According to U.S. government projections, employment of health care practitioners is projected to increase 14 percent through 2028, adding about 1.9 million new jobs. The U.S. Department of Labor also says that many of the fastest growing occupations are concentrated in the health care industry. By 2028, employment of home health aides is expected to grow by 37 percent, personal care aides by 36 percent, physical therapist assistants and aides by 26 percent, medical assistants by 23 percent, and medical and health service managers by 18 percent. Employment of medical secretaries will grow by 16 percent. There may be a general perception that careers in health care require advanced education; however, most jobs require less than four years of college.
Employment growth for physicians is expected to be faster than average, at 7 percent. More doctors will be needed because the population is both growing and aging and because government legislation may help millions in the United States obtain health insurance. Also, many new technological improvements require the expertise of greater numbers of medical specialists. However, the need for primary care providers will be far greater than the need for medical specialists. Job prospects will be best for those working as nursing aides, home health aides, orderlies and attendants, and pharmacy technicians. As the population continues to age, opportunities in gerontology, home health care, and nursing and residential care will increase due to families being less able to care for elderly relatives.
Since managed-care programs are growing because of their cost efficiency, employment opportunities in hospitals are expected to decline, especially in administrative and support jobs. Some observers expect that consolidations and closings will reduce the number of community hospitals by as much as 10 percent. Remaining hospitals are likely to cut costs, reduce staff, curb the use of advanced technologies, encourage outpatient care, and reduce paperwork. In the next decade, most health care workers will be employed in some kind of corporate, group, or network environment.
One of the fastest growing job categories in the industry is home health care. Home health care workers include nurses, physical therapists, and consultants, as well as lower paid workers who cook, clean, bathe, and dress homebound patients, such as the elderly and disabled.
Opportunities are excellent for nurse practitioners and physician assistants, too. They will begin to assume many of the functions of primary care physicians in the next few years, including taking patient histories and making preliminary diagnoses. Nurse practitioners are in very high demand, with 28 percent employment growth projected between 2018 and 2028. Physician assistants will experience even stronger growth (31 percent) during the same timeframe.
The employment outlook for all kinds of nurses is very favorable. Many hospitals don't have enough nurses; the demand is bigger than the supply. Also, as health care services expand, even more nurses will be needed. The U.S. Department of Labor included nurses on its list of the fastest growing occupations through 2028, forecasting employment growth of 12 percent.
The employment outlook for physical therapists is also excellent through 2028, at 22 percent. Occupational and physical therapy are expected to remain among the top growth careers in the United States. Other health care jobs with a promising outlook include dental assistants and hygienists, cardiovascular technologists, emergency medical technicians, and respiratory therapists.
A major influence on the future of health care will be the Patient Protection and Affordable Care Act (ACA), signed into law by President Obama in March 2010. The ACA, the first comprehensive health reform in the United States in decades, is purported to make health care more affordable and accessible for all Americans. One of its goals is to benefit those who lack health insurance through an employer or are pushed out of the health insurance market due to the high cost of buying private insurance or because of pre-existing medical conditions that leave them uninsurable by giving them access to insurance plans through federal- and state-backed health insurance marketplaces. Enrollment in those plans began on October 1, 2013, with the new insurance coverage taking effect on January 1, 2014. The rollout of the new law suffered online difficulties, delays, and other chronic problems, but the government reported meeting its initial goal of 7 million enrollees in the first year. The Department of Health and Human Services reported that, as of March 2016, more than 20 million people obtained health insurance through a provision of the ACA such as signing up through a Marketplace or remaining on their parents health plan.
By the end of 2016, though, new problems emerged with the ACA plan. Citing rising costs and loss of profits, many insurers withdrew from the marketplace, leaving customers in some regions with only a single option for a provider. While the ACA enabled millions to purchase insurance, it also contributed to increased rates for some previously insured customers. Lastly President Obama's oft-cited promise that those who liked their current doctors would be able to keep them after implementation of the ACA proved false as changes to plans and markets deprived some insured of their regular physicians.
The ACA remains a divisive topic. In November 2016 Donald Trump was elected as the next president on a platform that included repealing the ACA. Critics of Trump warned against losing some of the protections provided by the ACA, such as making it illegal to deny insurance to individuals with preexisting conditions. They also expressed worry that the 20 million newly insured might lose their benefits. Despite efforts to repeal the ACA and replace it with the American Health Care Act of 2017 (AHCA), the new legislation lacked Republican support and was withdrawn. However, the financial penalties for not having health insurance, as required by the ACA, were removed beginning in 2019 per the Tax Cuts and Jobs Act, which Congress passed in December 2017. At the beginning of 2020, it appeared that health care legislation would remain a hotly debated topic leading up to the 2020 presidential election and beyond.
The coronavirus pandemic had a tremendous impact on the health care providers industry. In 2021, the Biden administration reversed the course by the previous administration on health services and issued executive orders that expanded the ACA coverage and strengthened Medicaid, in response to the pandemic. Health care providers have worked collaboratively to help accelerate the vaccine development and distribution, which occurred in early 2021. The changes that public and private health systems have had to make and adapt to during the pandemic are expected to continue post pandemic. The pandemic has accelerated changes in the health care industry. Deloitte reports in an article that examples of the shifts that have arisen in the industry due to COVID-19 include: "consumers' increasing involvement in health care decision-making; the rapid adoption of virtual health and other digital innovations; and unprecedented public-private collaborations in vaccine and therapeutics development." An American Medical Association article foresees that residents and fellows entering the health care field in the next few years may be more involved in telemedicine than before the pandemic, and there will be increased demand in specialties such as emergency medicine, critical care, pulmonology, infectious disease, and "the burgeoning field of 'COVID hospitalists'."