From 2000 to 2011, the number of workers in 10 large health care occupations who had less than a bachelor's degree surged 46%, vs. 39% growth for all health care jobs, the study says.
Health care workers with less than a four-year degree make up 61% of the industry's 12.1 million employees. Their growth can partly be traced to the need to more quickly turn out health workers to serve an aging population, says Brookings fellow and study co-author Martha Ross.
The findings have significant implications for a U.S. labor force that has grown increasingly polarized between high-wage and low-wage jobs, with the number of middle-income jobs shrinking in recent years. A sizable share of employment growth during the recovery has been in low-wage sectors, such as fast food and retail, whose workers have staged protests to demand higher pay and more consistent hours.
The health care industry can help bridge the divide between low- and high-paying jobs.
"It can provide people with lower levels of education a career ladder and a path toward upward mobility," Ross says. For example, nursing assistants can rise to become registered nurses.
Education and earnings levels for health care jobs vary widely. About half of diagnostic technicians and registered nurses have either associate degrees or some college, and their median annual salaries are the highest, at $52,000 to $60,000.
Licensed practical nurses, emergency medical technicians, paramedics and dental assistants typically have some college and earn $30,000 to $40,000.
Personal care aides and home health aides generally have high school diplomas and the lowest salaries — $21,000 to $25,000.
The bulk of the job gains for less educated health care workers has been among positions paying $30,000 or less, such as personal care aides, nursing aides and medical assistants.
The study recommends that such workers be utilized to a far greater extent, especially under a new health care law designed to increase efficiency and lower costs. For example, home health aides can be trained to monitor patients' conditions, enter electronic medical data and even do some health coaching, Ross says. The added duties, she says, would bring higher pay.
Similarly, medical providers and states should promote more team-based care that hands a bigger role to lower-level health workers and allows doctors to focus on specialized services.
Metro areas with the highest share of health care jobs filled by less educated workers — 58% to 72% — include: Modesto, Calif.; Lakeland, Fla.; Dayton, Ohio; and El Paso. Such areas typically have fewer medical schools and teaching hospitals and require a less educated and specialized workforce, the report says.