The coronavirus pandemic and subsequent public health response have led to extraordinary job loss in the United States. From February through May 2020, overall employment decreased 13% as roughly 20 million people lost work.
This chart collection examines where changes in healthcare employment have been concentrated and what these changes might tell us about short-term health spending. While the health sector has typically been insulated from job loss during periods of economic recession, the current economic downturn is unique in that it is driven by a pandemic. Out of concern that hospitals would be overwhelmed by COVID-19 cases and that staffing and supplies would be limited, non-emergency, elective, or routine medical services were delayed or cancelled. Additionally, out of concern of contracting the virus, some people went without medical care they might otherwise have received. As a result, healthcare revenue fell sharply in March and April, and more than 1.5 million healthcare jobs were lost from February through April 2020. Health services recovered more than 300,000 jobs in May, mainly in dental offices, but employment in certain healthcare settings continued to decrease.
Employment in healthcare settings decreased drastically from February through April, but rebounded slightly in May
Healthcare employment decreased 7.8% in April 2020 compared to April 2019. As shown by an Altarum analysis, healthcare employment decreased 9.5% from February through April 2020, as more than 1.5 million healthcare workers lost their jobs.
The healthcare sector added 312,400 jobs in May, but overall healthcare employment remained 6.0% lower than the same point in 2019. This drop in employment was less than that of non-healthcare sectors, which decreased 12.4% in May 2020 compared to May 2019. However, this contrasts with the three most recent recessions, when the healthcare sector continued adding jobs despite significant drops in employment in the rest of the economy.
Because health employment has dropped less than employment in other sectors, healthcare workers now account for a larger share of the employed workforce than they did a few months ago (from 10.8% in February up to 11.5% in May). Importantly, these employment numbers do not account for people whose hours were cut or pay decreased, rates of which could differ across sectors.
Ambulatory healthcare settings experienced sharper job losses through April, but were the only settings to begin recovering jobs in May
Pandemic-related job loss among healthcare workers has been primarily concentrated in office-based settings. Of the 1.5 million healthcare jobs lost from February through April, 521,000 (35%) were among staff in dental offices. However, dental offices recovered 245,000 jobs in May, which accounts for roughly half (47%) of the dental jobs lost since the start of the pandemic, 78% of all healthcare jobs added in May, and 10% of total jobs added in May. Dental offices were particularly hard hit since most practices were only seeing emergency patients and many others had closed entirely in order to avoid transmission of COVID-19 and conserve personal protective equipment. In May, many dental offices began to reopen or increase their patient load, however, overall employment at dental offices remained 30% lower than in February.
Combined, workers at physicians’ offices (-11%; -290,000 jobs) and the offices of other healthcare practitioners (-24%; -233,000 jobs) accounted for another third (32%) of total healthcare jobs lost from February through April. However, physicians’ offices experienced a 2% increase in employment in May, and the offices of other health practitioners also saw a 10% increase in employment. Hospitals (-2%; -122,000 jobs) and nursing and residential care facilities (-4%; -123,000 jobs) had relatively fewer job losses through April, but were among the few settings to continue losing jobs in May.
Recent changes in healthcare employment were proceeded by decreases in health spending
Overall, health services spending decreased 16% from February to March 2020. With the exception of hospitals, health services with larger decreases in spending in March experienced steeper drops in employment through April. Of health services, the sharpest decreases in personal consumption expenditures from February to March were for dental services (-31%), which saw the steepest decreases in healthcare employment through April (-56%). Hospital employment decreased only 2% from February through April, despite a 15% decrease in expenditures on hospital services. Nursing homes were the only service category for which expenditures did not decrease from February to March, yet employment at nursing homes decreased 4% from February to April.
Changes in healthcare employment may provide insight into national health spending
A previous KFF analysis outlined the ways in which COVID-19 could drive national health spending up or down. Recent spending and employment figures further indicate which areas of the health system might affect national health spending in 2020. On one hand, hospitals represent a large share of health spending (33% in 2018), so relatively small percentage point drops in employment (-3% since February) could nonetheless correspond to a substantial drop in current health spending. Comparatively, dental employment dropped steeply but dental services accounted for just 4% of national health spending before the pandemic. One-fifth (20%) of national health spending goes towards physician and clinical services, which have seen an 8% decrease in employment since February. It is likely that national spending on many services will be lower than expected through the second quarter of 2020, but pent up demand may lead to increased expenditures on services in the future.
Changes in healthcare employment vary geographically
Not all areas of the country have experienced the same degree of healthcare job loss, which could be driven by differences in coronavirus cases, local responses, economic circumstances, and other factors. Local area data for the month of May are not yet available, but healthcare employment in Washington, D.C. decreased 13.8% from February through April. New York City (NYC), the epicenter of the pandemic in the U.S., also experienced a sharper decline (-10.8%) in healthcare employment than the national average (-9.5%). In comparison, healthcare job losses in the Los Angeles (-8.3%) and Phoenix areas (-8.5%) have been a bit lower than the national rate. New York City and Washington, D.C. have much higher rates of COVID-19 cases per capita than Phoenix and Los Angeles, and yet the former two cities have seen steeper drops in healthcare employment so far during the pandemic.
Ambulatory health services have seen the sharpest declines in employment across metropolitan areas
Ambulatory healthcare services, including offices of physicians, dentists, and other health practitioners, saw the steepest drops in employment across all areas. From February through April 2020, employment in ambulatory healthcare settings decreased 20.7% in D.C., 16.1% in NYC, 15.3% in the Los Angeles area, and 13.2% in the Phoenix area. Employment in nursing and residential care facilities fell more sharply in D.C. (-8.8%) and NYC (-7.4%) than the Los Angeles (-1.0%) and Phoenix areas (-4.3%).
Unemployment among healthcare workers has risen more sharply among women than men
Women have endured more job loss in the healthcare sector since the start of the pandemic. For context, women make up three-quarters of the healthcare workforce and an even greater share of lower-paid positions. From May 2019 to May 2020, the unemployment rate among women who normally work in hospitals increased from 1.4% to 3.7%, which was roughly equivalent to the increase for men over the same period (0.8% to 3.2%). However, the unemployment rate for women who normally work in non-hospital healthcare settings increased from 3.0% to 11.2%, much higher than the rate increase for men (1.7% to 6.8%).
Decreases in healthcare employment during the early months of the pandemic reflect the sizable drop in healthcare utilization and revenue. Dental services and office-based physician and clinical services have been particularly hard-hit by recent job loss, which correspond with sharp decreases in expenditures for these services. These settings, however, were the first to begin recovering jobs in May as social distancing began to ease and their patient loads gradually increased. Notably, nursing care facilities and hospitals continued to lose jobs through May. The long-term impacts on health spending and employment are uncertain, as it remains to be seen when and where healthcare utilization will pick up.
The Peterson Center on Healthcare and KFF are partnering to monitor how well the U.S. healthcare system is performing in terms of quality and cost.