Perspective: 2021 Health Employment—A Tale of Three Settings 

The January jobs report gives us our first look at calendar year 2021 health care employment. According to the Current Employment Statistics, or “establishment” survey, health care employment increased very slightly in 2021, ending the year up 0.4%, or 63,000 jobs compared to December 2020.

Beneath this modest overall growth there was a marked shift from institutional settings to ambulatory care settings. Jobs in ambulatory settings such as provider offices, clinics, labs, and home health grew by 3.1% in 2021, while jobs in hospitals fell slightly by 0.6% and jobs in nursing and residential care fell substantially by 4.7%. In terms of numbers of jobs, ambulatory care settings added 242,000 jobs, hospitals lost 33,000 jobs, and nursing and residential care lost 146,000 jobs.

Where is the growth in ambulatory care jobs occurring?

Within ambulatory care, more than three-quarters of the jobs added in 2021 were in offices of physicians, dentists, and other health care practitioners (Figure 1), which grew by 2.6%, 5.1%, and 7.3%, respectively. Outpatient care centers, which includes multi-specialty clinics, urgent care centers, and ambulatory surgery centers, added fewer jobs and grew more slowly in percentage terms, as did home health. Medical and diagnostic labs added 14,000 jobs, only 6% of the growth in ambulatory care, but a 4.7% growth rate as this is a smaller setting.

Figure 1. Growth in 2021 employment by ambulatory care setting

As seen in Figure 1, the setting “Offices of Other Health Care Practitioners” has grown at the fastest rate in 2021, at 7.3% over the year. Establishment survey data allow us to go one level deeper into this setting, with data through November 2021. As we see in Figure 2, more than half the jobs added in this setting were in offices of physical therapists, occupational therapists, and speech therapists/audiologists. 

Figure 2. Growth in 2021 employment through November in Offices of Other Health Care Practitioners

How does employment through 2021 compare to pre-pandemic levels?

Comparing employment at the end of 2021 to employment prior to the COVID-19 pandemic, the story varies similarly by setting of care (Figure 3). Overall health employment remains below where it was in February 2020. As of December 2021, health employment is 450,000 jobs, or 2.7%, below the pre-pandemic peak. As shown in Figure 3, jobs in ambulatory care settings fell steeply by 17.1% early in the pandemic but were only 2.2% below the pre-pandemic level in December 2020 and had fully recovered in 2021 to end the year 0.8% above the pre-pandemic level. Jobs in hospitals fell more modestly, by 2.5% early in the pandemic, but have only partially been regained. Hospital employment was 1.2% below pre-pandemic levels at the end of 2020, and with modest losses in 2021, ended the year 1.8% below the level of February 2020. (Note that these data represent jobs directly employed by hospitals and do not reflect the industry-reported increased use of contract or temporary workers). The vast majority, more than 90 percent, of the reduction in health care employment since the start of the pandemic is in nursing homes and other residential care settings. Employment in these residential settings continues to fall, and is down 420,000 jobs, or 12.4%, since February.

Figure 3. Cumulative Job Growth Since February 2020 (pre-pandemic peak)

How does employment through 2021 compare to where it might have been without the pandemic?

We compared employment in each of the major health care settings through 2021 with an estimate of where employment would have been if the pre-pandemic trend had continued. The graphs below (Figures 4, 5, and 6) show actual employment as a solid line and a continuation of the trend line fitted through the monthly 2019 data as a dotted line. While we’ve noted that jobs in ambulatory care settings have recovered to just above the pre-pandemic peak, we can see from Figure 4 that prior to the pandemic employment in these settings had been steadily growing. We estimate that employment in ambulatory care would have been higher by 406,000 jobs, or 5.1%, if this historical trend had continued through the end of 2021. 

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Figure 4: Ambulatory care employment compared to continuation of pre-pandemic trend 

Hospital employment was also growing prior to the pandemic, but more modestly than employment in ambulatory care settings. Combined with the fact that hospital jobs have not yet returned to pre-pandemic levels, we estimate that employment in hospitals would have been higher by 212,000 jobs, or 4.1%, by the end of 2021 if the historical trend had continued. 

Figure 5: Hospital employment compared to continuation of pre-pandemic trend 

Finally, employment in nursing and residential care was close to flat prior to the pandemic, with a slow decline in jobs in nursing homes offset by slow growth in other residential care. Employment in both nursing homes and other residential settings fell and has continued to fall steadily since the start of the pandemic. Had the historical trend continued through 2021, we estimate that employment in nursing and residential care would have been higher by 457,000 jobs, or 15.5%.

Figure 6: Nursing and residential care employment compared to continuation of pre-pandemic trend 

While employment in each of the three major health care settings is below the projected trend, there are interesting exceptions by sub-setting. Consistent with the ambulatory care setting as a whole, employment in physician offices, outpatient care centers, and home health is below the projected trend by 4.8%, 5.8% and 7.4%, respectively. Even offices of other health care practitioners, which we saw had the fastest rate of job growth among ambulatory care settings in 2021, shows employment 6.9% below where it would have been if the pre-pandemic trend had continued. However, employment in dental offices, despite a large drop early in the pandemic, has recovered in both level and trend, is now within 1% of where jobs would have been under a continuation of the historical trend (Figure 7). 

Figure 7: Dental office employment compared to continuation of pre-pandemic trend

What’s Next?

The February jobs report, due to be released on Friday, February 4, 2022, will incorporate revisions to the December 2021 estimates as well as the annual benchmark revisions to the establishment survey. Data by detailed industry sub-setting, such as that shown in Figure 2, will be available through December 2021. We will revisit the story told in this blog with the updated data and go deeper into calendar year 2021 trends by sub-setting in a February blog.