So-called midlevel health-care occupations are in many respects today’s equivalent of the factory jobs that once vaulted millions of Americans into the middle class. Positions such as EMT, physical therapist assistant, phlebotomist, and paramedic pay decent wages — about $50,000 on average a year. They are secure even in tough economic times and provide a springboard to the middle class for the two-thirds of Americans who lack four-year college degrees.
Midlevel workers are also essential to a well-functioning health-care system — as became apparent during the pandemic. A new report by my organization, Opportunity America, explored how these workers fared in New York City during the health crisis. Our principal findings: They played a critical part in the response and remained in high demand through the pandemic — demand that will likely persist and grow as technology advances and the population ages.
Looking to the future, tasks such as driving ambulances, recording vital signs, and measuring and administering medications are nearly impossible to automate, which means these jobs aren’t likely to be taken over by new technology.
But unlike the factory jobs of the past, these occupations require at least some post-high-school training, often a certification for entry-level positions and an associate degree or more to move up the ladder. Such educational requirements can pose major obstacles for midlevel health-care workers, many of whom can’t afford to take time off for extra schooling or must juggle job demands with caring for their families. Without help, many have difficulty climbing further — and some may never get a chance to enter the field.
The needs of these workers should be a priority for grant makers interested in work-force development, but many foundations lack a clear understanding of how best to support them. Philanthropy can play several roles.
Support training. Would-be midlevel health-care workers usually start at a trade school or community college, taking courses that range from two weeks to a semester and typically culminate in occupational certifications that lead directly to the labor market. After a few years on the job, many workers seek to advance from, say, EMT to paramedic, or from medical assistant to phlebotomist to licensed practical nurse. But they often have trouble finding training, paying for it, and making the most of it to advance in their careers.
In most places, a patchwork of funding is available to help cover tuition costs. But like any patchwork, this fabric is often riddled with holes, and many workers struggle to pay for the training they need.
This can be especially hard for those seeking entry-level training. Students enrolled in unaccredited trade schools and nondegree community-college programs are ineligible for federal Pell Grants or loans. Government job-training programs can help. But the public work-force system is woefully underfunded, and students holding down jobs to make ends meet while they train often earn too much to be eligible.
Workers seeking midcareer training can sometimes turn to their employers or a labor union, and a growing number of hospital systems pay generous tuition reimbursement. But many, especially smaller employers, do not, and workers are often stymied by other, nontuition costs: They lack money for child care or transportation or can’t afford to set aside time for the unpaid internships or clinical placements required for many training programs.
Philanthropy can help but only if donors rethink their approach. Many already offer scholarships, but like federal financial aid, most are for students seeking academic degrees, which are of little use to people who need short, nondegree training.
New York’s LaGuardia Community College has pioneered a different model. Spurred by the pandemic, the college foundation, which raises $3 million a year for traditional academic scholarships, took on a new challenge: raising another $500,000 to cover tuition for students in a wide range of short, job-focused programs. In just a few months, the foundation raised $400,000, and it is now considering an annual commitment.
Few programs of this kind exist elsewhere, but philanthropists in other cities could help create them. The design need not be complicated — just a standard scholarship with somewhat different criteria.
Help schools align programs with labor-market needs. Like all industries today, health care is changing rapidly. Workers at every skill level, not just doctors and nurses but also medical assistants and building maintenance personnel, need IT skills. Openings for telemedicine techs exploded during the pandemic, and physical-therapist assistants are in ever-growing demand as the population ages.
But all too often, the training available at a local college or trade school lags so far behind the changing industry that graduates can’t find jobs or lack the skills they need to succeed at work. Faculty don’t talk to local employers or don’t keep up with changing technology. Other educators, focused more on academic success than employment outcomes, don’t heed the labor market signals telling them to open, close, or revamp programs. For years before the pandemic, hospitals in New York City faced a shortage of respiratory therapists but couldn’t persuade enough colleges to offer training — a failure that weighed heavily when the virus struck.
While a growing number of educators recognize the need for better labor-market alignment, they lack the up-to-date labor-market data to track job demand in their communities. The services that provide these data are expensive and out of reach for many institutions. Grant makers can help institutions pay for data or, better still, help them build their own in-house labor market information research centers.
New York State’s Monroe Community College, for example, created a state-of-the-art research hub that synthesizes data on job openings and wages with information about demand provided by employers, then compares this with the number of workers already being trained for in-demand positions in the region. The college then uses this information to tailor programs that match local demand with a robust supply of appropriately trained workers. Few philanthropic investments are likely to pay off better for students or the regional economy.
Encourage collaboration. Philanthropy can play a crucial role by helping connect the dots between educators, employers, and other service providers to make sure their efforts reinforce rather than duplicate each other.
There are countless ways to help. For instance, grant makers could fund colleges to hire instructors with industry work experience and contacts at local companies. They could bring together leaders at high schools, colleges, and community-based organizations to collaborate on a work-force training plan. And they could fund campus-level efforts to ensure that students who return to college later in life get credit for their prior learning.
When this type of coordination happens, training providers get input from employers so that students graduate with the skills they need. Trusted community organizations work with community colleges to help students navigate the often intimidating college experience. Community colleges collaborate, rather than compete, with government work-force training programs. And education and training institutions of every stripe work together to create jo- training ladders so workers don’t waste time and money repeating courses and relearning skills as they advance.
In spring 2020, when the coronavirus first terrorized the nation, thousands of Americans dropped whatever they were doing in the early evening and went to their windows to cheer for health-care workers — shouting, clapping, and banging pots and pans. During those tragic months, midlevel health-care workers were the glue that held the health-care system together. Now, as the pandemic subsides, we need to give them the support they need to acquire skills, advance in their careers, and help the rest of us stay healthy.
