Help Wanted: Will Californians Miss Out on a Billion-Dollar Growth Industry?

Help Wanted: Will Californians Miss Out on a Billion-Dollar Growth Industry? Funded by a grant to Fenton Communications from The California Wellness Foundation

California s Population California s Population + Michigan s Population Over the next 20 years, California s population will grow by 10.2 million people an increase that is equivalent to adding the entire state of Michigan. 10.2 million people 2 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Executive Summary Help Wanted demonstrates the gap between how many allied health workers California will need versus how many it is prepared to train over the next 20 years and what these facts mean to the state s economy. To reach this conclusion, researchers analyzed population data (page 12), identified the increasing demand on the health care system (page 13), and compared the allied health workforce supply against demand (page 18). Demographic Forecast: Looking at California in 2030 California s population is growing and graying and these trends offer opportunities in the form of health jobs. Over the next 20 years, California s population will grow by 10.2 million people an increase that is equivalent to adding the entire state of Michigan. At the same time, the number of Californians over the age of 65 will more than double. This demographic shift has significant implications for the healthcare workforce. Because Americans over 65 use more health services than any other age group, the growth and aging of the state s population means that California will need more healthcare workers than ever. And the majority of those job opportunities will be in allied health a sector that includes a wide range of clinical, administrative, and support positions, from radiologic technicians and laboratory workers to nursing aides and medical secretaries. While the current economic recession means that health care is growing more slowly for the time being, the overall trend remains upward. And the results of this study clearly indicate that it will continue to be a growth industry for years to come. 3

Equal to approximately 20,000 allied health workers 605,000 allied health workers 988,000 allied health workers 4 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Job Opportunities for California Workers Californians looking for strong, long-term job security will find opportunities in allied health. Health care will continue to be an engine of economic growth over the coming years as California s population grows and ages. And even though public attention often focuses on the need for doctors and nurses, the fastest growing sector will be allied health, with a projected 63 percent increase between 2010 and 2030. California already employs more than 605,153 allied health workers. Between new job creation and the need to replace workers who retire or otherwise leave the field, the state will need to train nearly 1 million more allied health workers by 2030. 5

Equal to $100,000,000 $1.9 Billion payroll taxes paid by allied health workers $9.6 Billion payroll taxes paid by allied health workers 6 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Economic Value of the Allied Health Workforce Allied health workers are a significant force in the California economy. The allied health sector in California already generates approximately $23 billion in payroll. That amount will more than double every 10 years, and by 2030, the state s 1 million allied health workers will have a collective earning power of more than $116 billion. Income taxes paid by allied health workers contribute considerably to state coffers. Based on current tax rates, payroll taxes paid by allied health workers will translate into $1.9 billion in state revenues in 2010, and $9.6 billion in 2030. 7

Equal to approximately 20,000 graduates or unfilled allied health positions In 2010-2020, the state will only have the capacity to educate 297,000 allied health workers, shutting Californians out of 145,000 family-sustaining jobs. By 2030, California s education capacity will almost double to produce 634,000 allied health workers, but it will still need to train 375,000 more to meet the state s needs. 8 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

The Hundred-Billion Dollar Question The bottom line: Will California be able to provide enough certified allied health workers to meet demand? Of the number of allied health jobs that need to be filled by 2030, about half are entry-level positions that do not require post-secondary training or certification, and can therefore be filled by most high-school educated members of the labor pool. The remaining allied health workers require certifications or post-secondary training. However, researchers estimate that California s universities and community colleges will only have the capacity to train 634,000 of the needed workers, between 63 and 79 percent of the allied health workers the state will require. Unless California increases the capacity of its education system, by 2030 there will be between 170,000 and 375,000 jobs that must be filled either by out-of-state workers or by Californians who would be forced to leave the state to get the necessary training. Already today there are allied health training programs with waiting lists of one year or more. Certified allied health positions are well-paying, family-sustaining jobs. According to Current Population Survey (CPS) data, workers with certifications earn 60 percent more on average over their lifetime than those without any post-secondary certification. But based on current trends, the state s training programs will not have the capacity to give California workers the opportunity to train and qualify for them. The question for California now is: How important is it for the state to expand local access to the training programs Californians need to qualify for jobs in a multi-billion-dollar growth industry? 9

Table of Contents 11 Introduction 12 Research Findings 12 Demographics Forecast: What Will California Look Like in 2030? 13 Demand Forecast: How Many Health Workers Will the State Need? 19 Supply Forecast: How Many Certified Workers Will the State Produce? 21 Gap Analysis: Comparing Certified Allied Health Workforce Demand and Supply 22 Economic Impact: Value of the Allied Health Workforce 22 Lifetime Wages: Comparing Earnings of Certified and Non-Certified Allied Health Workers 24 Conclusions & Recommendations 26 Appendix 26 Regional Snapshot: Los Angeles Area 28 Regional Snapshot: San Francisco Bay Area 30 Regional Snapshot: San Diego 32 Regional Snapshot: Sacramento 34 Regional Snapshot: Fresno/Visalia 10 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Introduction Funded by a grant from The California Wellness Foundation, Fenton Communications worked with Beacon Economics to study California s allied health workforce needs, projected shortages among trained and certified workers, and the allied health industry s economic impact. Beacon researchers conducted forecasts for demographics and healthcare occupational demand, assessed the supply the number of graduates of allied health educational and training programs in California and examined the economic implications by calculating total payroll for the allied health industry and projected state tax revenues based on current tax rates. This report uses data from the Bureau of Labor Statistics (BLS), Employment Development Department (EDD), Occupational Employment Statistics Survey (OES), U.S. Census Bureau, California Department of Finance (DOF), Integrated Postsecondary Education Data System (IPEDS), Centers for Disease Control (CDC), and Current Population Survey (CPS) to conduct its forecasts and research. Brad Kemp served as lead researcher for this report and is director of regional research at Beacon Economics. Prior to joining Beacon, Kemp was a labor research analyst for the California EDD. 11

Research Findings Demographics Forecast: What Will California Look Like in 2030? To better understand the projected demand for healthcare services in California, researchers forecasted changes in the state s total population (deaths/births and net migration) and changes in the age structure of the population through 2030 using data from the U.S. Census Bureau and the California Department of Finance. To simplify the analysis, the population was grouped into four age groups: Group 1 (0-29), Group 2 (30-44), Group 3 (45-64), and Group 4 (65+). California s population is growing bigger and getting older According to the forecasted data, California s population will grow by 10.2 million people over the next 20 years, an increase equivalent to adding the entire population of Michigan. At the same time, as the baby-boomer population moves into retirement age, and mortality rates among senior citizens decline, California is facing a significant aging of its population by 2030. Researchers estimate that the share of Californians age 65 and over will increase from 11.3 percent of the total population in 2010 to 15 percent in 2020, and to 18 percent in 2030. The total population of Californians age 65 and over will be more than double in the next 20 years, steadily increasing from just under 4.5 million in 2010, to almost 6.5 million in 2020, to almost 9 million in 2030. state will be faced with a rising demand for healthcare products and services and an increased need for trained and certified allied health workers. Figure A.1 Proportions of Total Population 50% 40% 30% 20% 10% 2010 2020 2030 Ages 0-29 Ages 30-44 Ages 45-64 Ages 65+ Table A.1 California s projected population by age groups 2010 2020 2030 Population/Share (%) Population/Share (%) Population/Share (%) Ages 0-29 16,839,000 (43%) 18,459,000 (42%) 19,888,000 (40%) Figure A.2 Population Growth Rates by Age Group 2010 2020 2030 Ages 30-44 7,977,000 (20%) 8,509,000 (19%) 9,940,000 (20%) Ages 45-64 9,908,000 (25%) 10,817,000 (24%) 10,578,000 (21%) 150% Ages 0-29 Ages 30-44 Ages 45-64 Ages 65+ Ages 65+ 4,458,000 (11%) 6,470,000 (15%) 8,991,000 (18%) TOTAL 39,182,000 44,255,000 49,397,000 120% *Population numbers rounded to the nearest thousand 90% Largest growth spurt to occur in coming decade 60% Another important finding is the immediacy with which this key population group is expected to grow. By decade (for each 10-year period, i.e. non- 30% cumulative), the growth rate of Californians over 65 is 45.1 percent from 2010 to 2020, and 38.9 percent from 2020 to 2030, making the coming 0% decade (2010 to 2020) the highest growth rate for this age group. By 2030, one out of every five Californians will have entered the age -30% bracket in which healthcare services are used most intensively. As a result, the 12 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Demand Forecast: How Many Health Workers Will the State Need? In conducting their analysis, researchers took two steps to determine how changes in California s population would impact the labor needs of the state s healthcare industry. Researchers first used data from the Centers for Disease Control and Prevention (CDC) to estimate the future demand for health services (days of care per person) for the various age groups in each of the three sub-sectors within health care. Trends in healthcare demand per capita by age group were used to project future needs. These per person needs were multiplied by the changing population base to arrive at an estimate of the total days of care needed in 2020 and 2030. Using estimates of California s total demand for healthcare services, researchers then forecasted future demand for healthcare workers by occupation using industrial employment data and occupational staffing patterns from the California Employment Development Department s (EDD) Occupational Employment Statistics (OES) survey. Total health care employment To meet growth in demand for health services driven by changes in population, the healthcare sector in California will need to employ 1.2 million workers in 2010 and 2 million workers in 2030, a 61.4 percent increase. Allied health employment From total healthcare employment, allied health professionals will comprise 605,000 workers in 2010 and 988,000 in 2030, representing a faster rate of growth (63 percent) than other workers in the health sector (60 percent). Figure B.1 2010 Hospital, Ambulatory, and Nursing Shares of Total Allied Health Employment 49% Ambulatory 22% Nursing 29% Hospital How trends in health care delivery impact allied health growth The increase in allied health employment is a result of a shift in how services are delivered within the healthcare industry. According to the North American Industrial Classification System (NAICS), the healthcare industry consists of three main sub-sectors, divided by the types of services provided at each facility: Ambulatory healthcare settings (ambulatory): Primarily provides out-patient services at facilities such as doctors offices, out-patient clinics, and clinical laboratories. Hospitals: Primarily provides in-patient health services and may provide some out-patient services as a secondary activity. Nursing and residential care facilities (nursing care): Provides residential care, such as community care for the elderly or mental health and substance abuse facilities. Of the three, ambulatory is by far the largest employer of allied health workers: almost half (49.4 percent) of all allied health workers will be employed in ambulatory care in 2010, with 28.7 percent and 21.9 percent employed in hospital and nursing care, respectively. As ambulatory and nursing care grow, so do allied health jobs The researchers anticipate that health services will increasingly be delivered via ambulatory and nursing care, the two sub-sectors with the highest shares of allied health employment. The increase in nursing and residential facility use is the result of the state s aging population. The shift toward ambulatory care is driven by the industry s need to be cost efficient. Advancements in medical technology have also allowed for more services that formerly required expensive hospital stays to be delivered via ambulatory care. For example, laparoscopic surgery, a procedure that requires only a small incision, is replacing more traditional invasive forms of surgery, which used to require a multiple-night hospital stay. The new procedure now often allows patients to go home the same day. The data supports the conclusion that not only is total demand for health care in California on the rise a pattern that will continue through 2030 but the form of healthcare consumption is clearly shifting from hospital usage to ambulatory usage. In all, the total consumption of hospital days per person will decline from 4 days in 2010 to 3.2 days in 2020 to 2.5 days in 2030. In contrast, the number of ambulatory visits per person will increase from 3.2 visits per person in 2010 to 3.6 visits per person in 2020 to 4.2 visits in 2030. With this growing demand for ambulatory health care, researchers expect to witness a heavier demand for professions that are employed within the ambulatory sector. 13

Figure B.2 Hospital Care vs. Ambulatory Care Consumption Overview: California s Allied Health Workforce The hidden healthcare workforce. That s a term sometimes used for allied health workers, who represent an estimated 60 percent of the health workforce in California. While most patients are familiar with physicians and nurses, they rarely recognize how many other professionals work behind the scenes to provide timely, high-quality care. Comprising approximately 50 different positions from medical assistants to laboratory technicians to dental hygienists allied health professionals provide a range of diagnostic, technical, therapeutic, and direct patient care and support services that are absolutely critical to the other health professionals they work with and the patients they serve. The good news is that there are many job opportunities within allied health and for applicants with varying experience levels. For example, home health aides are entry-level positions that are high in demand yet require a minimal educational investment. Equally as important are more specialized occupations that require training and certification, such as clinical laboratory scientists and pharmacy technicians. Several allied health jobs only require a two-year degree or a few months training a characteristic that makes them an attractive choice for Californians unable to or uninterested in committing several years to a medical or nursing degree. The bad news is that Californians interested in these careers may find it difficult to find a space in a program. Our education system, especially with current funding cuts, is severely limited in its capacity to train allied health workers. The operating cost of training programs is often a barrier, since the necessary equipment for clinical training and low instructor-tostudent ratios make them considerably more expensive than non-scientific or non-technical programs. But inaction will only worsen this problem. There s a pressing need for the state to convene health service providers, educational institutions, and other stakeholders to engage in a sustained, long-term effort to expand our ability to train Californians for these critical jobs. Susan Chapman, Ph.D., RN, Director of Allied Health Care Workforce Program, UCSF Center for the Health Professions 2010 2020 2030 4.0 3.6 3.2 3.2 Hospital days of care per person Ambulatory visits per person The projected decline in hospital stays follows a historical pattern, a key driver in the researchers forecast model. A decline from 41 days per person in 1980 to 21.7 days per person by 2000 among age group 4 (65+) underscores the shift in how healthcare services are delivered in the state. On the other hand, demand for ambulatory health care has been on the rise for the past couple of decades. For age group 4 (65+), the number of clinic visits per person increased from 3.91 in 1980 to 5.72 clinic visits per person in 2000, supporting the hypothesis that demand for ambulatory health care will increase. Looking ahead, the forecast results show that the number of visits per person to a clinic will increase from 6.9 in 2010 to 8.4 in 2020, and to 10.1 in 2030 in age group 4 (65+). Table B.1: Hospital (primarily in-patient services) versus ambulatory care (primarily out-patient services) usage in days per person 2010 2020 2030 Age Hospital Ambulatory Hospital Ambulatory Hospital Ambulatory 0-29 1.47 2.49 1.17 2.58.93 2.68 30-44 2.12 2.10 1.41 2.05.94 2.00 45-64 3.82 3.81 2.43 4.17 1.55 4.57 65+ 16.10 6.99 12.01 8.42 8.96 10.14 All ages 4.00 3.17 3.16 3.61 2.53 4.17 Allied health employment is increasing in every sub-sector of health care The number of allied health workers in all three sub-sectors of health care will increase over the next 20 years: Hospital: In 2010, allied health workers will comprise 42.4 percent of total hospital employment. Allied health employment in hospitals will increase from 174,000 in 2010 to 194,000 in 2020, and to 225,000 in 2030. In all, allied health employment in hospitals will increase by 29.5 percent between 2010 and 2030. 4.2 2.5 14 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Ambulatory: Allied health workers will comprise 51.9 percent of ambulatory care workers in 2010. Allied health employment will increase from 299,000 in 2010 to 383,000 in 2020, and to 495,000 in 2030. Total allied health employment in ambulatory care will increase by 65.7 percent between 2010 and 2030. Nursing: Allied health workers will comprise 51 percent of nursing care workers in 2010. Allied health employment will increase from 132,000 in 2010 to 193,000 in 2020, and to 267,000 in 2030. Total allied health employment in nursing care will more than double (an increase of 102.1 percent) between 2010 and 2030. benchmark. Given historical levels of training and the observed job growth between 1990 and 2004, an implicit number of replacements (the number of replacements necessary to generate the observed employment levels historically) was calculated at 7.5 percent. This forms the low scenario and includes both permanent separations from the industry as well as vacant positions due to intra-industry job transfers/promotions. Because of the forecasted increase in people aging into retirement and the upward pressure it will put on net replacements, this number could grow up to 10 percent in the near future, which provides the alternative (high) scenario. The range of total replacements jobs that will become available as a Figure B.3 Allied Health Care Employment by Sector 2010 2020 2030 500k Hospital Ambulatory Nursing Care 400k 300k 200k 100k Ambulatory care employs significantly more allied health workers than hospital or nursing care. It is also the fastest-growing sector of the three. Calculating the number of allied health workers needed There are two sources of demand for workers in the allied health industry. The first is the expansion of demand as driven by population growth. The second is the annual pace of turnover of the existing labor force. This rate represents the number of positions that will need to be filled due to permanent separations from the allied healthcare industry, such as from deaths, retirements, changing of career, or moving out of the state. Permanent separations do not come, for example, from a technician moving from one hospital to another within California, which just moves the opening from one employer to another but does not create a new opening in the state. The replacement rate in this study is adjusted to include the number of workers who will vacate an allied healthcare position, but who remain in the healthcare industry. These also represent positions that will need to be filled moving forward. In this study, the researchers provide two replacement rates, 7.5 percent (low scenario) and 10 percent (high scenario). The low number was generated by using past data on staffing and graduation rates as a result of the situations noted above calculated in the study are: 507,000-676,000 from 2010 to 2020 1.1 million - 1.5 million from 2010 to 2030 500000 The total number of allied health workers required to meet California s needs over the coming decades was obtained by combining net replacements data with employment counts. By 400000 2030, California will need more than 2.5 million allied health workers in a high scenario case and 2 million allied health workers in a low scenario 300000 case. Table B.2 Total Allied Health Demand with Net Replacements 200000 Year 2010 2020 2030 Employment Counts 605,153 769,837 988,154 100000 Net Replacements 506,995-675,993 1,154,686-1,539,581 Total Demand 605,153 1,276,832-1,445,830 2,142,840-2,527,735 0 15

Total demand for each occupation is shown in table B.3, sorted by 2030 employment counts, from largest to smallest: Table B.3 Total Allied Health Demand By Occupation Occupation 2010 2020 2030 Nursing Aides, Orderlies, Attendants 93,825 197,964-224,166 332,232-391,908 Medical Secretaries 61,460 129,677-146,840 217,629-256,720 Medical Assistants 60,261 127,147-143,976 213,385-251,713 Licensed Practical and Licensed Vocational Nurses 50,236 105,995-120,024 177,885-209,837 Home Health Aides 45,768 96,568-109,349 162,065-191,174 Dental Assistants 43,589 91,969-104,142 154,347-182,071 Dental Hygienists 24,192 51,043-57,799 85,663-101,049 Medical and Health Services Managers Personal and Home Care Aides Radiologic Technologists and Technicians Healthcare Support Workers, All Other 16,455 34,718-39,314 58,266-68,732 15,801 33,339-37,751 55,951-66,001 15,038 31,729-35,929 53,250-62,814 13,512 28,510-32,284 47,848-56,442 Physical Therapists 13,186 27,821-31,503 46,690-55,076 Medical Records and Health Information Technicians Respiratory Therapists and Technicians Medical and Clinical Laboratory Technologists Emergency Medical Technicians and Paramedics Health Technologists and Technicians, All Other Medical and Clinical Laboratory Technicians Medical and Public Health Social Workers 12,750 26,901-30,462 45,147-53,256 11,660 24,602-27,858 41,288-48,704 11,660 24,602-27,858 41,288-48,704 10,494 22,142-25,072 37,159-43,834 10,243 21,613-24,473 36,272-42,787 8,718 18,394-20,828 30,869-36,414 7,955 16,784-19,006 28,168-33,228 Psychiatric Technicians 6,974 14,715-16,663 24,696-29,131 Surgical Technologists 6,974 14,715-16,663 24,696-29,131 Pharmacy Technicians 6,429 13,565-15,361 22,766-26,855 Occupational Therapists 5,993 12,646-14,320 21,223-25,035 Medical Transcriptionists 5,667 11,956-13,538 20,065-23,669 Physician Assistants 5,558 11,726-13,278 19,679-23,214 Opticians, Dispensing 4,686 9,887-11,195 16,592-19,573 Physical Therapist Aides 4,141 8,737-9,893 14,663-17,297 Medical Equipment Preparers 3,814 8,047-9,112 13,505-15,931 Dietitians and Nutritionists 3,487 7,358-8,331 12,348-14,566 Health Educators 2,942 6,208-7,030 10,418-12,290 Cardiovascular Technologists and Technicians Healthcare Practitioners and Technical Workers, All Other Nuclear Medicine Technologists 2,833 5,978-6,769 10,033-11,835 2,724 5,748-6,509 9,647-11,379 1,635 3,449-3,905 5,788-6,828 Recreational Therapists 1,090 2,299-2,604 3,859-4,552 Diagnostic Medical Sonographers 1,090 2,299-2,604 3,859-4,552 Dietetic Technicians 1,090 2,299-2,604 3,859-4,552 Occupational Therapist Aides Ambulance Drivers and Attendants, Except Emergency Medical Technicians Occupational Therapist Assistants 1,090 2,299-2,604 3,859-4,552 1,090 2,299-2,604 3,859-4,552 981 2,069-2,343 3,473-4,097 Psychiatric Aides 872 1,839-2,083 3,087-3,641 Medical Equipment Repairers 327 690-781 1,158-1,366 Therapists, All Other 218 460-521 772-910 Pharmacy Aides 109 230-260 386-455 Orthotists and Prosthetists * * * Medical Appliance Technicians Total Demand 605,153 * * * 1,276,832-1,445,830 * Indicates that employment counts reported by EDD were less than 100. 2,142,840-2,527,735 By 2030, allied health occupations facing the largest demand, as shown in table B.3, will be nursing aides, orderlies, and attendants with up to 391,908 jobs; medical secretaries with up to 256,720 jobs; and medical assistants with up to 251,713 jobs. Ocupations with the smallest measurable demands are pharmacy aides with 455 jobs, medical equipment repairers with 910 jobs, psychiatric aides with 3,641 jobs, and occupational therapist assistants with 4,097 jobs. Regions Studied Region Los Angeles San Francisco Area San Diego Sacramento Fresno/Visalia Counties Included Los Angeles, Orange, San Bernardino, Riverside, Ventura, Kern, Inyo counties Alameda, San Francisco, Contra Costa, San Mateo, Santa Clara, Napa, Sonoma, Marin, Mendocino, Solano, Lake counties San Diego County Sacramento, San Joaquin, Stanislaus, Yuba, Yolo, Placer, Sutter, Tuolumne, Nevada, Plumas, El Dorado, Amador, Calaveras, Colusa, Sierra counties Mariposa, Madera, Fresno, Merced, Tulare, Kings counties Speech-Language Pathologists Physical Therapist Assistants 3,269 6,898-7,811 11,576-13,655 3,269 6,898-7,811 11,576-13,655 Table B.4 presents the range of total demand (from the lower 7.5 percent to the higher 10 percent net replacement scenarios) broken down by region. In 2030, the Los Angeles area will have the highest total demand for allied 16 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

healthcare employment at up to 1,279,631 jobs, where as the Fresno/ Visalia area will have the lowest total demand at 129,637 jobs. Table B.4 Regional Total Demand Data for Allied Healthcare Region Los Angeles Area San Francisco Bay Area Sacramento Area San Diego Area Fresno/ Visalia Area Population Share 2010 Demand 2020 Demand 2030 Demand 50.6% 306,350 646,379-731,932 1,084,783-1,279,631 19.6% 118,907 250,886-284,092 421,048-496,677 10.0% 60,501 127,652-144,548 214,232-252,712 8.3% 50,151 105,815-119,820 177,583-209,481 5.1% 31,036 65,483-74,151 109,897-129,637 * More detailed regional snapshots from each area are included as appendices. New Demand: The significance of looking at newly created jobs New demand is the increase in the number of job openings between 2010 and 2030. It combines new jobs created by the growth in the health industry with the number of net replacements occurring within the same time period. This number provides an important data point in comparing the state s workforce needs to its ability to train and certify Californians to work in allied health jobs. The distinction between total demand and new demand is that total demand takes into account the number of existing jobs already filled by workers who do not need to be trained or certified again in addition to the number of new jobs and net replacements. New demand, on the other hand, totals the number of new jobs and net replacements only. In other words, total demand is the number of existing workers in the industry plus the number of vacancies to be filled while new demand refers only to the number of vacancies to be filled. Again, the new demand data is presented as a range between two scenarios, with the 7.5 net replacement net on the lower end, up to a high scenario of 10 percent net replacement rate. Table B.5 New Demand Totals Period 2010-2020 2010-2030 New Jobs 164,684 383,002 Net Replacements 506,995-675,993 1,154,686-1,539,581 New Demand 671,679-840,677 1,537,688-1,922,583 Occupational new demand data, organized by the standard occupational code, is similar to total demand data in terms of the occupations that show the highest number of job increases. Again, in the high scenario case (10 percent net replacements) nursing aides, orderlies, and attendants will have the highest increase in new demand between 2010 and 2030 at 298,083 new jobs, followed by medical secretaries at 195,260, and medical assistants at 191,452. The occupations that will have the lowest measurable number of new job increases are pharmacy aides at 346, medical equipment repairers at 1,039, and psychiatric aides at 2,770. Viewpoint: A Health Service Provider s Perspective When people think of health care, they picture physicians and nurses the people whom they interact with most. However, that s just one chapter in a much longer story. This report identifies 47 different allied health positions. The term may be vague, but the work of these trained professionals is specific and vital in the delivery of quality patient care. Think of the pharmacist who makes sure you get the right type and dose of medication. Or the radiological technician that takes and develops your x-rays. Or clinical laboratory scientists who test your blood so doctors can diagnose and treat what ails you. These behind-the-scenes workers are the unsung heroes of health care, and we face daunting shortages of them in coming years. California s graying population, including many of our most experienced workers, means more patients will require quality care. And there are simply not enough graduates from allied health programs ready to step in and fill that void. That s why Sutter Health Sacramento Sierra Region decided to be proactive. At SHSSR, which serves Placer, Sacramento, and Yolo counties, we work with our local education partners to create and/or enhance our communities allied health programs. One example is the Yuba College Radiological Technologist program. In partnership with local health systems, we provide financial support for the equipment, classrooms, and faculty needed to educate 50 students each semester. We also provide clinical training and instructors. This is our way of ensuring the continuum of quality care for which we re known. While economists are increasingly talking about allied health as an important and inevitable growth sector for the California economy, Sutter and other providers know firsthand that these positions are essential for quality care as well. That s why we must continue to look for ways to proactively develop this untapped workforce. Anette Smith-Dohring, Workforce Development Manager for Sutter Health Sacramento Sierra Region 17

Table B.6 New Demand By Occupation Occupation 2010-2020 2010-2030 Nursing Aides, Orderlies, Attendants 104,139-130,341 238,408-298,083 Medical Secretaries 68,217-85,380 156,169-195,260 Medical Assistants 66,886-83,715 153,124-191,452 Licensed Practical and Licensed Vocational Nurses 55,759-69,788 127,649-159,601 Home Health Aides 50,800-63,581 116,296-145,406 Dental Assistants 48,381-60,553 110,758-138,482 Dental Hygienists 26,851-33,607 61,471-76,858 Medical and Health Services Managers 18,264-22,859 41,811-52,277 Personal and Home Care Aides 17,538-21,951 40,150-50,200 Radiologic Technologists and Technicians Healthcare Support Workers, All Other 16,691-20,891 38,212-47,776 14,998-18,772 34,335-42,929 Physical Therapists 14,635-18,317 33,504-41,891 Medical Records and Health Information Technicians Medical and Clinical Laboratory Technologists Emergency Medical Technicians and Paramedics Respiratory Therapists and Technicians Health Technologists and Technicians, All Other Medical and Clinical Laboratory Technicians Medical and Public Health Social Workers 14,151-17,712 32,397-40,506 12,942-16,198 29,628-37,044 12,942-16,198 29,628-37,044 11,648-14,578 26,665-33,340 11,369-14,230 26,028-32,543 9,676-12,111 22,152-27,696 8,829-11,051 20,213-25,273 Psychiatric Technicians 7,741-9,689 17,721-22,157 Surgical Technologists 7,741-9,689 17,721-22,157 Pharmacy Technicians 7,136-8,932 16,337-20,426 Occupational Therapists 6,652-8,326 15,229-19,041 Medical Transcriptionists 6,289-7,872 14,399-18,003 Physician Assistants 6,169-7,721 14,122-17,656 Opticians, Dispensing 5,201-6,509 11,907-14,887 Physical Therapist Aides 4,596-5,753 10,522-13,156 Medical Equipment Preparers 4,233-5,298 9,691-12,117 Dietitians and Nutritionists 3,870-4,844 8,861-11,079 Speech-Language Pathologists 3,629-4,542 8,307-10,386 Physical Therapist Assistants 3,629-4,542 8,307-10,386 Health Educators 3,266-4,087 7,476-9,348 Cardiovascular Technologists and Technicians Healthcare Practitioners and Technical Workers, All Other 3,145-3,936 7,199-9,001 3,024-3,785 6,922-8,655 Nuclear Medicine Technologists 1,814-2,271 4,153-5,193 Recreational Therapists 1,210-1,514 2,769-3,462 Diagnostic Medical Sonographers 1,210-1,514 2,769-3,462 Dietetic Technicians 1,210-1,514 2,769-3,462 Occupational Therapist Aides 1,210-1,514 2,769-3,462 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 1,210-1,514 2,769-3,462 Occupational Therapist Assistants 1,089-1,362 2,492-3,116 Psychiatric Aides 968-1,211 2,215-2,770 Medical Equipment Repairers 363-454 831-1,039 Therapists, All Other 242-303 554-692 Pharmacy Aides 121-151 277-346 Orthotists and Prosthetists * * Medical Appliance Technicians * * Total 671,679-840,677 1,537,688-1,922,583 * Indicates that employment counts reported by EDD were less than 100. 18 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Supply Forecast: How Many Certified Workers Will the State Produce? To determine whether the state will be able to train and certify enough Californians to meet its allied health workforce needs, Beacon Economics researchers partnered with the Center for the Health Professions at the University of California San Francisco (UCSF) to study the supply of allied health workers in the state. For the purposes of this study, supply is defined as the number of graduates of certified allied health educational and training programs in California. To measure this supply, UCSF drew data from the Integrated Postsecondary Education Data System (IPEDS) database and determined the number of qualified training facilities for each of the targeted healthcare occupations and collected the number of possible annual graduates from each program. Another critical data source was the California Employment Development Department s (EDD) comprehensive list of training programs, coded by the classification of instructional programs and searchable by occupational code. Supply data for each occupation in the state was obtained and projected until 2030, using a 1.3 percent annual growth rate, which is the traditional average growth rate that has been historically observed for these programs. Defining certified allied health workers The supply forecast studied allied health occupations where a degree or training certificate is required for entry and are therefore dependent on the capacity of the state s post-secondary education system to produce qualified workers. These occupations will be referred to collectively as certified allied health occupations. In other words, it did not include a number of entry-level jobs that do not require specific training or certification and would thus be drawing from an unlimited labor pool. This certified group is forecasted to account for 52 percent (530,316) of total allied health employment in 2030. The remaining 48 percent (479,874) of allied health occupations do not require any post-secondary certification as a prerequisite for entry into the field. Figure C.1 Composition of Allied Health Employment 52% Certified (530,316) 48% Non-Certified (479,874) Regional Spotlight: San Diego s Investment in Allied Health Education Making dreams come true for students is what the life of an educator is all about. Most educators spend much of their lives dreaming about how many more dreams they could help come true if they only had the right equipment, better technology or a first-class classroom. In Southern California, such dreams are becoming reality. San Diego Mesa College just opened the doors of a state-of-theart teaching facility that is a model of technology and innovation, thanks to a visionary investment by voters. The brand new, $24.9 million, 50,000-square-foot allied health building provides training facilities and classroom space for degree and certificate programs for five health care fields: dental assisting, health information technology, medical assisting, physical therapy assisting and radiologic technology. The San Diego Workforce Partnership identifies four of these fields as among the 10 most in-demand health care fields through 2014. As this report shows, allied health is in high demand statewide and the demand will continue to rise. Mesa College will help fill that demand locally, as well as train incumbent health care professionals in the field. Like so many of our fellow community colleges, we are the primary training ground for the allied health workforce. My hope is that the public will come to see the benefit of what they voted for: putting students on the path to stable, family-sustaining jobs that will boost our local economy. The new allied health building at Mesa College will be one of the solutions to economic recovery in the San Diego region by training and placing high-skilled technicians in the health care field. When the public has confidence in an educational institution, and when those institutions work with industry to build the workforce that a community needs, dreams really can come true. Margie Fritch, Dean of the School of Health Sciences/Public Service, San Diego Mesa College 19

Researchers forecast the total supply of all certified allied health occupations from training facilities within the state to be 296,723 from 2010 to 2020, and 634,357 by 2030, more than doubling the in-state supply of certified allied health workers from one decade to the next. Table C.1 2010 2030 Total Certified Allied Health Supply Period Supply 2010-2020 296,723 2010-2030 634,357 Table C.2 presents all certified allied healthcare worker supply numbers for each occupation, sorted from highest to lowest by occupation. Table C.2 2010 2030 Supply by Allied Health Occupation Occupation 2010-2020 2010-2030 Medical Assistants 109,123 233,292 Emergency Medical Technicians and Paramedics 33,187 70,951 Dental Assistants 32,823 70,171 Licensed Practical and Licensed Vocational Nurses 29,906 63,936 Pharmacy Technicians 21,004 44,904 Radiologic Technologists and Technicians 9,655 20,642 Surgical Technologists 6,033 12,898 Respiratory Therapists & Technicians 5,798 12,395 Physical Therapists 4,998 10,685 Dental Hygienists 4,610 9,856 Dietitians and Nutritionists 4,598 9,831 Cardiovascular Technologists and Technicians 4,410 9,428 Psychiatric Technicians 4,175 8,925 Speech-Language Pathologists 3,834 8,196 Physician Assistants 3,799 8,121 Occupational Therapists 3,799 8,121 Medical and Public Health Social Workers 2,846 6,084 Diagnostic Medical Sonographers 2,446 5,230 Opticians, Dispensing 2,129 4,551 Health Educators 1,929 4,123 Medical Records and Health Information Technicians 1,576 3,369 Physical Therapist Assistants 1,270 2,715 Medical and Clinical Laboratory Technologists 1,000 2,137 Recreational Therapists 729 1,559 Occupational Therapist Assistants 682 1,458 Dietetic Technicians 365 779 Total 296,723 634,357 Medical assistants, emergency medical technicians (EMTs) and paramedics, and dental assistants are expected to produce the largest supply of workers by 2030 (233,292, 70,951, and 70,171, respectively). Dietetic technicians, occupational therapist assistants, recreational therapists, and medical and clinical laboratory technologists will supply the fewest workers with 779, 1,458, 1,559, and 2,137 by 2030, respectively. 20 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Gap Analysis: Comparing Certified Allied Health Workforce Demand and Supply This analysis reveals a significant gap between the projected demand for health services within the state and the supply of California-certified applicants who will be working to deliver those services. The gap between supply and demand is derived by subtracting total supply from new demand (for certified allied health workers only) as defined in the previous sections. Since new demand is estimated at two different levels (7.5 percent and 10 percent) of net replacements, this report presents a range of the projected gap. Researchers project the overall shortage of workers among certified allied health occupations to reach up to 144,605 by 2020, and 374,936 by 2030. In this scenario, training institutions in California will only be able to meet as little as 63 percent of the need (new demand) for certified allied health workers by 2030. Table D.1 Projected Shortages in Certified Allied Health Period 2010-2020 2010-2030 New Demand 352,609-441,328 807,235-1,009,293 Supply 296,723 634,357 Gap 55,886-144,605 172,879-374,936 Most certified allied health occupations will experience shortages between 2010 and 2030. The largest shortages will occur among licensed practical and licensed vocational nurses (a shortage of up to 96,060), dental assistants (68,654), and dental hygienists (67,193). LVNs and dental assistants will have a large supply in terms of sheer numbers, but will be far below the number needed to meet rapidly growing demand for these workers. The smallest shortages will occur among dietitians and nutritionists (1,276), occupational therapy assistants (1,665), and recreational therapists (1,912). Table D.2 Certified Allied Health Worker Shortages by Occupation Occupation 2010-2020 2010-2030 Licensed Practical and Licensed Vocational Nurses 25,983-40,055 64,010-96,060 Dental Assistants 15,671-27,881 51,758-68,654 Dental Hygienists 22,304-29,081 40,845-67,193 Medical Records and Health Information Technicians Medical and Clinical Laboratory Technologists 12,609-16,180 29,103-37,237 11,972-15,239 27,560-34,999 Physical Therapists 9,671-13,365 22,897-31,309 Radiologic Technologists and Technicians Medical and Public Health Social Workers Respiratory Therapists & Technicians 7,075-11,288 17,659-27,253 6,004-8,233 14,176-19,251 5,053-7,718 12,455-18,524 Psychiatric Technicians 3,584-5,538 8,837-13,287 Occupational Therapists 3,084-4,548 7,384-10,968 Opticians, Dispensing 2,869-4,397 7,144-10,373 Physician Assistants 2,384-3,941 6,034-9,579 Surgical Technologists 2,367-3,680 5,611-9,314 Physical Therapist Assistants 1,726-3,283 4,865-7,697 Health Educators 1,345-2,169 3,370-5,247 Dietetic Technicians 848-1,153 1,996-2,691 Speech-Language Pathologists 483-719 1,217-2,216 Recreational Therapists 409-788 1,040-1,912 Occupational Therapist Assistants (-)197-684 130-1,665 Dietitians and Nutritionists (-)719-258 (-)949-1,276 Cardiovascular Technologists and Technicians (-)1,258 - (-)464 (-)2,212 - (-)405 Diagnostic Medical Sonographers (-)1,234 - (-)929 (-)2,454 - (-)1,759 Pharmacy Technicians (-)13,851 - (-)12,050 (-)28,529 - (-)24,427 Emergency Medical Technicians and Paramedics (-)20,215 - (-)16,949 (-)41,254 - (-)33,815 Medical Assistants (-)42,081 - (-)25,200 (-)79,813 - (-)41,366 Total 55,886 144,605 172,879 374,936 * (-) indicates a Surplus In evaluating the accuracies of these estimates, it s important to consider that many assumptions were necessarily used in the analysis, and vagrancies in the data must be considered. On one hand, we may be underestimating the true shortage. Not everyone who graduates with an allied health degree necessarily goes on to obtain a job in the industry. Similarly, the research does not take into account workers with multiple degrees, resulting in a possible overcount of the available supply. Additionally, the industry has consistently moved toward requiring certification and licenses in an effort to maintain quality. A portion of the currently non-certified allied health workforce may start requiring a post-secondary education, further increasing the need to expand educational infrastructure in the state. On the other hand, the private sector has in the past shown the ability to step up when there is demand for a type of degree or training, and made money available for students in the form of educational loans. The capacity of the private sector to expand and respond is not explicitly handled in this research. Instead, these results should be viewed as a cautionary tale of what might happen if the education system, public and private, is unable or unwilling to invest in expanding programs. 21

Economic Impact: Value of the Allied Health Workforce Researchers also studied payroll and tax revenue data for allied health occupations to gauge potential wage gains for Californians should the state s post-secondary education system have the capacity to educate and train enough workers to meet demand. Allied health payroll data was obtained from the Current Population Survey (CPS). The payroll data was adjusted for inflation and projected to 2030 using a constant percentage growth. The data shows that total payroll for allied health workers will top $23.3 billion in 2010, $51.9 billion in 2020, and $116 billion in 2030. Table E.1 Allied Health Payroll Data Year Total Payroll Total Payroll Tax 2010 $23,354,060,403 $1,926,709,983 2020 $51,940,787,662 $4,285,114,982 2030 $116,559,361,642 $9,616,147,335 Assuming a constant tax rate from today, total revenues derived from California s allied health payroll tax will increase from $1.9 billion in 2010 to $4.3 billion in 2020 to $9.6 billion in 2030. Thus, tax revenues from allied health occupations will continually increase, more than quadrupling from 2010 to 2030. Lifetime Wages: Comparing Earnings of Certified and Non-Certified Allied Health Workers The final element of this research was to collect wage data for certified and non-certified allied health workers, by age group, from the Current Population Survey (CPS). Both categories, certified and non-certified, were analyzed and graphed to present a comprehensive view of the lifetime earnings of each group (Figure F.1). As stated throughout this report, certified occupations are those occupations that require enrollment in a training program or the completion of a certificate program. Non-certified occupations are those that do not require any form of post-secondary training or certification as a prerequisite to practice in that occupation. According to the CPS wage data, certified workers earn 60 percent more on average than those without certification over their lifetimes. Also, those without certificates/degrees reach their wage peak earlier in their career (typically in their 30s), after which their earnings remain flat (inflationadjusted). While these workers receive pay increases, the increases are not greater than cost of living increases in their area. In contrast, certified workers reach their wage peak much later in their careers, continuing to increase their earnings often until their late 50s. Figure F.1 Allied Health Workers Average Annual Wage by Age (2006-2008) Figure E.1 California Tax Revenues from Allied Healthcare Payrolls 2010 2020 2030 Age Group $50k 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 $40k $10b $30k $8b $20k $6b $10k Certified Non-Certified $4b $2b Overall, non-certified allied health workers reach their wage peak during their 30s at $35,273 while certified allied health workers peak at $45,388 much later in their lives, as shown in the graph above. This demonstrates a clear benefit in obtaining a training certificate or degree as it increases a worker s lifelong earnings and purchasing power a key factor in driving the movement of goods and services that fuel the state s economy and boosting the tax revenues that fill state coffers. 22 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry? 10

Case Study: Addressing Shortages with Public-Private Partnerships A newborn spending the night in a neonatal intensive care unit. A patient recovering from a lung infection in intensive care. An elderly woman suffering from shortness of breath. These are just some of the common circumstances that require the care of a trained respiratory therapist vaguelyknown but critically important allied health professionals. In 2006, MemorialCare, a not-for-profit health care system that includes four Southern California hospitals, had a respiratory therapist vacancy rate of 17 percent. We relied on 41 traveling or registry replacements to fill the void an expensive solution. Looking ahead, future estimates revealed that the number of trained workers would fall far below our projected need, especially because nearly half of our respiratory therapists are over 50 and nearing retirement. MemorialCare recognized that one barrier to producing more respiratory therapists is a lack of clinical instructors for existing programs. In 2006, we formed a partnership with Orange Coast College (OCC), the Costa Mesa community college that supplied all of Orange County s respiratory therapy graduates. Key to the partnership was MemorialCare s decision to provide and pay for one of our best respiratory therapists to work as an instructor. MemorialCare also helped develop student recruitment and stipend processes, and we provided economic assistance to qualified students who would then work at least two years for MemorialCare. OCC, in return, agreed to expand the number of students in the program to help meet our hospitals needs. It worked. We produced 24 additional graduates between 2008 and 2009. And we estimate that by hiring OCC graduates instead of contractor replacements, we ll save nearly $1.4 million between 2008 and 2012. These promising numbers are just a start but they re the right start if providers, educators and state decision-makers want to proactively address shortages that affect our economy and our health care. Maria-Jean Caterinicchio, RN, MS, and Director of Workforce Development at Orange County MemorialCare Medical Centers & Memorial Care University 23

Conclusions & Recommendations By 2030, the population of Californians age 65 and over is projected to increase by 4.5 million. Because people of this age group are major consumers of healthcare products and services, the state faces a significant need to grow its supply of certified allied health workers to deliver those services. Total demand for healthcare employment stands to increase by 61 percent between 2010 and 2030. Allied health employment, which will increase faster than that for healthcare workers overall, will grow by approximately 63 percent. The greater increase in demand for allied health workers compared to overall healthcare workers may be driven by a shift in how health services are being provided (in ambulatory care settings outpatient settings such as doctors offices, clinics and labs as opposed to hospitals). With an inadequate number of existing allied health training facilities and an insufficient growth pattern in training programs, California s rising demand for allied health workers will not be met by the educational supply available in the state. The projected shortage of certified allied health workers in 2030 is considerable: nearly 375,000 positions in the worst case scenario. Staffing shortages in allied health will have significant short-term impacts on the quality of healthcare services provided to Californians. Patients may have to endure longer waiting times at hospitals and clinics; appointments may be harder to obtain or reschedule; lab test results may be delayed. In addition, healthcare providers may face cost increases from outsourcing lab work, hiring contract workers, and having to increase wages to attract employees. If the state does not provide sufficient training opportunities in allied health, this situation will represent a missed opportunity for hundreds of thousands of Californians looking for family-sustaining wages and job security. And as shown in the wage data, workers with certifications or degrees earn 60 percent more on average over their lifetime than those without certifications a compelling reason for the state to expand its postsecondary education system. To prepare Californians to fill these in-demand occupations, the state would need to rapidly increase the number of students that it is training through in existing allied health certification programs and invest more in expanding new training programs and facilities across California. 24 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

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Appendix Regional Snapshot: Los Angeles Area (Los Angeles, Orange, San Bernardino, Riverside, Ventura, Kern, Inyo Counties) Los Angeles Area (low scenario 7.5 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, Attendants 15.50% 47,497 100,216 168,188 Medical Secretaries 10.16% 31,113 65,647 110,172 Medical Assistants 9.96% 30,506 64,367 108,023 Licensed Practical and Licensed Vocational Nurses 8.30% 25,431 53,658 90,052 Home Health Aides 7.56% 23,169 48,886 82,043 Dental Assistants 7.20% 22,066 46,558 78,136 Dental Hygienists 4.00% 12,247 25,840 43,366 Medical and Health Services Managers 2.72% 8,330 17,576 29,496 Personal and Home Care Aides 2.61% 7,999 16,877 28,324 Radiologic Technologists and Technicians 2.49% 7,613 16,063 26,957 Healthcare Support Workers, All Other 2.23% 6,841 14,433 24,222 Physical Therapists 2.18% 6,675 14,084 23,636 Medical Records and Health Information Technicians 2.11% 6,454 13,618 22,855 Medical and Clinical Laboratory Technologists 1.93% 5,903 12,454 20,901 Emergency Medical Technicians and Paramedics 1.93% 5,903 12,454 20,901 Respiratory Therapists & Technicians 1.73% 5,312 11,209 18,811 Health Technologists and Technicians, All Other 1.69% 5,186 10,941 18,362 Medical and Clinical Laboratory Technicians 1.44% 4,413 9,312 15,627 Medical and Public Health Social Workers 1.31% 4,027 8,497 14,260 Psychiatric Technicians 1.15% 3,531 7,449 12,502 Surgical Technologists 1.15% 3,531 7,449 12,502 Pharmacy Technicians 1.06% 3,255 6,867 11,525 Occupational Therapists 0.99% 3,034 6,402 10,744 Medical Transcriptionists 0.94% 2,869 6,053 10,158 Physician Assistants 0.92% 2,813 5,936 9,962 Opticians, Dispensing 0.77% 2,372 5,005 8,400 Physical Therapist Aides 0.68% 2,096 4,423 7,423 Medical Equipment Preparers 0.63% 1,931 4,074 6,837 Dietitians and Nutritionists 0.58% 1,765 3,725 6,251 Speech-Language Pathologists 0.54% 1,655 3,492 5,860 Physical Therapist Assistants 0.54% 1,655 3,492 5,860 Health Educators 0.49% 1,489 3,143 5,274 Cardiovascular Technologists and Technicians 0.47% 1,434 3,026 5,079 Healthcare Practitioners and Technical Workers, All Other 0.45% 1,379 2,910 4,884 Nuclear Medicine Technologists 0.27% 827 1,746 2,930 Recreational Therapists 0.18% 552 1,164 1,953 Diagnostic Medical Sonographers 0.18% 552 1,164 1,953 Dietetic Technicians 0.18% 552 1,164 1,953 Occupational Therapist Aides 0.18% 552 1,164 1,953 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 552 1,164 1,953 Occupational Therapist Assistants 0.16% 496 1,048 1,758 Psychiatric Aides 0.14% 441 931 1,563 Medical Equipment Repairers 0.05% 165 349 586 Therapists, All Other 0.04% 110 233 391 Pharmacy Aides 0.02% 55 116 195 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 306,350 646,379 1,084,783 Los Angeles Regional Payroll $11,465,814,746 $30,408,759,452 $87,941,920,432 26 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Los Angeles Area (high scenario 10 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 47,497 113,481 198,398 Medical Secretaries 10.16% 31,113 74,336 129,961 Medical Assistants 9.96% 30,506 72,886 127,426 Licensed Practical and Licensed Vocational Nurses 8.30% 25,431 60,760 106,227 Home Health Aides 7.56% 23,169 55,357 96,779 Dental Assistants 7.20% 22,066 52,721 92,171 Dental Hygienists 4.00% 12,247 29,260 51,155 Medical and Health Services Managers 2.72% 8,330 19,902 34,794 Personal and Home Care Aides 2.61% 7,999 19,111 33,412 Radiologic Technologists and Technicians 2.49% 7,613 18,189 31,799 Healthcare Support Workers, All Other 2.23% 6,841 16,343 28,573 Physical Therapists 2.18% 6,675 15,948 27,882 Medical Records and Health Information Technicians 2.11% 6,454 15,421 26,960 Medical and Clinical Laboratory Technologists 1.93% 5,903 14,103 24,656 Emergency Medical Technicians and Paramedics 1.93% 5,903 14,103 24,656 Respiratory Therapists & Technicians 1.73% 5,312 12,692 22,190 Health Technologists and Technicians, All Other 1.69% 5,186 12,389 21,660 Medical and Clinical Laboratory Technicians 1.44% 4,413 10,544 18,434 Medical and Public Health Social Workers 1.31% 4,027 9,621 16,821 Psychiatric Technicians 1.15% 3,531 8,435 14,747 Surgical Technologists 1.15% 3,531 8,435 14,747 Pharmacy Technicians 1.06% 3,255 7,776 13,595 Occupational Therapists 0.99% 3,034 7,249 12,673 Medical Transcriptionists 0.94% 2,869 6,854 11,982 Physician Assistants 0.92% 2,813 6,722 11,752 Opticians, Dispensing 0.77% 2,372 5,667 9,908 Physical Therapist Aides 0.68% 2,096 5,008 8,756 Medical Equipment Preparers 0.63% 1,931 4,613 8,065 Dietitians and Nutritionists 0.58% 1,765 4,218 7,374 Speech-Language Pathologists 0.54% 1,655 3,954 6,913 Physical Therapist Assistants 0.54% 1,655 3,954 6,913 Health Educators 0.49% 1,489 3,559 6,222 Cardiovascular Technologists and Technicians 0.47% 1,434 3,427 5,991 Healthcare Practitioners and Technical Workers, All Other 0.45% 1,379 3,295 5,761 Nuclear Medicine Technologists 0.27% 827 1,977 3,456 Recreational Therapists 0.18% 552 1,318 2,304 Diagnostic Medical Sonographers 0.18% 552 1,318 2,304 Dietetic Technicians 0.18% 552 1,318 2,304 Occupational Therapist Aides 0.18% 552 1,318 2,304 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 552 1,318 2,304 Occupational Therapist Assistants 0.16% 496 1,186 2,074 Psychiatric Aides 0.14% 441 1,054 1,843 Medical Equipment Repairers 0.05% 165 395 691 Therapists, All Other 0.04% 110 264 461 Pharmacy Aides 0.02% 55 132 230 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 306,350 731,932 1,279,631 Los Angeles Regional Payroll $11,465,814,746 $30,408,759,452 $87,941,920,432 27

Regional Snapshot: San Francisco Bay Area (Alameda, San Francisco, Contra Costa, San Mateo, Santa Clara, Napa, Sonoma, Marin, Mendocino, Solano, Lake Counties) San Francisco Bay Area (7.5 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 18,436 38,898 65,281 Medical Secretaries 10.16% 12,076 25,480 42,762 Medical Assistants 9.96% 11,841 24,983 41,928 Licensed Practical and Licensed Vocational Nurses 8.30% 9,871 20,827 34,953 Home Health Aides 7.56% 8,993 18,975 31,844 Dental Assistants 7.20% 8,565 18,071 30,328 Dental Hygienists 4.00% 4,753 10,029 16,832 Medical and Health Services Managers 2.72% 3,233 6,822 11,449 Personal and Home Care Aides 2.61% 3,105 6,551 10,994 Radiologic Technologists and Technicians 2.49% 2,955 6,235 10,463 Healthcare Support Workers, All Other 2.23% 2,655 5,602 9,402 Physical Therapists 2.18% 2,591 5,467 9,174 Medical Records and Health Information Technicians 2.11% 2,505 5,286 8,871 Medical and Clinical Laboratory Technologists 1.93% 2,291 4,834 8,113 Emergency Medical Technicians and Paramedics 1.93% 2,291 4,834 8,113 Respiratory Therapists & Technicians 1.73% 2,062 4,351 7,301 Health Technologists and Technicians, All Other 1.69% 2,013 4,247 7,127 Medical and Clinical Laboratory Technicians 1.44% 1,713 3,614 6,066 Medical and Public Health Social Workers 1.31% 1,563 3,298 5,535 Psychiatric Technicians 1.15% 1,370 2,891 4,852 Surgical Technologists 1.15% 1,370 2,891 4,852 Pharmacy Technicians 1.06% 1,263 2,665 4,473 Occupational Therapists 0.99% 1,178 2,485 4,170 Medical Transcriptionists 0.94% 1,113 2,349 3,943 Physician Assistants 0.92% 1,092 2,304 3,867 Opticians, Dispensing 0.77% 921 1,943 3,260 Physical Therapist Aides 0.68% 814 1,717 2,881 Medical Equipment Preparers 0.63% 749 1,581 2,654 Dietitians and Nutritionists 0.58% 685 1,446 2,426 Speech-Language Pathologists 0.54% 642 1,355 2,275 Physical Therapist Assistants 0.54% 642 1,355 2,275 Health Educators 0.49% 578 1,220 2,047 Cardiovascular Technologists and Technicians 0.47% 557 1,175 1,971 Healthcare Practitioners and Technical Workers, All Other 0.45% 535 1,129 1,895 Nuclear Medicine Technologists 0.27% 321 678 1,137 Recreational Therapists 0.18% 214 452 758 Diagnostic Medical Sonographers 0.18% 214 452 758 Dietetic Technicians 0.18% 214 452 758 Occupational Therapist Aides 0.18% 214 452 758 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 214 452 758 Occupational Therapist Assistants 0.16% 193 407 682 Psychiatric Aides 0.14% 171 361 607 Medical Equipment Repairers 0.05% 64 136 227 Therapists, All Other 0.04% 43 90 152 Pharmacy Aides 0.02% 21 45 76 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 118,907 250,886 421,048 San Francisco Regional Payroll $5,161,657,528 $13,689,354,453 $39,589,517,685 28 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

San Francisco Bay Area (10 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 18,436 44,047 77,006 Medical Secretaries 10.16% 12,076 28,853 50,443 Medical Assistants 9.96% 11,841 28,290 49,459 Licensed Practical and Licensed Vocational Nurses 8.30% 9,871 23,584 41,231 Home Health Aides 7.56% 8,993 21,486 37,564 Dental Assistants 7.20% 8,565 20,463 35,775 Dental Hygienists 4.00% 4,753 11,357 19,855 Medical and Health Services Managers 2.72% 3,233 7,725 13,505 Personal and Home Care Aides 2.61% 3,105 7,418 12,969 Radiologic Technologists and Technicians 2.49% 2,955 7,060 12,342 Healthcare Support Workers, All Other 2.23% 2,655 6,344 11,090 Physical Therapists 2.18% 2,591 6,190 10,822 Medical Records and Health Information Technicians 2.11% 2,505 5,985 10,464 Medical and Clinical Laboratory Technologists 1.93% 2,291 5,474 9,570 Emergency Medical Technicians and Paramedics 1.93% 2,291 5,474 9,570 Respiratory Therapists & Technicians 1.73% 2,062 4,926 8,613 Health Technologists and Technicians, All Other 1.69% 2,013 4,809 8,407 Medical and Clinical Laboratory Technicians 1.44% 1,713 4,093 7,155 Medical and Public Health Social Workers 1.31% 1,563 3,734 6,529 Psychiatric Technicians 1.15% 1,370 3,274 5,724 Surgical Technologists 1.15% 1,370 3,274 5,724 Pharmacy Technicians 1.06% 1,263 3,018 5,277 Occupational Therapists 0.99% 1,178 2,814 4,919 Medical Transcriptionists 0.94% 1,113 2,660 4,651 Physician Assistants 0.92% 1,092 2,609 4,561 Opticians, Dispensing 0.77% 921 2,200 3,846 Physical Therapist Aides 0.68% 814 1,944 3,399 Medical Equipment Preparers 0.63% 749 1,791 3,130 Dietitians and Nutritionists 0.58% 685 1,637 2,862 Speech-Language Pathologists 0.54% 642 1,535 2,683 Physical Therapist Assistants 0.54% 642 1,535 2,683 Health Educators 0.49% 578 1,381 2,415 Cardiovascular Technologists and Technicians 0.47% 557 1,330 2,325 Healthcare Practitioners and Technical Workers, All Other 0.45% 535 1,279 2,236 Nuclear Medicine Technologists 0.27% 321 767 1,342 Recreational Therapists 0.18% 214 512 894 Diagnostic Medical Sonographers 0.18% 214 512 894 Dietetic Technicians 0.18% 214 512 894 Occupational Therapist Aides 0.18% 214 512 894 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 214 512 894 Occupational Therapist Assistants 0.16% 193 460 805 Psychiatric Aides 0.14% 171 409 716 Medical Equipment Repairers 0.05% 64 153 268 Therapists, All Other 0.04% 43 102 179 Pharmacy Aides 0.02% 21 51 89 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 118,907 284,092 496,677 San Francisco Regional Payroll $5,161,657,528 $13,689,354,453 $39,589,517,685 29

Regional Snapshot: San Diego (San Diego County) San Diego Area (7.5 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 7,776 16,406 27,533 Medical Secretaries 10.16% 5,093 10,747 18,036 Medical Assistants 9.96% 4,994 10,537 17,684 Licensed Practical and Licensed Vocational Nurses 8.30% 4,163 8,784 14,742 Home Health Aides 7.56% 3,793 8,003 13,431 Dental Assistants 7.20% 3,612 7,622 12,791 Dental Hygienists 4.00% 2,005 4,230 7,099 Medical and Health Services Managers 2.72% 1,364 2,877 4,829 Personal and Home Care Aides 2.61% 1,309 2,763 4,637 Radiologic Technologists and Technicians 2.49% 1,246 2,630 4,413 Healthcare Support Workers, All Other 2.23% 1,120 2,363 3,965 Physical Therapists 2.18% 1,093 2,306 3,869 Medical Records and Health Information Technicians 2.11% 1,057 2,229 3,741 Medical and Clinical Laboratory Technologists 1.93% 966 2,039 3,422 Emergency Medical Technicians and Paramedics 1.93% 966 2,039 3,422 Respiratory Therapists & Technicians 1.73% 870 1,835 3,079 Health Technologists and Technicians, All Other 1.69% 849 1,791 3,006 Medical and Clinical Laboratory Technicians 1.44% 722 1,524 2,558 Medical and Public Health Social Workers 1.31% 659 1,391 2,334 Psychiatric Technicians 1.15% 578 1,219 2,047 Surgical Technologists 1.15% 578 1,219 2,047 Pharmacy Technicians 1.06% 533 1,124 1,887 Occupational Therapists 0.99% 497 1,048 1,759 Medical Transcriptionists 0.94% 470 991 1,663 Physician Assistants 0.92% 461 972 1,631 Opticians, Dispensing 0.77% 388 819 1,375 Physical Therapist Aides 0.68% 343 724 1,215 Medical Equipment Preparers 0.63% 316 667 1,119 Dietitians and Nutritionists 0.58% 289 610 1,023 Speech-Language Pathologists 0.54% 271 572 959 Physical Therapist Assistants 0.54% 271 572 959 Health Educators 0.49% 244 514 863 Cardiovascular Technologists and Technicians 0.47% 235 495 831 Healthcare Practitioners and Technical Workers, All Other 0.45% 226 476 799 Nuclear Medicine Technologists 0.27% 135 286 480 Recreational Therapists 0.18% 90 191 320 Diagnostic Medical Sonographers 0.18% 90 191 320 Dietetic Technicians 0.18% 90 191 320 Occupational Therapist Aides 0.18% 90 191 320 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 90 191 320 Occupational Therapist Assistants 0.16% 81 171 288 Psychiatric Aides 0.14% 72 152 256 Medical Equipment Repairers 0.05% 27 57 96 Therapists, All Other 0.04% 18 38 64 Pharmacy Aides 0.02% 9 19 32 Orthotists and Prosthetists 0.00% 0 0 0 Medical Appliance Technicians 0.00% 0 0 0 Total Demand 50,151 105,815 177,583 San Diego Regional Payroll $2,014,419,498 $5,342,489,767 $15,450,443,178 30 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

San Diego Area (10 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 7,776 18,577 32,479 Medical Secretaries 10.16% 5,093 12,169 21,275 Medical Assistants 9.96% 4,994 11,932 20,860 Licensed Practical and Licensed Vocational Nurses 8.30% 4,163 9,947 17,390 Home Health Aides 7.56% 3,793 9,062 15,843 Dental Assistants 7.20% 3,612 8,631 15,089 Dental Hygienists 4.00% 2,005 4,790 8,374 Medical and Health Services Managers 2.72% 1,364 3,258 5,696 Personal and Home Care Aides 2.61% 1,309 3,129 5,470 Radiologic Technologists and Technicians 2.49% 1,246 2,978 5,206 Healthcare Support Workers, All Other 2.23% 1,120 2,675 4,678 Physical Therapists 2.18% 1,093 2,611 4,564 Medical Records and Health Information Technicians 2.11% 1,057 2,524 4,413 Medical and Clinical Laboratory Technologists 1.93% 966 2,309 4,036 Emergency Medical Technicians and Paramedics 1.93% 966 2,309 4,036 Respiratory Therapists & Technicians 1.73% 870 2,078 3,633 Health Technologists and Technicians, All Other 1.69% 849 2,028 3,546 Medical and Clinical Laboratory Technicians 1.44% 722 1,726 3,018 Medical and Public Health Social Workers 1.31% 659 1,575 2,754 Psychiatric Technicians 1.15% 578 1,381 2,414 Surgical Technologists 1.15% 578 1,381 2,414 Pharmacy Technicians 1.06% 533 1,273 2,226 Occupational Therapists 0.99% 497 1,187 2,075 Medical Transcriptionists 0.94% 470 1,122 1,962 Physician Assistants 0.92% 461 1,100 1,924 Opticians, Dispensing 0.77% 388 928 1,622 Physical Therapist Aides 0.68% 343 820 1,433 Medical Equipment Preparers 0.63% 316 755 1,320 Dietitians and Nutritionists 0.58% 289 690 1,207 Speech-Language Pathologists 0.54% 271 647 1,132 Physical Therapist Assistants 0.54% 271 647 1,132 Health Educators 0.49% 244 583 1,018 Cardiovascular Technologists and Technicians 0.47% 235 561 981 Healthcare Practitioners and Technical Workers, All Other 0.45% 226 539 943 Nuclear Medicine Technologists 0.27% 135 324 566 Recreational Therapists 0.18% 90 216 377 Diagnostic Medical Sonographers 0.18% 90 216 377 Dietetic Technicians 0.18% 90 216 377 Occupational Therapist Aides 0.18% 90 216 377 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 90 216 377 Occupational Therapist Assistants 0.16% 81 194 339 Psychiatric Aides 0.14% 72 173 302 Medical Equipment Repairers 0.05% 27 65 113 Therapists, All Other 0.04% 18 43 75 Pharmacy Aides 0.02% 9 22 38 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 50,151 119,820 209,481 San Diego Regional Payroll $2,014,419,498 $5,342,489,767 $15,450,443,178 31

Regional Snapshot: Sacramento (Sacramento, San Joaquin, Stanislaus, Yuba, Yolo, Placer, Sutter, Tuolumne, Nevada, Plumas, El Dorado, Amador, Calaveras, Colusa, Sierra Counties) Sacramento Area (7.5 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 9,380 19,792 33,215 Medical Secretaries 10.16% 6,145 12,965 21,758 Medical Assistants 9.96% 6,025 12,712 21,333 Licensed Practical and Licensed Vocational Nurses 8.30% 5,022 10,597 17,784 Home Health Aides 7.56% 4,576 9,654 16,203 Dental Assistants 7.20% 4,358 9,195 15,431 Dental Hygienists 4.00% 2,419 5,103 8,564 Medical and Health Services Managers 2.72% 1,645 3,471 5,825 Personal and Home Care Aides 2.61% 1,580 3,333 5,594 Radiologic Technologists and Technicians 2.49% 1,503 3,172 5,324 Healthcare Support Workers, All Other 2.23% 1,351 2,850 4,784 Physical Therapists 2.18% 1,318 2,781 4,668 Medical Records and Health Information Technicians 2.11% 1,275 2,689 4,514 Medical and Clinical Laboratory Technologists 1.93% 1,166 2,460 4,128 Emergency Medical Technicians and Paramedics 1.93% 1,166 2,460 4,128 Respiratory Therapists & Technicians 1.73% 1,049 2,214 3,715 Health Technologists and Technicians, All Other 1.69% 1,024 2,161 3,626 Medical and Clinical Laboratory Technicians 1.44% 872 1,839 3,086 Medical and Public Health Social Workers 1.31% 795 1,678 2,816 Psychiatric Technicians 1.15% 697 1,471 2,469 Surgical Technologists 1.15% 697 1,471 2,469 Pharmacy Technicians 1.06% 643 1,356 2,276 Occupational Therapists 0.99% 599 1,264 2,122 Medical Transcriptionists 0.94% 567 1,195 2,006 Physician Assistants 0.92% 556 1,172 1,967 Opticians, Dispensing 0.77% 468 988 1,659 Physical Therapist Aides 0.68% 414 873 1,466 Medical Equipment Preparers 0.63% 381 805 1,350 Dietitians and Nutritionists 0.58% 349 736 1,234 Speech-Language Pathologists 0.54% 327 690 1,157 Physical Therapist Assistants 0.54% 327 690 1,157 Health Educators 0.49% 294 621 1,042 Cardiovascular Technologists and Technicians 0.47% 283 598 1,003 Healthcare Practitioners and Technical Workers, All Other 0.45% 272 575 964 Nuclear Medicine Technologists 0.27% 163 345 579 Recreational Therapists 0.18% 109 230 386 Diagnostic Medical Sonographers 0.18% 109 230 386 Dietetic Technicians 0.18% 109 230 386 Occupational Therapist Aides 0.18% 109 230 386 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 109 230 386 Occupational Therapist Assistants 0.16% 98 207 347 Psychiatric Aides 0.14% 87 184 309 Medical Equipment Repairers 0.05% 33 69 116 Therapists, All Other 0.04% 22 46 77 Pharmacy Aides 0.02% 11 23 39 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 60,501 127,652 214,232 Sacramento Regional Payroll $2,155,127,193 $5,715,663,984 $16,529,660,411 32 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Sacramento Area (10 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 9,380 22,411 39,181 Medical Secretaries 10.16% 6,145 14,680 25,666 Medical Assistants 9.96% 6,025 14,394 25,165 Licensed Practical and Licensed Vocational Nurses 8.30% 5,022 11,999 20,979 Home Health Aides 7.56% 4,576 10,932 19,113 Dental Assistants 7.20% 4,358 10,412 18,203 Dental Hygienists 4.00% 2,419 5,778 10,102 Medical and Health Services Managers 2.72% 1,645 3,930 6,872 Personal and Home Care Aides 2.61% 1,580 3,774 6,598 Radiologic Technologists and Technicians 2.49% 1,503 3,592 6,280 Healthcare Support Workers, All Other 2.23% 1,351 3,228 5,643 Physical Therapists 2.18% 1,318 3,150 5,506 Medical Records and Health Information Technicians 2.11% 1,275 3,045 5,324 Medical and Clinical Laboratory Technologists 1.93% 1,166 2,785 4,869 Emergency Medical Technicians and Paramedics 1.93% 1,166 2,785 4,869 Respiratory Therapists & Technicians 1.73% 1,049 2,507 4,382 Health Technologists and Technicians, All Other 1.69% 1,024 2,447 4,278 Medical and Clinical Laboratory Technicians 1.44% 872 2,082 3,641 Medical and Public Health Social Workers 1.31% 795 1,900 3,322 Psychiatric Technicians 1.15% 697 1,666 2,912 Surgical Technologists 1.15% 697 1,666 2,912 Pharmacy Technicians 1.06% 643 1,536 2,685 Occupational Therapists 0.99% 599 1,432 2,503 Medical Transcriptionists 0.94% 567 1,354 2,366 Physician Assistants 0.92% 556 1,327 2,321 Opticians, Dispensing 0.77% 468 1,119 1,957 Physical Therapist Aides 0.68% 414 989 1,729 Medical Equipment Preparers 0.63% 381 911 1,593 Dietitians and Nutritionists 0.58% 349 833 1,456 Speech-Language Pathologists 0.54% 327 781 1,365 Physical Therapist Assistants 0.54% 327 781 1,365 Health Educators 0.49% 294 703 1,229 Cardiovascular Technologists and Technicians 0.47% 283 677 1,183 Healthcare Practitioners and Technical Workers, All Other 0.45% 272 651 1,138 Nuclear Medicine Technologists 0.27% 163 390 683 Recreational Therapists 0.18% 109 260 455 Diagnostic Medical Sonographers 0.18% 109 260 455 Dietetic Technicians 0.18% 109 260 455 Occupational Therapist Aides 0.18% 109 260 455 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 109 260 455 Occupational Therapist Assistants 0.16% 98 234 410 Psychiatric Aides 0.14% 87 208 364 Medical Equipment Repairers 0.05% 33 78 137 Therapists, All Other 0.04% 22 52 91 Pharmacy Aides 0.02% 11 26 46 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 60,501 144,548 252,712 Sacramento Regional Payroll $2,155,127,193 $5,715,663,984 $16,529,660,411 33

Regional Snapshot: Fresno/Visalia (Mariposa, Madera, Fresno, Merced, Tulare, Kings Counties) Fresno/Visalia Area (7.5 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 4,812 10,153 17,039 Medical Secretaries 10.16% 3,152 6,651 11,161 Medical Assistants 9.96% 3,091 6,521 10,944 Licensed Practical and Licensed Vocational Nurses 8.30% 2,576 5,436 9,123 Home Health Aides 7.56% 2,347 4,953 8,312 Dental Assistants 7.20% 2,235 4,717 7,916 Dental Hygienists 4.00% 1,241 2,618 4,393 Medical and Health Services Managers 2.72% 844 1,781 2,988 Personal and Home Care Aides 2.61% 810 1,710 2,869 Radiologic Technologists and Technicians 2.49% 771 1,627 2,731 Healthcare Support Workers, All Other 2.23% 693 1,462 2,454 Physical Therapists 2.18% 676 1,427 2,395 Medical Records and Health Information Technicians 2.11% 654 1,380 2,315 Medical and Clinical Laboratory Technologists 1.93% 598 1,262 2,117 Emergency Medical Technicians and Paramedics 1.93% 598 1,262 2,117 Respiratory Therapists & Technicians 1.73% 538 1,136 1,906 Health Technologists and Technicians, All Other 1.69% 525 1,108 1,860 Medical and Clinical Laboratory Technicians 1.44% 447 943 1,583 Medical and Public Health Social Workers 1.31% 408 861 1,445 Psychiatric Technicians 1.15% 358 755 1,267 Surgical Technologists 1.15% 358 755 1,267 Pharmacy Technicians 1.06% 330 696 1,168 Occupational Therapists 0.99% 307 649 1,088 Medical Transcriptionists 0.94% 291 613 1,029 Physician Assistants 0.92% 285 601 1,009 Opticians, Dispensing 0.77% 240 507 851 Physical Therapist Aides 0.68% 212 448 752 Medical Equipment Preparers 0.63% 196 413 693 Dietitians and Nutritionists 0.58% 179 377 633 Speech-Language Pathologists 0.54% 168 354 594 Physical Therapist Assistants 0.54% 168 354 594 Health Educators 0.49% 151 318 534 Cardiovascular Technologists and Technicians 0.47% 145 307 515 Healthcare Practitioners and Technical Workers, All Other 0.45% 140 295 495 Nuclear Medicine Technologists 0.27% 84 177 297 Recreational Therapists 0.18% 56 118 198 Diagnostic Medical Sonographers 0.18% 56 118 198 Dietetic Technicians 0.18% 56 118 198 Occupational Therapist Aides 0.18% 56 118 198 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 56 118 198 Occupational Therapist Assistants 0.16% 50 106 178 Psychiatric Aides 0.14% 45 94 158 Medical Equipment Repairers 0.05% 17 35 59 Therapists, All Other 0.04% 11 24 40 Pharmacy Aides 0.02% 6 12 20 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 31,036 65,483 109,897 Fresno/Visalia Regional Payroll $854,558,369 $2,266,394,536 $6,554,397,204 34 Help Wanted: Will California Miss Out on the Next Billion-Dollar Growth Industry?

Fresno/Visalia Area (10 percent) Occupation Percentage Share 2010 2020 2030 Nursing Aides, Orderlies, and Attendants 15.50% 4,812 11,497 20,099 Medical Secretaries 10.16% 3,152 7,531 13,166 Medical Assistants 9.96% 3,091 7,384 12,909 Licensed Practical and Licensed Vocational Nurses 8.30% 2,576 6,156 10,762 Home Health Aides 7.56% 2,347 5,608 9,805 Dental Assistants 7.20% 2,235 5,341 9,338 Dental Hygienists 4.00% 1,241 2,964 5,182 Medical and Health Services Managers 2.72% 844 2,016 3,525 Personal and Home Care Aides 2.61% 810 1,936 3,385 Radiologic Technologists and Technicians 2.49% 771 1,843 3,221 Healthcare Support Workers, All Other 2.23% 693 1,656 2,895 Physical Therapists 2.18% 676 1,616 2,825 Medical Records and Health Information Technicians 2.11% 654 1,562 2,731 Medical and Clinical Laboratory Technologists 1.93% 598 1,429 2,498 Emergency Medical Technicians and Paramedics 1.93% 598 1,429 2,498 Respiratory Therapists & Technicians 1.73% 538 1,286 2,248 Health Technologists and Technicians, All Other 1.69% 525 1,255 2,194 Medical and Clinical Laboratory Technicians 1.44% 447 1,068 1,868 Medical and Public Health Social Workers 1.31% 408 975 1,704 Psychiatric Technicians 1.15% 358 855 1,494 Surgical Technologists 1.15% 358 855 1,494 Pharmacy Technicians 1.06% 330 788 1,377 Occupational Therapists 0.99% 307 734 1,284 Medical Transcriptionists 0.94% 291 694 1,214 Physician Assistants 0.92% 285 681 1,191 Opticians, Dispensing 0.77% 240 574 1,004 Physical Therapist Aides 0.68% 212 507 887 Medical Equipment Preparers 0.63% 196 467 817 Dietitians and Nutritionists 0.58% 179 427 747 Speech-Language Pathologists 0.54% 168 401 700 Physical Therapist Assistants 0.54% 168 401 700 Health Educators 0.49% 151 361 630 Cardiovascular Technologists and Technicians 0.47% 145 347 607 Healthcare Practitioners and Technical Workers, All Other 0.45% 140 334 584 Nuclear Medicine Technologists 0.27% 84 200 350 Recreational Therapists 0.18% 56 134 233 Diagnostic Medical Sonographers 0.18% 56 134 233 Dietetic Technicians 0.18% 56 134 233 Occupational Therapist Aides 0.18% 56 134 233 Ambulance Drivers and Attendants, Except Emergency Medical Technicians 0.18% 56 134 233 Occupational Therapist Assistants 0.16% 50 120 210 Psychiatric Aides 0.14% 45 107 187 Medical Equipment Repairers 0.05% 17 40 70 Therapists, All Other 0.04% 11 27 47 Pharmacy Aides 0.02% 6 13 23 Orthotists and Prosthetists 0.00% * * * Medical Appliance Technicians 0.00% * * * Total Demand 31,036 74,151 129,637 Fresno/Visalia Regional Payroll $854,558,369 $2,266,394,536 $6,554,397,204 35