Although this line of work probably interests you because of its humanitarian and service aspects, the industry as a whole—hospitals, nursing homes, home health care, specialized clinics, and nontraditional options such as homeopathic treatment—is all business these days. That said, the business of health care is booming. In 2002, it’s expected that the U.S. will spend a whopping $1.37 trillion on health care—almost 14 percent of the gross domestic product.

The health care industry provides diagnostic, healing, rehabilitation, and prevention services for the injured, ailing, incapacitated, and disabled. The individual physician is its first line of contact with consumers. However, the health care organization—the hospital or health management organization (HMO)—is the conduit of insurance payments, which form the preponderance of the industry's, and the physician's, revenues. The lion's share of these revenues comes from employee health insurance plans, Medicare (health insurance for Americans over the age of 65), and Medicaid (health insurance for Americans on welfare). Health care organizations, except for county hospitals, are usually run for profit. This creates tension between doctors who want to prescribe expensive treatments and diagnostic tests and health care organizations, which want to cut costs.

There are an abundance of opportunities for people interested in health care—whether or not you have an MD (or even a bachelor's degree). As of December 2001, more than ten million people nationwide worked in the health care service industry. That number will only rise as people are living longer and needing more preventative and long-term care. The demand for health care workers is expected to grow faster than the average rate of increase for all other occupations until 2010. Statistics indicate a growing need for home care aides, registered nurses, physician assistants, nurse practitioners, physical therapists, nontraditional health aides, and physicians. Not to mention all of the technical and administrative jobs that are in high demand as hospitals focus their energies on efficient management and profitability.

Trends

Cost Tensions
There are some major tensions in the industry between forces that want to lower costs and forces that have the effect of raising costs. On the one hand, payers (primarily insurance companies, HMOs, and the government) have reduced their reimbursements for various medical services, and health care providers have become much more careful about disbursing services. On the other hand, there are new drugs and new procedures that can help patients like never before, political pressures to treat patients better via better medical care and patient privacy, and a tremendous labor shortage (primarily of nurses and medical technicians), which health care organizations are trying to address—all of which costs money. In addition, an aging Baby Boomer population is making for greater demand than ever for quality medical care. Managing these tensions is a key issue for the industry these days.

Cardiac Care
One of the areas of the industry with the most impressive advances in recent years has been cardiac care. Advances in products like defibrillators and artificial hearts have made cardiac care more effective than ever before. Companies like ZOLL Medical, Cardiac Science, ABIOMED, and World Heart are among those that focus on making these kinds of devices.

How It Breaks Down

Hospitals
Despite the increased outsourcing of medical records, housekeeping, lab testing, and clinical services like orthopedics and radiology, hospitals are still the biggest employers in the health care industry. The huge networks such as HCA and Tenet need a steady supply of doctors, nurses, administrators, medical technicians, therapists, and other support staff. In areas where competition from HMOs is mounting and cost cutting is a priority, former staff may move outside the immediate confines of a hospital. However, close and important links remain—particularly for any type of surgery or specialized treatment like chemotherapy.

HMOs and PPOs
Health maintenance organizations and preferred provider organizations are hybrids between a hospital and an insurance company. Each type of managed care plan covers primary care visits, preventative services, and copayments for prescription drugs, while only PPOs allow the enrollee to choose his or her physician (HMOs maintain a list of plan-approved doctors). Some of the largest organizations actually have their own medical staffs and facilities at which they treat patients; smaller ones may just access networks of private providers and hospitals. Competition is fierce in this arena—mergers, acquisitions, and internal strife often destabilize the job market. Coventry, Humana, Harvard Pilgrim Health Care, Group Health Cooperative, and Pacificare (one of the leading Medicare HMOs) are a few of the better-known players.

Specialty Providers
As hospitals have attempted to cut costs, they have turned to firms that can provide specialized services at rock-bottom prices. These include everything from nursing homes (Beverly Enterprises) to home infusion therapy providers (Apria Healthcare) to diabetes treatment providers (American Healthways). Clinics that focus on special treatments such as chemotherapy, MRIs, and other scanning techniques, and physical therapy for the handicapped are also proliferating. Most are small and locally run, but Gambro and Fresenius Medical Care are two enormous service companies that focus on this type of care; more will undoubtedly emerge as their popularity increases.

Home Care
Advances in technology have done much to improve efficiency and reduce costs for both patients and home care staff. Today, home care nurses and aides can administer complex treatments, previously only available in hospitals or clinics, to the elderly and severely disabled in their own homes. And because almost all hospitals and HMOs now release patients before they are self-sufficient, home care is often the most viable choice. Most jobs in this sector don't require much training (they are closely supervised by an RN, NP, or physician), just deep reserves of patience and kindness. But the pay is low—often under $10 an hour—and the work is arduous. The rewards? Hours are extremely flexible, and there is plenty of personal contact with clients.

Job Prospects

There are several types of health care professionals requiring varying levels of education and training. Registered nurses (RNs) are trained at the undergraduate level, while nurse practitioners (NPs) have gone on to specialize at the master's level within the nursing field. Physician assistants (PAs) are licensed to practice medicine with physician supervision. Doctors of osteopathy and medical doctors both complete four years of post-graduate work to earn the titles of DO and MD, respectively, as well as the right to prescribe medicine and perform surgery.

Some of the biggest growth opportunities are expected for personal and home care aides, home health aides and nurses, and physical therapists and their assistants. To qualify for some positions (including doctor, nurse, tech, and others), you need technical training, and to land a job you often need a strong network in a given area and practical experience in the industry.

Vacancy rates for RNs, pharmacists, and radiological technicians continue to rise, and employers are looking at ways to attract people to these in-demand professions by offering signing bonuses, tuition reimbursement or loan repayment, flexible scheduling, and incentives for voluntary overtime shifts. But even with these improvements, it takes considerable time to train and educate new nurses, so if you’re looking for a job now, you have some serious leverage.

The HMO segment offers jobs in management as well as medicine—particularly if you understand IT and data system development. As a job seeker, you should know that HMOs have been the catalyst for many of the efficient business practices imposed on all aspects of health care in recent years, and technical and administrative support are in high demand as the health care industry evolves in a competitive market. Health care IT is a steadily growing sector, due to the industry's relative lack of IT investment thus far.