In many – if not most – communities across the United States, large health systems have increasingly become centers of job growth and economic development. Many cities and towns have watched manufacturers leave their communities, often taking with them “good jobs” that used to be available to their working-class residents.
Health systems have now replaced manufacturers as leading employers in town, but what kinds of jobs does the health sector provide for the working-class? We know that the health sector provides high quality jobs for workers with advanced degrees, such as physicians, pharmacists, and administrators. But does the health care sector provide “good jobs” for men and women without a college degree?
Jobs in the health care sector for non-college workers include direct care occupations like nursing assistants, home health aides, personal care aides, as well as middle-skill occupations that require additional training and more specialized skills, such as surgical technicians, ultrasound technicians, or associate-level registered nurses.
Most occupations within the health care sector that are filled by workers without a college degree are heavily gendered, meaning they are filled primarily by women. In fact, over 25% of women without a college degree are employed in the health care industry. The other major employers of women without a four-year degree are the retail and food service industries.
On the other hand, only about 5% of non-college men work in the health care sector; instead, the manufacturing and construction industries remain the largest employers of working-class men, but the percentage of men employed in these blue-collar industries is declining over time.
In a recent study published in Social Science Research, my co-author Melissa Hodges and I looked at job quality in the health sector as compared to other leading employers of working-class men and women, including food service, retail, manufacturing, and construction. In particular, we wanted to know whether the health care sector was replacing the “good jobs” that manufacturers have traditionally provided for the working-class.
What is a “good job?” Job quality can involve personal preference; for example, you might want a job that involves a lot of personal interaction, physical activity, or working with numbers. However, Arne Kalleberg argues that there are critical and necessary components of “good jobs,” including compensation and benefits, control over schedule and autonomy in job tasks, and job security. In other words, a job can’t be a “good job” unless it has these job qualities. In our study of the health care sector, we focus on four of these job characteristics: decent wages (especially on whether workers make at least $15 per hour), employer-based health insurance, fulltime hours, and protection from layoff.
We find that whether the health care sector is a source of “good jobs” depends very much on whether you are a woman or a man.
For women without a college degree, the health care sector is more likely to provide “good jobs” as compared to the other two most common alternatives for working-class women: retail and food service. Women employed in the health care sector have higher wages, are more likely to have employer-based health insurance and to work fulltime hours, and are less likely to be laid off. For example, about 25% of working-class women in the health care sector earn at least $15 per hour, as compared about 10% in retail and 5% in food service.
For working-class men, however, the health care sector is not a source of “good jobs,” despite that men have better job quality in the health care sector as compared to women. For example, the predicted wage for men in the health care sector is just over $14 per hour as compared to $13 per hour for women. However, when we compare men’s wages in health care ($14 per hour) to wages in manufacturing and construction, which are around $16 and $17 per hour, respectively, health care falls behind. Around 45% of men in the health care sector earn at least $15 per hour, but over 60% of men in manufacturing and construction earn at least $15 per hour. Given these wage differences, it is not surprising that so few working-class men are working in the health care sector.
However, when we compare men’s wages in health care ($14 per hour) to wages in manufacturing and construction, which are around $16 and $17 per hour, respectively, health care falls behind. Around 45% of men in the health care sector earn at least $15 per hour, but over 60% of men in manufacturing and construction earn at least $15 per hour. Given these wage differences, it is not surprising that so few working-class men are working in the health care sector.
That said, the health care sector does provide some advantages for men. The health care sector was protective of jobs during the Great Recession, and men working in health care were far less likely to be laid off as compared to manufacturing and especially construction. Jobs in the health care sector are also more likely to provide employer-based health insurance as compared to construction. So working-class men face a trade-off: they can earn higher wages in manufacturing and construction, but they will have greater job security and potentially better fringe benefits in the health care sector. Given the low percentage of men working in the health care sector, it seems clear that at this point working-class men are choosing blue-collar work and higher wages.
Low- and middle-skill health care jobs are among the fastest growing occupations in the United States. The New York Times has been providing excellent reporting on these female-dominated care work occupations and the loss of blue-collar jobs, and The Atlantic has asserted that these jobs are “the new steel.” How do health care jobs compare to the manufacturing jobs that they are replacing? The majority are filled by women, and for women, health care jobs are “good jobs.” But they don’t replace the wages and job quality provided by manufacturing. Instead, the growth of the health care sector is contributing to growing economic strain within working-class families. More specifically, in light of recent economic patterns, our findings suggest that dual-earner working-class households may continue to experience downward mobility in household income as more stable, “good jobs” for women continue to pay less on average relative to men’s more contingent blue-collar work.
The health care sector – which is now the largest employer in the United States – needs to take greater responsibility for promoting the economic wellbeing of working-class families by improving job quality for its lowest earners. A recent report by the Institute for Women’s Policy Research gives a number of recommendations for improving the wages of non-college, female-dominated health care occupations, including increasing Medicaid reimbursement rates for long-term care services where there is a concentration of the poorest paying jobs. The report also recommends that there needs to be policy changes to make it easier for health care workers to organize and demand better pay and working conditions through unionization. And finally, beyond raising wages, implementing clear career ladders within health care organizations and organizational resources for education and training can also help support worker mobility and career advancement.
Janette Dill and Melissa Hodges. “Is health care the new manufacturing? Industry, gender, and “good jobs” for low- and middle-skill workers.” Social Science Research 2019.
Image: Truckee Meadows Community College (CCA 2.0 Generic)