Massage Therapists or R.N.s

New report argues for-profit sector is not producing the kinds of health care professionals that are really needed.
January 21, 2011

WASHINGTON — Lobbyists for for-profit colleges talk frequently about the role their institutions play in educating health care professionals. But a Center for American Progress report issued Thursday finds that, while these colleges are producing lots of graduates, the graduates aren't in the specific fields that address the country’s top health care needs.

Julie Margetta Morgan, report co-author and policy analyst at the think tank, noted at a discussion Thursday that for-profit education’s largest contribution to the health care workforce are graduates in medical assisting. The next largest health care program in the for-profit sector is massage therapy. Of all the health care credentials awarded at for-profit institutions in the 2008-09 academic year, 78 percent were at the associate level or below.

“For-profit colleges tend to focus on health care ‘support’ occupations like medical assisting, massage therapy, and dental assisting rather than ‘practitioner’ or ‘technical’ health occupations like registered nursing, medicine, or diagnostic technologist fields,” Morgan said. “Though health care support occupations are growing, the field is less than half the size of the health care practitioner and technician group. And health care support jobs tend to be lower paying than practitioner jobs.”

Given these realities, Morgan noted, not-for-profit institutions are doing most of the work to address the country’s projected health care workforce needs. For example, not-for-profits train 93 percent of registered nurses, 80 percent of licensed practical nurses and 89 percent of nursing aids. Still, Morgan argued that if the country's health care needs are ever to be met, the for-profit sector is needed.

“We should be maximizing all available resources as we work to get more students into college and more workers into jobs,” Morgan said. “For-profit colleges are part of the arsenal of resources to meet the growing demand in health care fields. We can begin to think about how to maximize their impact while minimizing any negative impact on students by shedding light on how they operate in the health care sphere.”

In addition to giving students more information about health care fields and programs — such as making it clear that they are likely to make less as support staff than as practitioners — Morgan advocated remedying the mismatch between supply and demand in the for-profit sector by “incentivizing [both for- and not-for-profit] schools to offer and students to choose health career programs” in high-demand fields. For example, she suggested expanding the U.S. Department of Education’s National Science & Mathematics Access to Retain Talent (or SMART) Grant program, which gives additional funds to those already receiving Pell Grants if they choose certain majors, to include “high-wage, high-demand health care occupations.”

A panel of academics responded to the paper at the discussion, most questioning how to encourage the for-profit sector to train more students in high-demand fields. And while they agreed that the sector produces too many entry-level support staffers when the health care system needs more practitioners, they did offer some defense of the current role the sector plays in workforce training.

Kevin Kisner, a professor of educational administration and policy studies at the State University of New York at Albany who studies for-profit education, noted that caution must be taken when comparing the output of health care professionals from the relatively small for-profit sector and the much larger not-for-profit sector.

Tim Bates, program analyst at the Center for Healthcare Professions at the University of California at San Francisco, noted that policy makers should exercise caution in how they try to encourage for-profit institutions in what types of health care professionals to train.

“We could go overboard in demonizing for-profits,” said Bates, noting their role in educating low-income and minority students. “Over-regulation may limit access to people.”

No representatives from the for-profit sector were part of the official discussion and response period at the event. Still, a number of sector advocates and institutions responded to the report.

Anthony Bieda, spokesman for the Accrediting Council of Independent Colleges and Schools, a body that accredits many for-profit institutions, said he was pleased to see the report acknowledge the “key role” the for-profit sector plays “in meeting the workforce needs relative to allied health fields.” Still, he did have some reservations about its conclusion that the sector needs to expand its educational offerings.

“It argues that if the for-profit schools want to demonstrate a higher level of relevance to society they should have greater capacity to train tech folks and practitioners,” Bieda said. “Still, one of the considerations that they should have is, who is going to be left to educate for these entry-level jobs?”

Kent Jenkins, spokesman for Corinthian Colleges, which runs institutions offering allied health programs, said his institutions are simply sticking with the programs they know well. “We have nursing programs, but numerically we do offer more medical assistant and pharmacy tech programs,” Jenkins said. “We’re not saying that we don’t want to offer degrees in those other areas, but we’ve had great success in helping people [in support fields]. This is, historically, our strength.”

The Association of Private Sector Colleges and Universities (formerly known as the Career College Association) issued a white paper Thursday “to clarify certain statements in the CAP report” and “to address points on which it disagrees,” mostly characterizations and implications found within.

"We are taking the opportunity in the CAP report to say to our harshest critics and our staunchest allies alike: let us work together as fellow educators — whether at non-profit, public, and for-profit institutions — to find the best way forward in meeting the nation's education and workforce goals,” wrote Harris Miller, APSCU president, in a statement. “Our schools are playing an integral role in delivering health care in America, and in increasing jobs in the sector. The sooner we recognize the importance of private sector schools to our nation's future, the sooner we can move forward to help creating more jobs and delivering better health care."


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