• Health care job growth conundrum

    Jared Bernstein points out a reality that health care could be understood as the only part of the economy that never has a recession (and so health sector employment is up 1.4 million jobs since Dec. 2007 while total employment is down by 6.5 million jobs).

    The reasons why?

    * government has a deep footprint in health care, accounting for about half of the sector’s expenditures, so that’s obviously made a difference in its immunity to recession (and another e.g. of why the conservative meme “government doesn’t create jobs” is so foolish and wrong);

    * our aging demographics certainly generate increasing demand for health services;

    * demand for health care tends to be pretty inelastic…I’m sure there’s a falloff in cosmetic surgery in recessions, but you get sick enough, you’ll go to the doctor, regardless of the unemployment rate (at least, you will if you have coverage);

    * health services tend to be non-tradable; also, jobs there are less susceptible to replacement by labor saving technology—a home-health aide isn’t likely to be replaced by a robot anytime soon…at least I hope not.

    This is obviously mixed news since we need to create jobs and slow down health care cost inflation. A true conundrum, made more complicated by the fact that increased productivity could aid in slowing health care cost inflation. Austin provides some useful context and a more focused post that notes that productivity gains in health care (wages rising, but not necessarily producing more care) lag behind other sectors (though the research discussed by Austin was unable to control for quality which is a problem)–you can read more here.

    • It would be interesting to see the separation between physicians and all other health care groups (hospitals, therapy, medication, nursing home, etc). I know I’ve had a 30% drop in my income as a primary care doc.

    • This is a tad surprising. On the hospital side, numbers have been down a bit the last couple of years.The surveys have access to suggest that numbers are down 2%-3%. Things must be growing on the out patient side.


    • demand for health care tends to be pretty inelastic- I think this is incorrect. If you listen to any of the earnings calls from acute care hospitals, they are hurting badly due to the economy. Yes, elective procedures are declining (which is why they are called elective); however, overall visits continue to suffer. As well, outpatient providers like Amsurg are hurting due to sluggish demand.

    • My clinic has added positions in the past year, but it is largely to handle the continuously growing morass of requisite hyperdocumentation (including repetitious documentation of clinically irrelevant medical history and examination findings, that play no role in diagnosing or treating the patient’s condition, but are required by the insurance company, or hospital, or pharmacy, or attorneys), phone calls to insurance companies, follow-up phone calls to insurance companies, reminder phone calls to patients the day prior to their clinic appointments, follow up phone calls from patients who still did a “no-call-no-show” at a confirmed clinic appointment and now want to discuss their ailments on the phone (during someone else’s clinic time), meetings required by the hospital, overseeing the nursing care (via my clinic’s nurses) hospitalized patient care to guard against omissions/errors/patient frustrations that result from overworked and understaffed hospital nurses, etc. In short, we, as is true throughout healthcare, have added jobs to perform innumerable required tasks that serve little or no function in the actual delivery of care, and are seldom benefit the quality or timeliness of my patients’ care.
      (For anyone who likes to bemoan the cost versus quality of care in this country, as compared to other first world countries, consider whether any other first world country has a comparably huge and largely unopposed hoard rule makers who are able to impose new requirements, at will, on the duties of healthcare providers. Perhaps England is the closest to our system in that regard, and their healthcare system is similarly in duress.)
      Nurses, physicians, and other care providers have little recourse but to devote ever larger percentages of our time responding to new (and often redundant) clerical demands, protocols, and requirements that may be generated by a discordant sea of committees, petty bureaucrats, business people, and others who have no direct responsibility for care of the patient.
      Although much concern is voiced about the risk of clinical decision-making being progressively taken out of the hands of physicians, I believe the more insidious, and ultimately even more dangerous transition is the dismantling of a system in which physicians and MBAs/CPAs/JDs et al maintained an ongoing struggle, ostensibly a balance of power, in the constant debate of cost versus outcomes.