For-Profits Specialize in Healthcare Fields, but Not the Ones Most Needed

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Training students to fill jobs in the so-called allied health professions – a category that includes scores of occupations other than doctor, dentist or pharmacist – is a primary attraction of many for-profit colleges. But a new report by the Center for American Progress found that most of the jobs for which they train students are at the lower end of the health career ladder, and often in areas where there soon could be a surplus of workers.

Rather than training students to become registered nurses, an occupation forecast to need more than a million new workers in the next decade, the for-profit schools are turning out mostly medical assistants and massage therapists, jobs for which there are nearly enough workers to fill the current needs. While nonprofit and public schools produced 150,000 new registered nurses in the 2008-09 school year, for-profits graduated 11,000 registered nurses, many of whom were already licensed and returned to school to earn their bachelor’s degree.

The report, Profiting from Health Care: The Role of For-Profit Schools in Training the Health Care Workforce by Julie Margetta Morgan and Ellen-Marie Whelan, explores the way that students at for-profit colleges might be nudged into the more-needed fields of healthcare, which also pay significantly more.

But first, the authors said, the for-profit schools need to be persuaded to provide the more expensive training required for students in high-level fields, not just the online classes that allow licensed nurses with an associate to upgrade to a bachelor’s. New nurse training programs – and others for technical professions such as radiological technologists and technicians – need to permit students to advance in their fields, meaning the programs need to be accredited by the agencies appropriate to the various fields.

That way, for example, a licensed practical nurse would be able to go on to a bachelor’s without having to repeat courses. Currently, credits and degrees or certificates from for-profit schools are not accepted by public and nonprofit institutions.

Many of the additional health professionals will be needed because of the new Affordable Care Act (assuming it is not repealed), which is predicted to cover 34 million more Americans in the coming decade. The greatest needs will be in the number of home health care aides, who care for the elderly and disabled in their own homes and in care-giving facilities and need little or no postsecondary training , and those who treat patients, including not only physicians and registered nurses, but also licensed practical nurses, licensed vocational nurses and dental hygienists, among others.

Getting more 'bang for the buck'

Speaking at a forum this morning at the Center for American Progress, Morgan said there needs to be better information for students to decide whether the higher costs usually associated with for-profit colleges are worth it. For example, she said, not only do students need to know completion or graduation rates for a program, they need to know what percentage of graduates passed the corresponding licensure examinations and whether graduates were satisfied with their training.

A comparison of tuition costs among public, nonprofit and for-profit schools found rather comparable costs for four-year programs – the for-profit tuition ranked between that of public and nonprofit private schools. Costs were substantially higher at for-profit schools for two-year and certificate programs, the ones that account for most of the for-profit healthcare students.

Despite the discrepancies, students choosing these lower paying occupations are flocking to for-profit schools and paying premium prices. The for-profit schools graduated most of the medical assistants (88 percent) in 2008-09 and nearly all of the massage therapists, according to the report.

“This is, of course, no surprise because the for-profit colleges tend to focus on certificate-level programs and less education generally corresponds to lower wages. But given the price of the programs at for-profit colleges one must wonder whether it is possible to give students a little more ‘bang for the buck,’ ” the authors wrote.

The researchers recommend several ways to get more higher-level health professionals from the for-profits, including extending so-called SMART grants to students pursuing degrees in high-wage, high-demand health care occupations. (SMART grants are available to students studying math, science and technology.)

They also recommend that students receive much more help and counseling when considering their choice of career and college, so that they don’t spend too much money on courses that lead only to low-paying jobs and as a way to lead them into the more needed health care jobs.

Panelist Kevin Kinser, a professor at SUNY Albany, suggested this is a “great opportunity to use the carrot approach” rather than the stick against for-profits to get them to increase the number of students training to be the higher-level health workers.  

Another panelist, Jeff Strohl, research director of Georgetown University’s Center for Education and the Workforce, said that the ability of for-profits to make changes quickly to conform to workforce demands could prove to be an asset in shifting toward the more needed, higher-level health care training.

But panelist Tim Bates, of the Center for Healthcare Professions at the University of California-San Francisco, noted that there are also constraints on the schools in terms of accreditation and being able to provide the clinical work needed for those fields – not just the online instruction in which they specialize.