Health care jobs changing, growing in Ocean State

Bryant University economics professor Sam Mirmirani is a believer in health care’s growing role in the expansion of the local economy, and has the numbers to back it up.
As a percentage of the state’s total labor force, health care represents 9.3 percent, slightly higher than the national figure of 9 percent. “Health care is a huge part of [the state’s] economy in terms of employment,” he said.
An estimated 10.3 percent of the state’s GDP is spent on health care. While the New England average is slightly less, the national average is 17.6 percent, according to Medicare figures. “It is almost a $3 trillion industry, the largest sector of the economy; it used to be defense,” he said, during a panel discussion at Bryant’s third annual Rhode Island Economic Conference held March 13.
According to the U.S. Bureau of Labor Statistics, the health care industry is the fastest-growing and largest field of employment in the nation. Employment in all areas of health care, from positions ranging from physician’s assistants to diagnostic managers of new technology is expected to experience a 16 percent growth rate across the nation until at least 2018.
And Rhode Island stands to benefit, he said.
Rhode Island utilizes the same percentage of physicians per 1,000 people as the rest of
New England – 3.6 – a figure well above the national average of 2.6. However, New England as a whole employs considerably more physician assistants on a percentage basis, 0.39 per 1,000 people, than Rhode Island or the rest of the nation, both at 0.27 per 1,000. “A lot of states have filed for accreditation of educational programs to train for physician assistants and there is a huge backlog,” Mirmirani said. “That’s a huge market.”
And “health care informatics is going to be one of the top career choices nationally,” he said. Informatics, or the managing of information, is a result of the new and continuously expanding field of health-information technology.
“If there is any hope for generating new jobs for Rhode Island, it will be in the area of informatics and medical managers,” he said.
Fellow panel members Christopher F. Koller, the state’s health insurance commissioner, and Lt. Gov. Elizabeth H. Roberts acknowledged the growing need but were more cautious about job creation. Both are members of the Rhode Island Healthcare Reform Commission, formed in January 2011 to evaluate options for job growth as well as better and more affordable health care. “It is really hard to speak of health care as an engine for economic development on one hand, then complain about our insurance premiums on the other,” Koller said. “How do we improve the value of health care in Rhode Island so that it becomes an economic incentive for companies to move and invest in the Ocean State? What parts of health care have the potential to spur economic development?”
All of the panelists agreed that the landscape of the health care industry is shifting away from the traditional health care management foundation. Rather than treat illnesses, more focus is now on prevention.
According to Dr. Michael Fine, director of the Rhode Island Department of Health, many medical procedures have moved from an inpatient to an outpatient setting. The prevention of diabetes is entirely outpatient and surgeries once performed in hospitals are now performed in communities. “The hospital sector, obviously, is shrinking as hospital jobs are disappearing, but the number of health care jobs in communities is growing,” he said.
“The health care jobs of the future will be in community health centers and primary-care practices, in free-standing surgical centers and in free-standing oncology centers, dialysis centers and free-standing specialty groups,” Fine said.
He envisions that every community of 10,000 to 15,000 people will have a multidisciplinary, primary-care facility that will provide 90 percent of the services that are needed, using teams of professionals from almost all health care disciplines.
“Rhode Island has the opportunity to do that, to lead the region and the nation in the development of an educational process to train these teams,” he said. “Rhode Island has the opportunity to develop and then market these organizational and data-management tools in order to support the work of these community-based, multidisciplinary teams,” he said. Fine also pointed to the field of electronic health-information medical records and the developing statewide medical-information exchange. “We as a state aren’t there yet but we’re making progress. If we can get there first – and I think we can – the rest of the country will beat a path to our door looking to buy the technology and the approaches we will be developing,” he said.
Roberts agreed. “Health care information technology is an enormous infrastructure investment that will be worth every penny if we take advantage of it,” she said. “It’s going to be worth so much in research and so much in managing our health care system more effectively.
“And it’s not just about patients, it’s about pre-patients and how we keep them from being patients,” she said. “It’s also about the statistics and how we can impact our own health as well as improving our health care delivery system.”
She said that investing in prevention strategies will provide additional opportunities for job growth. Research is also an economic driver, as is the advancement and development of technology experienced in Providence’s Knowledge District. Roberts also believes that biomedical-research investments might be a longer-term solution with a greater payback.
The changing nature of the industry is being reflected by the economic difficulties currently being faced by the state’s hospitals. “The hospital structures in our state, pretty much uniformly, were built around the health care needs of two-to-four generations ago and not the health care needs of us, our children or our future,” she said. “They have been anchored in a reimbursement and delivery-system structure that does not meet the needs of the community they are serving anymore.”
People now travel for health care, she said, and overall hospital visits have been declining. According to the Hospital Association of Rhode Island, the state’s hospitals as a whole lost money in 2011. “If you were running them as a business there are probably more of them that could be closed than are closed right now,” Roberts said. •

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