUTION FIGURE 105: MEDICAL EQUIPMENT PREPARERS EMPLOYMENT FORECAST FIGURE 106: MEDICAL EQUIPMENT PREPARERS WAGE DISTRIBUTION FIGURE 107: MEDICAL TRANSCRIPTIONISTS EMPLOYMENT FORECAST FIGURE 108: MEDICAL TRANSCRIPTIONISTS WAGE DISTRIBUTION FIGURE 109: MENTAL HEALTH AND SUBSTANCE ABUSE SOCIAL WORKERS EMPLOYMENT FORECAST FIGURE 110: MENTAL HEALTH AND SUBSTANCE ABUSE SOCIAL WORKERS WAGE DISTRIBUTION FIGURE 111: NUCLEAR MEDICINE TECHNOLOGISTS EMPLOYMENT FORECAST FIGURE 112: NUCLEAR MEDICINE TECHNOLOGISTS WAGE DISTRIBUTION FIGURE 113: OCCUPATIONAL THERAPISTS EMPLOYMENT FORECAST Page vi San Diego Workforce Partnership

11 List of Figures FIGURE 114: OCCUPATIONAL THERAPISTS WAGE DISTRIBUTION FIGURE 115: OPTICIANS, DISPENSING EMPLOYMENT FORECAST FIGURE 116: OPTICIANS, DISPENSING WAGE DISTRIBUTION FIGURE 117: PSYCHIATRIC TECHNICIANS EMPLOYMENT FORECAST FIGURE 118: PSYCHIATRIC TECHNICIANS WAGE DISTRIBUTION San Diego Workforce Partnership Page vii

12 INTRODUCTION

13 Introduction INTRODUCTION Careers in San Diego s Healthcare Sector: A Healthy Future provides information on the healthcare sector, which offers health services to the general public through hospital, emergency care, and outpatient care facilities; medical laboratories and offices; and long term care facilities. The publication is organized into the following sections: Healthcare Sector Profile and Outlook, Occupational Overview, Career Ladder Pathways, Primary Occupation Profiles, and Secondary Occupation Profiles. The Healthcare Sector Profile and Outlook section provides a description of the healthcare sector, as well as information on facilities, employment, and industry trends. The Occupational Overview examines occupation wages and employment; and the Career Ladder Pathways section describes opportunities to move up from one occupation to another within the healthcare sector. The two sections of occupation profiles comprise the majority of this report. The Primary Occupation Profiles section includes information on current and projected employment, wages, education and training requirements, education and training providers, and career ladder opportunities for 26 occupations. The Secondary Occupation Profiles section outlines current and projected employment and wages for another 11 occupations. Employment numbers in this report reflect only the number of people in an occupation within this sector as defined in Table 1. Therefore, these numbers may differ from other countywide occupational employment numbers that include workers in every sector. More information on supply and demand conditions and policy recommendations related to the healthcare sector are available in San Diego s Healthcare Sector: A Prescription for Strength. San Diego Workforce Partnership Page 3

14 HEALTHCARE SECTOR PROFILE AND OUTLOOK

15 Healthcare Sector Profile and Outlook HEALTHCARE SECTOR PROFILE AND OUTLOOK The healthcare sector includes establishments providing such services as preventive care, vaccination, diagnosis, prescription and administration of medicine, surgery, and attendance at childbirth. Healthcare services are delivered by specialist providers, such as midwives, doctors, nurses, home health aides, vaccination technicians, and physician assistants. Healthcare is one of the world's largest and fastest growing sectors and professions. For this study, the healthcare sector includes all of the sub-sectors in the healthcare and social assistance sector (NAICS 1 code 62) excluding those related to social assistance (those beginning with code 624) (see Table 1). Table 1 Sub-Sectors in the San Diego Healthcare Sector Sub-Sector NAICS Code Offices of Physicians (except Mental Health Specialists) Offices of Physicians, Mental Health Specialists Offices of Dentists Offices of Chiropractors Offices of Optometrists Offices of Mental Health Practitioners (except Physicians) Audiologists Offices of Podiatrists Offices of All Other Miscellaneous Health Practitioners Family Planning Centers Outpatient Mental Health and Substance Abuse Centers HMO Medical Centers Kidney Dialysis Centers Freestanding Ambulatory Surgical and Emergency Centers All Other Outpatient Care Centers The North American Industry Classification System (NAICS) has been used since 1997 by the U.S. Government to group businesses and calculate economic activity among industries in the U.S. economy. NAICS is an economic classification system based on a single economic concept: economic units that use like processes to produce goods or services are grouped together. San Diego Workforce Partnership Page 7

16 Healthcare Sector Profile and Outlook Table 1 (Cont.) Sub-Sector NAICS Code Medical Laboratories Diagnostic Imaging Centers Home Health Care Services Ambulance Services Blood and Organ Banks All Other Miscellaneous Ambulatory Health Care Services General Medical and Surgical Hospitals Psychiatric and Substance Abuse Hospitals Specialty Hospitals, except Psychiatric and Substance Abuse Nursing Care Facilities Residential Mental Retardation Facilities Residential Mental Health and Substance Abuse Facilities Continuing Care Retirement Communities Homes for the Elderly Other Residential Care Facilities Source: North American Industry Classification System, 2002 These 30 sub-sectors can be grouped into five broad segments (see Table 2): Hospital and Emergency Care Services Full service hospitals and ambulance services. Medical Laboratories Laboratories and other medical analysis centers. Medical Offices Offices for general and specialized medical treatment. Outpatient Services Family planning centers, HMO medical centers, and other outpatient centers. Long Term Care Facilities or services where patients receive care while residing at home or an offsite facility. Page 8 San Diego Workforce Partnership

17 Healthcare Sector Profile and Outlook Table 2 Healthcare Sector Segments Group Name Sub-Sector NAICS Code Freestanding Ambulatory Surgical and Emergency Centers Hospital/Emergency Care Services Medical Laboratories Medical Offices Outpatient Services Long Term Care Ambulance Services Blood and Organ Banks All Other Miscellaneous Ambulatory Health Care Services General Medical and Surgical Hospitals Psychiatric and Substance Abuse Hospitals Specialty Hospitals, except Psychiatric and Substance Abuse Medical Laboratories Diagnostic Imaging Centers Offices of Physicians (except Mental Health Specialists) Offices of Physicians, Mental Health Specialists Offices of Dentists Offices of Chiropractors Offices of Optometrists Offices of Mental Health Practitioners (except Physicians) Audiologists Offices of Podiatrists Offices of All Other Miscellaneous Health Practitioners Family Planning Centers Outpatient Mental Health and Substance Abuse Centers HMO Medical Centers Kidney Dialysis Centers All Other Outpatient Care Centers Home Health Care Services Nursing Care Facilities Residential Mental Retardation Facilities Residential Mental Health and Substance Abuse Facilities Continuing Care Retirement Communities Homes for the Elderly Other Residential Care Facilities Source: North American Industry Classification System, FACILITIES AND EMPLOYMENT In 2004, there were 5,626 healthcare facilities in the San Diego region. There was a 5 percent increase in the number of healthcare facilities between 2002 and Home healthcare services and diagnostic imaging centers experienced the greatest increase in the number of facilities, while general medical and surgical hospitals and miscellaneous ambulatory healthcare services experienced the greatest decrease in the number of facilities (see Table 3). San Diego Workforce Partnership Page 9

18 Healthcare Sector Profile and Outlook Table 3 Healthcare Sector Facilities in San Diego, NAICS Code Sub-Sector 2002 Number of Facilities 2004 Number of Facilities % Change Offices of Physicians, except Mental Health 1,792 1,932 8% Offices of Mental Health Physicians % Offices of Dentists 1,366 1,436 5% Offices of Chiropractors % Offices of Optometrists % Offices of Mental Health Practitioners % Offices of Specialty Therapists % Offices of Podiatrists % Offices of Miscellaneous Health Practitioners % Family Planning Centers % Outpatient Mental Health Centers % HMO Medical Centers % Kidney Dialysis Centers % Freestanding Emergency Medical Centers % All Other Outpatient Care Centers % Medical Laboratories % Diagnostic Imaging Centers % Home Healthcare Services % Ambulance Services % Blood and Organ Banks % Miscellaneous Ambulatory Healthcare Services % General Medical and Surgical Hospitals % Psychiatric and Substance Abuse Hospitals Specialty Hospitals, except Psychiatric and Substance Abuse Nursing Care Facilities % Residential Mental Retardation Facilities % Residential Mental and Substance Abuse Care % Continuing Care Retirement Communities % Homes for the Elderly % Other Residential Care Facilities % Healthcare Sector Total 5,336 5,626 5% A hyphen (-) indicates that data was either suppressed or not provided for that year. Data may have been suppressed to preserve the confidentiality of businesses providing data. Source: California Employment Development Department, Quarterly Census of Employment and Wages (ES202), Data include private sector facilities only. Page 10 San Diego Workforce Partnership

19 Healthcare Sector Profile and Outlook A total of 80,573 people were employed in the healthcare sector in San Diego in The subsectors with the highest concentrations of employment were general medical and surgical hospitals and offices of physicians excluding mental health; together, these sub-sectors comprise 47 percent of healthcare sector employment in San Diego. In 2002, 81,072 people were employed in the healthcare sector, indicating that employment in the healthcare sector actually declined by 1 percent between 2002 and During that two-year period, some sub-sectors expanded, while others declined. The largest employment gains were in HMO medical centers, continuing care retirement communities, and homes for the elderly. The largest employment losses were in offices of miscellaneous health practitioners, residential mental retardation facilities, and offices of mental health physicians (see Table 4). Between 2002 and 2004, the decreases in employment among residential mental retardation facilities and offices of mental health physicians corresponded to decreases in the number of facilities in these sub-sectors. In the case of general medical and surgical hospitals, hospital closures have not resulted in decreasing hospital employment overall. Although the number of general and medical surgical hospitals in San Diego decreased by 28 percent, employment in the sub-sector actually increased by two percent within the same time period. A look at changes in the average facility size within this sub-sector in 2002 and 2004 suggests that as hospitals close, hospital employees may be redistributed among the remaining area hospitals; in 2002, the average hospital size was 256 employees, whereas in 2004, the average hospital size was 366 employees. San Diego Workforce Partnership Page 11

20 Healthcare Sector Profile and Outlook Table 4 Healthcare Sector Employment in San Diego, NAICS Code Sub-Sector 2002 Average Employment 2004 Average Employment % Change Offices of Physicians, except Mental Health 18,241 18,129-1% Offices of Mental Health Physicians % Offices of Dentists 8,368 8,824 5% Offices of Chiropractors 1,485 1,425-4% Offices of Optometrists 901 1,007 12% Offices of Mental Health Practitioners 1,030 1,123 9% Offices of Specialty Therapists 1,565 1,325-15% Offices of Podiatrists % Offices of Miscellaneous Health Practitioners % Family Planning Centers % Outpatient Mental Health Centers % HMO Medical Centers % Kidney Dialysis Centers % Freestanding Emergency Medical Centers % All Other Outpatient Care Centers 1,039 1,067 3% Medical Laboratories 1,258 1,357 8% Diagnostic Imaging Centers % Home Healthcare Services 4,193 3,381-19% Ambulance Services 1,051 1,184 13% Blood and Organ Banks % Miscellaneous Ambulatory Healthcare Services % General Medical and Surgical Hospitals 3 19,183 19,653 2% Psychiatric and Substance Abuse Hospitals Specialty Hospitals, except Psychiatric and Substance Abuse Nursing Care Facilities 7,526 7,647 2% Residential Mental Retardation Facilities 3,308 2,468-25% Residential Mental and Substance Abuse Care 1,450 1,574 9% Continuing Care Retirement Communities 890 1,092 23% Homes for the Elderly 2,646 3,187 20% Other Residential Care Facilities 2,048 1,878-8% Healthcare Sector Total 81,072 80,573-1% A hyphen (-) indicates that data was either suppressed or not provided for that year. Data may have been suppressed to preserve the confidentiality of businesses providing data. Source: California Employment Development Department, Quarterly Census of Employment and Wages (ES202), Data include employment in private sector facilities only. Page 12 San Diego Workforce Partnership

21 Healthcare Sector Profile and Outlook According to Economy.com, healthcare sector employment in San Diego is expected to grow by 23 percent between 2004 and 2010 (see Table 5). The greatest employment gains are expected among psychiatric and substance abuse hospitals, outpatient care centers, offices of health practitioners, and nursing care facilities. 4 Table 5 Projected Healthcare Sector Employment in San Diego, Source: NAICS Code Sub-Sector 2004 Actual Average Employment 2010 Projected Average Employment % Change Offices of Physicians 18,825 21,486 14% 6212 Offices of Dentists 8,824 11,440 30% 6213 Offices of Other Health Practitioners 5,184 6,935 34% 6214 Outpatient Care Centers 3,205 4,552 42% 6215 Medical and Diagnostic Laboratories 1,764 2,021 15% 6216 Home Healthcare Services 3,381 4,496 33% 6219 Other Ambulatory Healthcare Services % 6221 General Medical and Surgical Hospitals 19,653 23,384 19% 6222 Psychiatric and Substance Abuse Hospitals % 6223 Specialty Hospitals, except Psychiatric and Substance Abuse 943 1,047 11% 6231 Nursing Care Facilities 7,647 10,268 34% 6232 Residential Mental Retardation, Mental Health and Substance Abuse Facilities 4,042 4,667 15% 6233 Community Care Facilities for the Elderly 4,279 4,910 15% 6239 Other Residential Care Facilities 1,878 2,300 22% Healthcare Sector Total 80,976 99,339 23% California Employment Development Department, Quarterly Census of Employment and Wages (ES202), 2004, and Economy.com s Detailed Employment Forecast for San Diego Economy.com forecast data is available at the 4-digit NAICS code level. Psychiatric and substance abuse hospitals (NAICS code 6222) encompasses psychiatric and substance abuse hospitals; 6214 outpatient care centers includes family planning centers, outpatient mental health and substance abuse centers, HMO medical centers, kidney dialysis centers, freestanding ambulatory surgical and emergency centers, and all other outpatient care centers; and 6231 nursing care facilities refers to nursing care facilities. 5 Data include employment in private sector facilities only. San Diego Workforce Partnership Page 13

22 Healthcare Sector Profile and Outlook WAGES In 2004, the average annual wage in the San Diego healthcare sector was $35,285 (see Table 6). The highest wages within the sector were found in offices of physicians, except mental health, ($60,893), and miscellaneous ambulatory healthcare services ($60,206). The lowest wages within the sector were found in family planning centers and homes for the elderly. Table 6 Healthcare Sector Average Wages in San Diego, 2004 NAICS Code Sub-Sector 2004 Average Annual Wage Offices of Physicians, except Mental Health $60, Offices of Mental Health Physicians $48, Offices of Dentists $36, Offices of Chiropractors $31, Offices of Optometrists $27, Offices of Mental Health Practitioners $35, Offices of Specialty Therapists $31, Offices of Podiatrists $24, Offices of Miscellaneous Health Practitioners $28, Family Planning Centers $19, Outpatient Mental Health Centers $29, HMO Medical Centers $46, Kidney Dialysis Centers $42, Freestanding Emergency Medical Centers $41, All Other Outpatient Care Centers $34, Medical Laboratories $52, Diagnostic Imaging Centers $55, Home Healthcare Services $28, Ambulance Services $28, Blood and Organ Banks $32, Miscellaneous Ambulatory Healthcare Services $60, General Medical and Surgical Hospitals 6 $46, Psychiatric and Substance Abuse Hospitals Specialty Hospitals, except Psychiatric and Substance Abuse Nursing Care Facilities $25, Residential Mental Retardation Facilities $23, Residential Mental and Substance Abuse Care $24, Continuing Care Retirement Communities $26, Homes for the Elderly $19, Other Residential Care Facilities $24,883 Healthcare Sector Average $35,285 A hyphen (-) indicates that data was not provided for that year. Source: California Employment Development Department, Labor Market Information Division, Occupational Employment Statistics Survey, Data include private sector facilities only. Page 14 San Diego Workforce Partnership

23 Healthcare Sector Profile and Outlook SECTOR TRENDS The major issues facing the healthcare sector include a continuing decline in hospital profitability and continuing increases in healthcare insurance costs for both employers and consumers within a system that is becoming increasingly consumer-driven. These trends will likely increase the demand for healthcare employment in the region. Declining Hospital Profitability Hospital profitability is predicted to decline in the foreseeable future as cost burdens are shifted to hospital facilities, hospital costs exceed Medicare and Medicaid reimbursements, and hospitals treat a growing number of uninsured patients. Forty-six percent of hospitals and health systems have low credit ratings, and many hospitals operate with low to negative profit margins. According to California s Office of Statewide Health Planning and Development, more than half of California hospitals have negative patient care margins. Historically, inadequate Medicare reimbursement has adversely impacted hospitals, but most particularly in recent years. Between 1998 and 2002, California hospitals bore the brunt of $6 billion in Medicare payment cuts as a result of the federal Balanced Budget Act passed in In 13 of the last 15 years, hospitals have suffered from a 21 percent payment gap resulting from Medicare reimbursement updates that have not kept pace with inflation. Although Medicare reimbursement rates increased in 2004 and 2005, this is only a temporary boon for hospitals. Continued budget cuts at the national level make it likely that inadequate hospital Medicare reimbursement will persist. Medicaid payment shortfalls will continue to plague hospitals as well. The Medicaid fiscal crisis is particularly extreme in California: California ranks last among the states in per-beneficiary spending, but first in percentage of state residents enrolled in Medi-Cal, at 18 percent. With California s continuing budget crisis, Medi-Cal spending will be a likely target for state legislators. Working groups of governors and state legislators nationwide have proposed sweeping reforms to the Medicaid program, including increasing the costs (through copays) and reducing the benefits to recipients. In the meantime, states are dropping recipients from their Medicaid rolls by reducing eligibility, thereby increasing the already growing uninsured population. The growing uninsured population, particularly in California, greatly contributes to hospitals financial woes. In California, where over 20 percent of the state s population is without health insurance and another 4 percent is underinsured, hospitals uncompensated care costs rose from less than $4 billion in 2002 to slightly more than $5 billion in Because of the economic slowdown, California s uninsured population is expected to increase. Indigent care in itself tends to be more costly by default. Because uninsured individuals lack a regular (and therefore preventive) source of care, health problems are usually addressed when it is most costly to do so at the emergency room. Increasing Health Insurance Costs Increases in health insurance premiums continue to negatively impact both employers and consumers. Since 2001, health insurance premiums for a family of four have increased annually at a double-digit rate of growth, while workers earnings have been slowly decreasing in the same time San Diego Workforce Partnership Page 15

24 Healthcare Sector Profile and Outlook period. As a result, employers are reacting by thinning out the health plan benefits that they offer their employees, increasing the share of premiums paid by the employees, and declining to provide coverage for employees dependents. Health insurance plans in turn have been moving towards what is known as consumer-driven healthcare, which increases consumers responsibility for the costs associated with their healthcare. For example, medical savings accounts with defined contributions accompanied by catastrophic insurance are emerging as an option to keep consumers out-of-pocket premium expenses low. The use of medical savings accounts allows consumers to purchase health insurance plans with lower monthly premiums but higher deductibles. It is anticipated that this solution may backfire on healthcare insurance providers for two reasons: One, adverse selection may result, with the highestcost consumers those with the most serious medical problems opting for these lowpremium/high-deductible plans because they will easily reach their deductible during the plan year. Two, consumers with higher deductibles may be more reluctant to seek care except for the most life-threatening (and therefore the most costly) health problems, putting off the preventive care office visits that might have averted the serious health conditions. Page 16 San Diego Workforce Partnership

25 OCCUPATIONAL OVERVIEW

26 Occupational Overview OCCUPATIONAL OVERVIEW Careers in San Diego s Healthcare Sector provides data on current and projected growth, wages, education requirements, education and training providers, recruitment strategies, and career ladder movement to and from each occupation for 26 primary occupations. This overview is an analysis of these 26 healthcare occupations. In 2004, the occupations with the greatest employment were registered nurses; nursing aides, orderlies, and attendants; licensed practical and licensed vocational nurses; and dental assistants. These occupations are projected to have the greatest employment in 2010 as well (see Table 7). Table 7 Healthcare Occupations with the Greatest Employment in San Diego, 2004 and 2010 Occupation 2004 Employment 2010 Projected Employment Registered Nurses 12,693 15,305 Nursing Aides, Orderlies, and Attendants 6,269 7,982 Licensed Practical and Licensed Vocational Nurses 4,039 4,994 Dental Assistants 3,852 4,994 Medical Assistants 3,598 4,165 Home Health Aides 1,901 2,274 Dental Hygienists 1,377 1,785 Physical Therapists 892 1,108 Medical Records and Health Information Technicians 880 1,036 Radiologic Technologists and Technicians Source: SourcePoint and Godbe Research, San Diego Workforce Partnership Page 19

27 Occupational Overview In 2004, the median annual wage among the 26 primary healthcare occupations was $37,951. The occupations that had the highest median annual wages were dental hygienists, physician assistants, and occupational therapists (see Table 8). Table 8 Healthcare Occupations with the Highest Median Annual Wages in San Diego, 2004 Occupation Wage Dental Hygienists $87,445 Physician Assistants $70,746 Occupational Therapists $65,131 Physical Therapists $64,958 Speech Language Pathologists $64,665 Nuclear Medicine Technologists $61,661 Registered Nurses $60,521 Radiation Therapists $59,811 Diagnostic Medical Sonographers $58,361 Clinical, Counseling, and School Psychologists $58,260 Source: SourcePoint and Godbe Research, Page 20 San Diego Workforce Partnership

28 CAREER LADDER PATHWAYS

29 Career Ladder Pathways CAREER LADDER PATHWAYS The focus on career ladders and pathways within the healthcare sector has intensified as the need for skilled and experienced workers within the sector has increased. The growing demand for journeyman level occupations, such as registered nurses and dental hygienists, provides an opportunity for today s certified nurse assistants and dental assistants to attain higher wages by increasing their skills and productivity. While the advantages of career ladders for employees have always been obvious acquiring better jobs and higher wages, career ladders provide advantages to employers as well. By advancing staff through career ladders, employers are able to develop the human capital in their own organizations, which both builds employee loyalty and saves them the expense of recruiting workers from the external labor market. HEALTHCARE CAREER LADDERS The three healthcare career ladder flow charts, shown on the next pages, show potential career paths in all five healthcare sector segments: hospital and emergency services, medical laboratories, medical offices, out patient services, and long-term care. 7 The three career paths cut across the five sector segments, and are defined instead by occupation type: Patient Care Positions Employees that have direct patient contact, such as nurses (see Figure 1). Technical Positions Employees that run tests or dispense medications, such as pharmacy technicians (see Figure 2). Clerical Positions Employees that process paperwork or handle billing, dictation, and scheduling, such as unit assistants (see Figure 3). 7 These flow charts were largely taken from The Career Ladder Mapping Project, with minor revisions based on advisory committee feedback and research findings. The Career Ladder Mapping Project was produced by the Shirley Ware Education Center, Service Employees International Union, and Kaiser Permanente-Northern California Region, in December San Diego Workforce Partnership Page 23

30 Figure 1 Patient Healthcare Career Ladders Nurse Educators/ Faculty (MSN) Managers or Directors of Programs, Clinics, or Research Speech-Language Pathologists Clinical Nurse Specialists (MSN) Occupational Therapists Occupational Therapy Assistants Figure 1 Patient Healthcare Career Ladders Doctoral Nursing Degree (PhD) Certified Registered Nurse Anesthetists (MSN) Master of Science in Nursing (MSN) Bachelor of Science in Nursing (BSN) Physical Therapists Registered Nurses (ADN) Physician Assistants Physical Therapy Assistants Licensed Vocational Nurses (LVN) Surgical Techs Certified Nurse Assistants, Medical Assistants, Unit Assistants, Home Health Aids, Respiratory Therapy Assistants, Physical Therapy Aides Nursing Aides, Orderlies, and Attendants Nurse Practitioners (MSN) Respiratory Therapists Respiratory Therapy Techs Certified Nurse Midwives (MSN) Dental Hygienists Dental Assistants

31 Figure 2 Technical Healthcare Career Ladders Figure 2 Technical Healthcare Career Ladders Assistant Directors, Associate Directors, and Directors of a Dietetic Department Supervisors, Operations Managers Administrative Directors, Executive Directors, Emergency Services, Instructors, Dispatchers, or Physician Assistants Cytogenetic Technologists Clinical Lab Scientists Pharmacists Dietetic Technicians Diagnostic UltraSonographers Diagnostic/PET Scan Techs Nuclear Med Techs, MRI, Techs, Radiation Therapy Techs Education Administrators or Supervisors of Counselors Clinical, Counseling, and School Psychologists Cytotechnologists Medical LabTechs Pharmacy Interns Pharmacy Techs (Inpatient/Outpatient) Dietetic Assistants Radiologic Techs Ortho Techs, EKG Techs ED Techs, OB Monitor Techs, Echo Techs, Optical Techs Psychiatric Technicians Histologic Technicians Lab Assistants Phlebotomists Pharmacy Clerks/Aides Emergency Medical Technicians & Paramedics Certified Nurse Assistants, Medical Assistants, Unit Assistants, Home Health Aides, Respiratory Therapy Assistants, Physical Therapy Aides Nursing Aides, Orderlies, and Attendants

32 Figure 3 Clerical Healthcare Career Ladders Figure 3 Clerical Healthcare Career Ladders Supervisors, Directors or Assistant Directors of a Medical Records and Health Information Department Medical Secretaries or Medical Transcribers Medical Coders Medical Records and Health Information Technicians Department Secretaries Medical Coder Trainees Certified Nurse Assistants, Medical Assistants, Unit Assistants, Home Health Aides, Respiratory Therapy Assistants, Physical Therapy Aides File Clerks, Unit Assistants and Schedulers Nursing Aides, Orderlies, and Attendants

33 Career Ladder Pathways Patient Care Patient care occupations include traditional nursing positions, physical and occupational therapy positions, and respiratory therapy positions. Employers for these occupations are largely found in the hospital and emergency services, medical offices, and long-term care segments within the healthcare sector. The nursing career pathway is the most recognized patient care and healthcare sector career ladder. With additional education, certified nurse assistants and medical assistants can progress to become licensed vocational nurses and then registered nurses. Further advancement is possible for nurses who pursue higher educational degrees in nursing. Physical and occupational therapy provides another example of a patient care career ladder tied to additional education. Physical therapy aides can progress up the ladder to become either physical therapy assistants or occupational therapy assistants, and from there move on to become physical or occupational therapists. The expandable skill sets most often found in patient care occupations include: Service Orientation Actively looking for ways to help people. Monitoring Monitoring/assessing performance of self, other individuals, or organizations to make improvements or take corrective action. Speaking Talking to others to convey information effectively. Reading Comprehension Understanding written sentences and paragraphs in work related documents. Information Gathering Observing, receiving, and otherwise obtaining information from all relevant sources. Technical Positions Technical healthcare occupations include pharmacy positions, medical and laboratory technicians and technologists, and positions in radiation and nuclear medicine therapy. Employers for these occupations are largely found in the hospital and emergency services, medical offices, and medical laboratories segments within the healthcare sector. The pharmacy career pathway is probably the most recognized career ladder among the technical occupations. Pharmacy clerks or aides can progress to become pharmacy technicians, then pharmacy interns, and finally pharmacists. Laboratory occupations provide another example of career ladders in the technical area. Laboratory assistants or phlebotomists progress up the ladder to become either 1) medical laboratory technicians who then move on to become clinical laboratory scientists, or 2) histologic technicians who then move on to become cytotechnologists and cytogenetic technologists. The expandable skill sets most often found in technical healthcare occupations include: Science Using scientific rules and methods to solve problems. Operation Monitoring Watching gauges, dials, or other indicators to make sure a machine is working properly. Reading Comprehension Understanding written sentences and paragraphs in work related documents. Information Gathering Observing, receiving, and otherwise obtaining information from all relevant sources. San Diego Workforce Partnership Page 27

34 Clerical Positions Clerical healthcare occupations include positions as medical coders, clerks or schedulers, medical transcribers, and secretaries. Employers for these occupations are largely found in the hospital and emergency services and medical offices segments of the healthcare sector. The clerical healthcare career pathway is the only pronounced career ladder within this classification. File clerks, unit assistants, and schedulers progress to become either 1) department secretaries who can advance to become medical secretaries or medical transcribers, or 2) medical coder trainees who can advance to become medical coders. The expandable skill sets most often found in clerical healthcare occupations include: Information Organization Arranging things or actions in a certain order or pattern according to a specific rule or set of rules. Service Orientation Actively looking for ways to help people. Speaking Talking to others to convey information effectively. Career Ladder Vignettes The healthcare sector offers many opportunities for individuals to move up career ladders to higher skilled jobs paying better wages. Advancement opportunities in this sector are frequently better than those in other sectors because there are so many job openings at every level along the career path. Moving up the healthcare career ladder, though, almost always requires additional education and training. Below are two stories of individuals who climbed their own healthcare career ladders, along with the potential salary increases each was eligible to receive. Dr. Jo-Ann Rossitto A Lifetime Commitment to Healthcare in San Diego Dr. Jo-Ann Rossitto began her healthcare career in 1969, enrolling in a licensed vocational nurse (LVN) training program at San Diego Mesa College. After passing the board exam, she began working in a local skilled nursing facility, where she started as a medication and treatment nurse and was promoted to an LVN charge nurse. After a couple of years working in the local skilled nursing facility, Dr. Rossitto decided to go back to school to get further education to become a registered nurse (RN). She applied and was accepted to the first career ladder program in San Diego, the LVN to RN program at San Diego City College. While going to school, Dr. Rossitto continued working as an LVN at the local skilled nurse facility. After graduating with an associate s degree in nursing and passing the board exam, Dr. Rossitto began working as an RN at the Veterans Administration (VA) Medical Center in San Diego. Dr. Rossitto worked in a variety of areas as a RN: medical-surgical nursing; head, eyes, ears, nose, and throat (HEENT); orthopedics/rehabilitation; skilled nursing; and hospital-based home care. In 1974, she returned to school to get a bachelor of science degree in nursing (BSN) from the University of San Diego, while continuing to work full time at the VA Medical Center. Dr. Rossitto remained at the VA after she received her BSN in 1976 and assumed more supervisory duties in addition to her work in patient care and as a charge nurse.

35 Career Ladder Pathways With her growing wealth of knowledge in the nursing arena, Dr. Rossitto decided to become an educator. Dr. Rossitto applied and was accepted to New York University's Master of Arts in Nursing Education Program ( ), where, for the first time, she received financial aid awards that enabled her to focus solely on her education. Dr. Rossitto received her master s degree in 1981, and applied to various colleges for a teaching position. She was hired at San Diego City College in August 1981 as a nursing instructor, teaching beginning and advanced nursing students. While at City College, Dr. Rossitto became department chairperson, and then assistant director. When the full-time director retired, Dr. Rossitto applied for her job and became the Associate Dean/Director. In1991, Dr. Rossitto decided to go back to school again, and began doctoral studies in nursing at the University of San Diego. While continuing to work full time at San Diego City College, Dr. Rossitto completed the coursework and dissertation for her doctorate. She graduated in 1997 with a doctorate of nursing science. Figure 4 Salary Potential: Nursing Profession $94,350 Nursing School Administrators* $66,060 Postsecondary Nurse Instructors and Teachers $63,340 Registered Nurses $38,470 Licensed Vocational Nurses $23,430 Nursing Aides, Orderlies, and Attendants Source: Department of Labor, Bureau of Labor Statistics, Annual Mean Wages for San Diego MSA, * This salary is the salary for all postsecondary education administrators. Christopher Hayman A Career in Radiology Technology Originally from New York, Mr. Hayman received a license in radiology technology while serving in the US Air Force from 1979 to His first job out of the Air Force was at the Henry Mayo Hospital in Valencia, where he worked as a radiology technologist. In 1985 he was promoted to CAT scan and special procedure technologist involved in angiography procedures. For this job, he had to teach himself anatomy and the technical nuances of CAT scans. In 1987, Mr. Hayman started working for Mobile MR, which trained him to become a magnetic resonance imaging (MRI) technician. He began working with MRI because he enjoyed patient care, and his interest in cutting edge technology made him want to get in on the ground floor of this new technology. Mr. Hayman moved to San Diego in 1989 while still working for Mobile MR. In 1991, he started working for Sharp-Reese-Stealy, one of the hospitals he serviced, as an MRI technologist. In 1993, Mr. Hayman became a lead technician and evaluator at the Mira Mesa Sharp- Reese-Stealy Outpatient Facility. In 2001, he became the regional supervisor for radiology at Sharp- Reese-Stealy, working out of the downtown facility. In 2003, Mr. Hayman again saw a chance to get in on the ground floor of a new technology and became the Picture Archive Communication System (PACS) manager for Sharp-Memorial outpatient care. Mr. Hayman s job was to help set up the PACS technology, which translated radiology San Diego Workforce Partnership Page 29

36 information (x-rays) into a digital format. In 2004, he took a job as the imaging manager for the Sharp-Reese-Stealy Outpatient Radiology Department. Mr. Hayman has enjoyed his career in the healthcare sector, and the opportunity it provided for him to combine patient care with cutting edge technology. Figure 5 Salary Potential: Radiology Technology $85,665 Imaging Services Administrators $70,212 Radiologic Technology Managers $57,927 Lead Radiologic Technologists $50,253 Radiologic Technologists Source: American Society of Radiologic Technologists, Wage and Salary Survey, California mean wages were derived by taking national radiology technology occupational wage data and applying a correction factor to account for higher average radiology technology wages in California in comparison to the average radiology technology wages in the United States.