The respiratory therapists, dressed in blue scrubs, have gathered near the patient. One measures breathing with a stethoscope, others monitor the heartbeat on the screen.
The students are just days from graduating but on this day they’re not treating an actual patient. The Community College of Allegheny County has sent out a photographer to capture what it’s like to be in the lab — in an effort to help pitch the program to new students.
Education and medicine, or “eds and meds,” have been heralded for fueling the Pittsburgh region’s economic renaissance. At a critical time in public health, enrollment is plummeting in programs like the respiratory therapy one, which had only half as many students in 2020 as in 2018. Across the community college’s allied-health programs, enrollment fell by nearly 6% during that same period.
The future rests on training new workers for those careers and drawing new people into them. Across the country, there’s a 98,700-person shortage of medical and lab technicians, according to reports. And, keeping the people who are already in those and other allied health jobs is a challenge, too.
In Pittsburgh, more than 90% of hospital workers thought of leaving the profession, according to a recent survey by the University of Pittsburgh. Hospital workers who participated in the study reported insufficient staffing, mental and emotional exhaustion, and a need for better wages.
For many people the jobs can pay off, but not always. The careers that fall under the allied health umbrella are varied, requiring different levels of education. They’re sometimes little known, often undervalued, and — in the midst of the pandemic — increasingly difficult to fill.
The last couple of years have exacerbated the supply and demand challenges in the health-care field, but they’ve been brewing for much longer, says Ray Engel, a professor of social work at the University of Pittsburgh who has spent the past five years researching the working conditions of hospital workers.
“People appreciate the roles that healthcare systems are playing in changing what Pittsburgh looks like,” he said, transforming it from an industrial town over the past 20 years to one driven by educational institutions and healthcare settings. “There’s a general sense of value to that work.”
But, he added, people haven’t appreciated many of those jobs, and the people doing them, enough. “We find it ironic that it was only with the pandemic that people started to see, particularly lower wage workers, as suddenly essential.”
Many careers, many outcomes
One of the biggest draws for programs in allied health has been the promise of available jobs and solid salaries. Some deliver on those promises — others fall short.
Allied health covers a wide range of jobs: nursing assistants, respiratory therapists, massage therapists, medical insurance billers, and surgical technologists among them. Just as varied as the jobs, though, are the pay and working conditions.
For respiratory therapists? On average, they earn $72,295 per year in Pittsburgh after an 18 month-program. That’s well over Pittsburgh’s median household income of $55,500.
For people working in diagnostic, intervention, and treatment care, salaries tend to be closer to $46,000 two years after graduation. But students who pursue clinical or medical lab programs earn almost exactly the same as the average high-school graduate without a college degree: $26,000.
Prospective students should do thorough research on program costs and labor market outcomes, said Shalin Jyotishi, a senior policy analyst for New America, a national public policy organization on issues like health or education.
Students can rely on resources such as College Scorecard, a database supported by the U.S. Department of Education that offers an overview of costs and debt for students or look over salary estimates published by the Bureau of Labor Statistics.
“Really look at the pay for these occupations,” he said. “How does it stack up at the local living wage? How does it compare with other jobs that you can get for a similar amount of time and money investments?”
But both colleges and healthcare employers also need to do more to make sure students can truly benefit from training programs, Jyotishi said. For example, he said, colleges should offer stackable credentials so a student could build the groundwork for a career and then also have the chance to return for more training that could lead to better jobs with higher pay.
Hospitals and other healthcare providers should work to improve job quality, he said, by offering workers schedule flexibility so they have time to pursue more credentials or other skill-based training, good compensation, and resources for mental health – especially as the pandemic adds stress to their jobs.
In April, Pittsburgh’s incoming mayor assigned a task force to examine why hospital workers were leaving their jobs. The study conducted surveys and interviews of more than 2,000 healthcare workers to hear their stories and experiences.
Hospital workers are under a lot of strain, said Jeff Shook, a University of Pittsburgh professor and researcher who has studied hospital conditions for the past five years. Those who stayed cited deep care for their patients.
But the layered problems, some of which existed pre-COVID, makes it challenging to stay. It also begs the question of what could happen to a city now centered so much around health care.
“Everyone is going to need health care,” Shook said. “If we have a workforce that is so strained and unable to do what they want to do, it is going to affect everyone in the city.”
Chasing enrollment
Colleges and hospital systems in Pittsburgh are scrambling to respond, devising new ways to draw students.
“It’s really a crisis. It’s a crisis in the respiratory therapy profession in Pittsburgh, and also across the country,” said Richard Laurent, the director of respiratory therapy at CCAC.
Across the country, he said, there has been a 27% decrease in enrollment in respiratory therapy programs. Yet, jobs in respiratory therapy are expected to increase by 23% by 2030.
Student interest is down from pre-pandemic levels for many health-care programs across Pittsburgh, often regardless of their return on investment in terms of pay and employability. Take Pittsburgh Technical College’s programs that train surgical technologists, for example. It’s a job with an average salary of $51,575 in Pennsylvania and one that’s in high demand. But interest in the college’s program has dropped.
On top of the general pandemic challenges, Laurent says his program — which has seen interest “wax and wane” over time — suffers from a general lack of awareness of the job.
At CCAC, there were 13 students in 2020, down from 29 in 2019 and 26 in 2018.
The job prospects are there, and the need for more workers is growing.
Laurent tells students that if they finish the program, they’ll have a job within two years and can work in various types of hospital settings like critical care or pediatrics.
Colleges are trying numerous approaches to draw students. Pittsburgh Technical College’s recruitment team is going out to more high schools to talk to students about programs like surgical technology.
CCAC is partnering with hospital systems, in part, to showcase potential students the job opportunities. Late last year, for example, CCAC announced multiple partnerships with systems like UPMC or Allegheny Health Network with the respiratory program and another health-care program, radiology.
Students who sign up for the program receive $6,000 in tuition assistance. The college requires $122 per credit hour but the hospital partnership will pay half. They are also guaranteed a position at the hospital and a sign-on bonus.
Ultimately, though, the challenge of the labor market may be hard for some of these college programs to overcome.
“We desperately need great allied health workers,” Jyotishi of New America said. “It’s an essential job, but unfortunately right now we do not compensate our essential workers the way we should and lots of folks are advocating for change.”
What it will take
If allied health fields are going to shore up the city’s economy, colleges are going to have to find more people like Andrea Gelotti.
For years, she was already working in Presbyterian Hospital taking patient orders and putting together patient meal trays as a food service employee. She ended up talking to respiratory therapists at the hospital and realized she wished she had a job she could be passionate about because she was saving lives.
“They loved their job and I felt like I could make a difference in people’s lives,” she said, adding that the demand for respiratory care also interested her.
She enrolled at CCAC in the 18-month respiratory program, which she completed while still working full time and taking care of her son. After graduation in 2019, she got a different job at Presbyterian Hospital.
But instead of food service, where she was earning $16.50 an hour, she’s working as a respiratory therapist, earning a starting hourly wage of $19.54 and helping patients in the intensive care unit breathe a little easier.
Naomi Harris is a national reporter for Open Campus, a nonprofit newsroom focused on higher education that partners with PublicSource. This story was supported by the Higher Education Media Fellowship at the Institute for Citizens & Scholars. The Fellowship supports new reporting into issues related to postsecondary career and technical education.