Ambulatory setting expected to provide more job growth than hospitals

During the next 10 years, the number of jobs in the ambulatory care setting most likely will grow faster than for inpatient services and other sectors of the economy.

The number of jobs in physician offices will surge 32.7% from 2,315,800 in 2010 to 3,073,600 in 2020, according to the biennial employment projections released Feb. 1 by the Bureau of Labor Statistics. Hospitals will add a greater number of jobs, but the growth will be slower. In 2010, there were 5,695,900 positions at hospitals, and this is projected to increase 16.5% to 6,638,400. The number of jobs in the economy as a whole is expected to rise 14.3% from 130.4 million in 2010 to 150.2 million by 2020.

Experts predict job creation in the ambulatory setting will be a response to the demands of an aging population. Other reasons include scientific improvements in care and changes to the health system prompted by reform legislation that would mean a greater proportion of payment based on quality of care and more patients kept out of the hospital.

The numbers tracking physician offices include office-based practices that may be owned by hospitals as well as by doctors and other entities. Hospitals have been buying an increasing number of practices to garner market share and secure revenue streams in light of the shift from inpatient services, which is expected to continue.

The BLS report states that job creation in physician offices will be primarily driven by new positions for managers, physician assistants, nurses, medical assistants, financial clerks, administrators, physicians and surgeons. There were 354,100 physicians working in the office setting in 2010, and the BLS expects the number to increase 30.8% to 463,200.

The projections for the next decade predict that the call for physicians will stay elevated. There were 691,000 physician jobs, including some considered self-employed or independent, in 2010. The BLS believes the number will go up 24.4% to 859,300 by 2020.

Growth will be most robust in ambulatory care. The number of physicians and surgeons working in the ambulatory setting is expected to expand 32% from 395,500 in 2010 to 522,100 in 2020. Jobs for physicians and surgeons in the hospital setting are projected to go up 12.7% from 133,800 in 2010 to 150,700 in 2020.

"Physicians will have plenty of opportunities for rewarding careers over the next decade," said Rob Morris, product director of MiracleWorkers.com, a CareerBuilder website for the medical industry. "Their challenges will be finding jobs in the regions of the country they want to live, at the organizations they want to work for, and in roles that fit their lifestyle."

The BLS projections are based on full employment for 2020. The numbers may be off the mark if the economy fails to fully recover, another recession hits, other legislation affects the health system or other unforeseen circumstances arise.

Two days after issuing its 10-year report, the BLS issued numbers reflecting the faster pace of job growth in physician offices compared with hospitals. According to the BLS monthly employment report issued Feb. 3, 64,900 jobs were added to physician offices in the 12 months running up to January for an annual growth rate of 2.8%.

A total of 95,600 jobs were added to hospitals in the 12 months ending in January for an annual growth rate of 2%.

The rise in jobs does not, however, mean the economic stress on physician offices caused by third-party pay rate cuts and the decline in patient visits linked to the recession will end anytime soon. A reduction to Medicare rates of 27.4% is on the table for March 1. Many health policy analysts believe that changes to the medical system, such as the implementation of accountable care organizations and bundled payments, may tighten the squeeze on some physician offices. In addition, economic recovery continues to be slow.

"Where this can get dicey for practices is the business models that are created to make health reform work are going to need to create some efficiency of scale," said Harold Jones, PhD, dean of the school of health professions at the University of Alabama at Birmingham. "Reform is not about pumping a lot of money into the system. In the '90s, reform was about access. Now it's about controlling health care costs."

Increased demand and a shortage of qualified professionals may prompt salaries to go up, but the need to contain health care costs may counter that, Jones said.

"Health care is going to be a secure employment opportunity," he said. "Health care will still pay a good wage. However, the upside financials of this may not be as big as you expect it to be."