When news broke on the same day last month that both Hahnemann University Hospital and the Philadelphia Energy Solutions (PES) refinery were going to shut down, putting 3,500 people out of work, some said the hospital workers had it better.
"Health care workers are in really high demand, so I don’t imagine it’s going to be as hard for those folks to find jobs as it might be for the refinery workers,” Jeff Hornstein, executive director for the Economy League of Greater Philadelphia, told PlanPhilly. “The [health-care workers’] employment future is pretty bright.”
The refinery workers are indeed in a bleak spot, as there are just 1,500 of those jobs in the region, most of them at the South Philly-based PES, while the health-care sector employs in one in five workers in Philadelphia and added nearly 2,600 jobs — the most of any industry — from 2013 to 2016.
But even in a growing industry, not all jobs are equal.
“The idea that workers won’t take a hit because the industry is growing just isn’t true,” said Rosemary Batt, a professor at Cornell University’s School of Industrial and Labor Relations, who coauthored a 2017 study about the changes in the health care industry and its effect on workers.
The growth in health care is not in hospitals
“Hospital jobs are the premium jobs in the industry,” said Cheryl Feldman, executive director of the District 1199c Training and Upgrading Fund, which is affiliated with the union representing Hahnemann workers and runs workforce training programs.
Many of these jobs — nurses, nursing assistants, housekeepers, patient transporters — are union jobs, like those at Hahnemann. They pay at the top of the pay scale and they have strong benefits, including access to training that can get people better jobs.
But hospital jobs, which make up one-third of the health-care jobs in the region, aren’t growing: Over the last decade, hospitals added about 125 jobs each year — less than 1 percent annual growth, according to an Economy League analysis of state data. That’s due in part to the fact that hospitals around Philly and across the country have been merging. The health-care industry is trying to shift care out of hospitals, Batt said, because it’s more expensive to deliver care that way.
The health-care jobs that are growing are in fields like home health care and urgent care, and they pay much less. They’re generally not unionized, in part because these facilities are much smaller and siloed (although an organization called the United Home Care Workers of Pennsylvania is organizing workers to get them more rights and training — something anti-union groups have been fighting). Those facilities are also newer, as opposed to Hahnemann, which has been unionized since the 1970s.
Aside from lower pay and worse benefits, they can also be dead-end jobs, said Batt, because these facilities tend to be flatter, without much opportunity to advance.
Not all hospital jobs are the same
There are “professional” workers, such as doctors and nurses, who have a high level of education and command high salaries. Then there are social service workers and medical technicians, who get paid slightly less. At the bottom of the pay scale are service workers — about 700 of the 2,500 losing their jobs at Hahnemann — such as nursing assistants, housekeepers, and food service workers. Low-skill health-care jobs have seen the most growth annually, adding 1,425 jobs a year between 2006 and 2016, according to the Economy League analysis.
Yet, Feldman said that service workers without credentials — a bachelor’s degree or a nursing assistant certification — will have the hardest time finding a comparable job. The demand for service workers in outpatient clinics such as urgent care centers is low because they’re not housing patients for long periods of time. Many of those clinics don’t have cafeterias.
If Hahnemann closes, Feldman’s Training Fund, along with publicly funded workforce organizations like Philadelphia Works, will offer training to workers in specialized health care fields including “supply processing and distribution," or sterilizing equipment, and pharmacy tech to give them a better chance at a job.
Even though professional workers won’t have as hard a time finding comparable employment, they might have to take temp or part-time work, which usually lacks benefits and security. (You may remember the emergency room doctors at three Philly-area hospitals employed by a staffing agency that last year had their contracts suddenly terminated and lost six weeks of pay.)
Another benefit nurses stand to lose, if they move to a nonunion hospital, is the ability to speak out about working conditions, said Eileen Appelbaum, codirector of the Center for Economic and Policy Research in Washington, who coauthored the health-care labor study with Batt. One of the most important things to nurses is staffing levels, so being able to raise those concerns effectively and without retribution is important.
Even Hornstein, the Economy League head who said Hahnemann’s workers would land on their feet, conceded in an interview that they might not be compensated as well in their next jobs.
“That’s on the labor movement to a degree," said Hornstein, a former union organizer, "to raise standards for those workers.”