Chapter 5: Analysis of Licensed Health Care Occupations

by: Matthew Halama, Economist

About the Data in this Chapter | Appendix Tables

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The research presented in this chapter will describe to potential workers, employers, and the general public how licensed health care occupational staffing levels, hours worked, and demographics have changed between 2010Q3 to 2015Q3 in Wyoming. This chapter pays particular attention to the urban/rural distribution of health care workers with implications for the availability of health care services for an aging rural population.

The information discussed in this article is presented in terms of persons working who were licensed for a particular occupation.

As discussed in Chapter 2 of this publication, an aging population requires more health care services. This chapter follows up on that by looking at the demographics of persons working in licensed health care occupations in Wyoming.

Research and Planning (R&P) compared the age distribution of individuals who were licensed to work in health care occupations and who were paid wages for 2010Q3 and 2015Q3, as well as the median wages and median hours worked of licensed occupations in urban and rural counties within different industries in 2015Q3. Industries are defined by the North American Industrial Classification System (NAICS).

This research is a first among labor market information shops in the country and in doing this research, R&P is laying groundwork that can be replicated and improved upon.

Literature Review

In 2016, the state of Wyoming published a new Unified Plan in accordance with the Workforce Innovation and Opportunity Act (WIOA), which is intended to promote national economic growth by improving employment, training, and education programs in the U.S. (State of Wyoming, 2016). The Unified Plan contained a sector analysis of health care & social assistance (NAICS 62), among other industries. The analysis included employment projections, demographic information, occupational breakdown, replacement need, and future influences on the health care & social assistance industry. A replacement need analysis in the Unified Plan listed the total number of persons working and those ages 55 and older in licensed health care occupations working in health care & social assistance in 2014Q3.

As noted in the Unified Plan (p. 15), health care & social assistance has a high percentage of workers age 55 and older (21.4%) and a high percentage of workers with a bachelor’s degree or higher (31.2%). At the occupational level within health care & social assistance, counselors, all other (SOC 21-1019) had the highest proportion of individuals ages 55 and older (36.8%) among licensed health care occupations in health care & social assistance, followed by physicians and surgeons, all other (SOC 29-1069) at 34.4%, and licensed practical & vocational nurses (SOC 29-2061) at 33.3% (State of Wyoming, 2016, p.31).

Methodology

As previously discussed in this publication, wage records represent an individual’s wage history based on employers’ quarterly wage and employment reports to the Unemployment Insurance (UI) tax section of the Wyoming Department of Workforce Services. For the research presented in this chapter, R&P was able to utilize its Wage Records database in order to determine the number of persons working in Wyoming in 2015Q3 and calculate the median wages and hours worked. Additionally, by linking wage records to health care files obtained through memoranda of understanding with Wyoming’s state licensing boards¹, R&P was able to gain an understanding of how the distribution of Wyoming’s health care delivery system changed from 2010Q3 to 2015Q3.

The distributions of licensed occupations were created by linking wage records with state licensing data. By using employer location and weekly hours worked, R&P can compare total employment and hours worked between urban and rural areas in Wyoming. The U.S. Census Bureau defines rural as all population, housing, and territory not included within an urbanized area or urban cluster. Urban areas are defined as areas with 50,000 or more people, and urban clusters are areas with at least 2,500 but fewer than 50,000 people (Ratcliffe et al., 2016). The U.S. Bureau of Labor Statistics defines a micropolitan area as one or more urban clusters with a population of at least 10,000 but less than 50,000 (Helmer 2008). For the purposes of this research, R&P used the Census Bureau’s definition of rural combined with Bureau of Labor Statistics definition for urban cluster; a list of Wyoming’s counties based on rural and urban designation is presented in Table 5.1.

One important distinction should be noted before reading the results presented in this chapter. Table 5.4 and Table 5.5 include the possibility that an individual can work in both a rural and urban area by having multiple jobs. The sum of urban and rural areas by occupation may not necessarily equal the statewide total, since individuals statewide are counted once. For the tables illustrating employment distribution percentages, the numbers for both urban and rural are summed, which would be equal to or larger than the statewide number because some are employed in both areas, but this method will still give a percentage equal to 100.

Results and Discussion

As shown in Table 5.2, the total number of persons working in licensed health care occupations in Wyoming increased from 15,725 in 2010Q3 to 17,558 in 2015Q3 (1,833, or 11.7%). It is important to note that Table 5.2 shows licensed health care occupations across all industries, not just in health care & social assistance; for example, nurses can work in schools. The largest increase in the number of persons working was seen in registered nurses, from 4,899 in 2010Q3 to 5,625 in 2015Q3 (726, or 14.8%). The greatest decrease was seen among nursing assistants (CNAs), from 4,323 in 2010Q3 to 4,149 in 2015Q3 (-174, or -4.0%). Physicians and surgeons, all other, increased 42.4% (78 individuals) from 184 to 262. Physicians and surgeons, all other, are those with specialized medical training, such as cardiologists or neurosurgeons.

While employment in licensed health care occupations increased overall, the statewide distribution of licensed health care occupations between urban and rural areas was relatively unchanged between 2010Q3 and 2015Q3. In 2010Q3, 74.5% of licensed health care occupations were found in urban areas, compared to 75.4% in 2015Q3. Likewise, the proportion of licensed health care occupations found in rural areas was largely unchanged, from 25.5% to 24.6%.

The change in the gender composition of licensed health care occupations was negligible between 2010Q3 and 2015Q3. In 2010Q3, females comprised 83.1% of the licensed health care workforce; by 2015Q3, that number declined slightly to 82.6%. The percentage of males in licensed health care occupations increased slightly, from 16.9% to 17.4%. Furthermore, there was little change in the gender ratio for urban and rural areas. Males made up 17.4% licensed health care occupations in urban areas in 2010Q3 compared to 17.6% in 2015Q3, and 15.4% in rural areas in 2010Q3 compared to 17.6% in 2015Q3.

Table 5.3 shows the employment distribution of licensed health care occupations specifically in health care & social assistance (NAICS 62). Statewide in 2015Q3, registered nurses accounted for 34.9% of all licensed health care occupations in health care & social assistance, while CNAs accounted for 23.1%, and licensed practical & vocational nurses accounted for 4.5%.

Health Care in Urban and Rural Areas

Table 5.4 details selected licensed health care occupations in health care & social assistance (NAICS 62) in urban and rural areas as well as statewide in Wyoming in 2010Q3 and 2015Q3. In 2015Q3, the majority of workers in licensed health care occupations were employed in urban areas (N = 10,550) compared to rural areas (N = 3,358). The median hourly wage was higher for workers in urban areas ($25.09) than in rural areas ($24.16). The median hours worked were also higher for those in urban areas (492) compared to rural areas (473). In some instances, however, wages were higher for individuals in rural areas; for example, the median hourly wage for pharmacists in rural areas was $66.47 compared to $53.07 for pharmacists in urban areas.

Figure 5.1 shows registered nurses made up a greater proportion of all licensed health care occupations in urban areas in Wyoming in 2015Q3, while CNAs made up a greater proportion in rural areas. Registered nurses made up 36.4% of all licensed health care occupations in urban areas, compared to 30.5% for rural areas. By comparison, RNs made up 27.5% of all licensed health care occupations in rural areas, compared to 21.7% in urban areas.

Figure 5.2 shows the median hours worked for registered nurses and CNAs in urban and rural areas in Wyoming in 2015Q3. The median number of hours worked for registered nurses in urban areas was 512, compared to 474 in rural areas. The difference in the median number of hours worked for CNAs in urban (440) and rural (430) areas was much less pronounced.

Table 5.5 shows the change in the number of persons working in licensed occupations in health care & social assistance in rural and urban areas from 2010Q3 to 2015Q3. The greatest percentage changes among rural health care workers were physicians & surgeons, all other (92.9%); speech-language pathologists (67.7%); counselors, all other (47.0%); physical therapists (45.7%); and surgeons (42.9%). Many of these large percentage changes were due to a small number of licensed health care occupations in rural areas; for example, the 92.9% increase in physicians & surgeons, all other, represented a growth of 13 individuals, from 14 in 2010Q3 to 27 in 2015Q3.

In urban areas, the greatest increases from 2010Q3 to 2015Q3 were seen in physical therapist assistants (57.5%); counselors, all other (53.6%); social workers, all other (44.9%); and radiologic technologists & technicians (35.8%).

Older Workers in Health Care

As discussed in Chapter 2, the median age of Wyoming’s population remained unchanged at 36.9 from 2010 to 2015, due to an increase in the number of millennials and a decrease in the number of baby boomers. The median age for Wyoming’s health care workforce decreased from 41 in 2010Q3 to 40 in 2015Q3, according to state licensing board files. Some licensed health care occupations, however, have a relatively large proportion of individuals ages 55 and older who will reach the traditional retirement age of 65 within the next 10 years, which could complicate Wyoming’s health care delivery system.

Table 5.6 and Figure 5.3 show a distribution of licensed health care occupations in which individuals ages 55 and older made up at least 25% of total licensees in 2010Q3 and 2015Q3. In 2015Q3, for example, nearly half (47.1%) of all psychiatrists licensed and working in Wyoming were ages 55 and older. Other licensed health care occupations with a high percentage of individuals ages 55 and older included substance abuse & behavioral disorder counselors (44.0%), surgeons (39.1%), and pediatricians, general (38.8%). One in four individuals licensed and working in the occupations in Table 5.6 and Figure 5.3 will reach the traditional retirement age of 65 within the next 10 years.

As previously discussed in Chapter 2 and shown in Table 2.3 of this publication, a greater proportion of adults ages 55 and older reside in smaller, rural counties. In many licensed health care occupations in Wyoming, the proportion of individuals ages 55 and older is quite different between rural and urban areas. As shown in Table 5.7, in rural areas in Wyoming, the licensed health care occupations with the greatest proportion of individuals ages 55 and older were physicians & surgeons, all (other 53.6%); surgeons (53.3%); and pediatricians, general (50.0%). By comparison, in urban areas in Wyoming, the licensed health care occupations with the greatest proportion of individuals ages 55 and older were substance abuse & behavioral disorder counselors (47.3%), marriage & family therapists (41.5%), and psychiatrists (40.0%).

Conclusions: Changes in Health Care Delivery

Wyoming’s health care workforce has grown over the last five years. From 2010Q3 to 2015Q3, the total number of individuals working in licensed health care occupations in Wyoming increased from 15,725 to 17,558 (1,833, or 11.7%; see Table 5.2).

The structure of health care delivery in Wyoming has changed from 2010Q3 to 2015Q3. The percentage of those obtaining educational awards in Wyoming has grown since 2010, and more individuals are completing high school and obtaining postsecondary certificates and undergraduate or graduate degrees (Halama, in press). As noted in Chapter 1, Wyoming subsidizes undergraduate nursing and faculty advanced degree education through the Wyoming Investment in Nursing (WyIN) program. These factors may explain in part the increase in the number of registered nurses in Wyoming (643 individuals, or 15.5%) from 2010Q3 to 2015Q3, compared to the decline in licensed practical & vocational nurses (-73, or -10.6%) and CNAs (-148, or -4.5%; see Table 5.3).

As mentioned in Chapter 2 of this publication, the number of primary care physicians has declined nationally, as more medical students choose to specialize in areas that lead to higher wages. This correlates to changes seen in Wyoming’s health care delivery system from 2010Q3 to 2015Q3. For example, the number of family & general practitioners increased moderately (11 individuals, or 5.9%) while the number of physicans & surgeons, all other, increased at a greater rate (64 individuals, or 35.6%; see Table 5.3).

Wages for licensed health care occupations tend to be higher in urban areas compared to rural areas. A shortage of certain health care occupations in rural areas may result in higher health care costs. In addition, a greater demand for services in urban areas may lead to more hours worked compared to rural areas. In other occupations where wages tend to be higher in rural areas than urban, such as pharmacists, individuals may be older and have more experience, which may lead to higher wages.

In addition, individuals working in urban areas tend to work more hours than those working in rural areas. With the varying populations of each county, individuals working in licensed health care occupations in urban areas may have the opportunity to work more hours because of the additional services offered to larger communities.

Some licensed health care occupations are predominantly held by females, such as dental assistants, CNAs, licensed practical & vocational nurses, and registered nurses. Other licensed health care occupations tend to be more male dominated, such as surgeons, physicians, and anesthesiologists.

A greater proportion of adults ages 55 and older reside in smaller, rural counties compared to larger, urban counties. Consequently, a greater proportion of individuals ages 55 and older work in some licensed health care occupations in rural areas. Rural areas will need to address the potential labor shortages as older workers reach the traditional retirement age of 65 and leave selected occupations.

References

Halama, M. (In press). Beveridge curve analysis of Wyoming.

Helmer, G. (2008, April). Micropolitan Statistical Areas: a few highlights. Retrieved March 22, 2017, from https://www.bls.gov/opub/mlr/2008/04/art4full.pdf

Ratcliffe, M., Burd, C., Holder, K., & Fields, A. (2016, December). Defining rural at the U.S. Census Bureau. Retrieved March 22, 2017, from http://www2.census.gov/geo/pdfs/reference/ua/Defining_Rural.pdf

State of Wyoming. (2016, October 2016). WIOA State Plan for the State of Wyoming. Retrieved April 10, 2017, from http://wyowdc.wyo.gov/unified-state-plan-1

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¹ These memoranda of understanding are available at http://doe.state.wy.us/LMI/education_we_connect.htm#mou.