The U.S. Health Resources and Services Administration projects a shortage of 20,400 primary care physicians by 2020.

Opportunity Knocks

Among the ACA's many changes, new career opportunities in occupational health are emerging.

Nearly every trend in occupational health and safety (OH&S) right now can be traced back to one source: the Affordable Care Act (ACA). One of the most impactful and controversial pieces of legislation in recent memory has been rewriting every level of the American health care system. Some 20 million more patients have gained insurance through the ACA, and new mandates are driving employers to take greater responsibility for their workers’ health. This growing volume of patients and the different directives for employers alone are fundamentally changing the roles of physicians, nurse practitioners (NPs), and registered nurses (RNs) in the industry.

But as the ACA's temblors are felt from hospitals to businesses, new opportunities are arising. Organizations are scrambling to address new mandates through health and wellness programs tied closely to the occupational health field. Long a crucial player in the health of organizations, OH&S is transitioning to a more proactive role with a different makeup of professionals and a new set of demands. At the same time, shifts in the profession are placing OH&S talent at a premium, and creating new avenues for OH&S professionals to advance their careers if they make the right moves today.

A Trillion-Dollar Issue
Employee health and productivity are inextricably linked. Employers lose about $1 trillion annually due to absenteeism, lost productivity, and workers' comp claims. Workers' comp claims alone are a drain on many companies' bottom line; the total cost of workers' comp benefits for employers rose to $77.1 billion in 2011, according to the National Academy of Social Insurance. Claims complicated by a secondary illness nearly tripled from 2000 to 2009, and those secondary claims cost twice the comparable initial claims.

In addition to the high cost of workers' comp, the ACA's mandates are forcing new introspection in many organizations around employee health and well-being. Many employers have long been reactive, dealing with workplace accidents or repetitive stress injuries as they arose. But as the cost of health care and workers' comp rises and the ACA holds more employers accountable for employee health, organizations are increasingly stepping out in front of any potential health issues and taking a more proactive approach to health and wellness.

A range of programs are flooding into businesses to educate employees, influence behavior, and incentivize healthy lifestyles. As of 2013, about half of employers with 50 or more employees had a wellness program in place. These programs include everything from smoking cessation programs to fitness campaigns and weight loss initiatives to assistance managing and controlling diabetes. Some organizations are so serious about employee health that they're setting up new obstacles to hiring, including two hospitals in Philadelphia that started refusing to hire smokers.

Two of the most popular and most impactful health and wellness programs are focused on smoking cessation and weight loss, both of which have proven their effectiveness. According to a report co-sponsored by the U.S. Department of Labor and the U.S. Department of Health and Human Services, smoking cessation programs can decrease the smoking rate of participating smokers by nearly 30 percent compared to non-participating smokers after just one year. Programs designed to improve nutrition and control weight are significantly associated with a drop in body mass index (BMI). These programs can "help contain the current epidemic of lifestyle-related diseases, the main driver of premature morbidity and mortality in the United States," and the potential health care savings of both programs, and many others, is only garnering them more attention.

New Surge in Demand for OH&S Professionals
Of course, OH&S professionals are behind every one of these programs, driving new awareness and action among employees to improve their health. But just at the moment of greatest need for OH&S talent, many of the best professionals are harder and harder to come by.

Precipitated by an aging workforce approaching retirement and the dearth of occupational health programs at many universities, the shortage in OH&S talent is a growing issue. According to the Centers for Disease Control and Prevention's 2011 National Assessment of the Occupational Safety and Health Workforce, only 2,800 new OH&S professionals graduated at the bachelor's degree level and higher in 2011. In the years leading up to 2017, just under 13,000 OH&S professionals will be entering the workforce. Yet employers are expected to hire more than 25,000 OH&S professionals between 2012 and 2017. That's a 52 percent surge over the 48,000 professionals already at work and 12,000 more than are expected to be available.

Complicating the issue further, health care professionals will see more demand for their services across the board as millions of Americans gain insurance through the ACA and add to the number of patients under the care of physicians. The ACA's goal of improved care and reduced costs will worsen the vast primary care physician shortage over the next decade as the new law goes into effect and transforms primary care services and the future of health care hiring. The U.S. Health Resources and Services Administration projects a shortage of 20,400 primary care physicians by 2020.

Many organizations are looking to staffing providers to source and hire these essential but difficult-to-find professionals as the talent pool dries up. To fill these roles, staffing providers and organizations are shifting their search to a different set of qualifications that’s not only a good fit for OH&S, but is increasingly valuable for the health care industry at large.

The Rise of the Nurse Practitioner
The expected shortage in physicians is already shifting attention to NPs, who can perform many of the functions of a doctor but are easier to find and less costly to retain. In my experience sourcing professionals for OH&S jobs all across the country, I've seen firsthand the changing direction of talent needs. Five years ago, some 60 percent of the positions we filled in OH&S went to RNs or physicians. Today, about 90 percent are filled by NPs.

This transitioning model is transforming the occupational and medical clinics that handle much of occupational health and worker’s comp. The days when the clinic would have multiple physicians in house are quickly becoming a relic of a pre-ACA world. Increasingly, such centers are staffed by NPs and physician assistants to handle the day-to-day patient care and employ just a single physician to oversee a particular area.

However, this surge in advanced practice nurses isn't merely a consequence of the shortage of physicians; it is also fueled by the growing numbers of NPs. NPs are increasingly seeing career opportunities in advanced degrees that bring with them new potential for leadership and management positions. The ranks of NPs will surge to 244,000 by 2025, nearly double the number in 2008.

The shortage of both physicians and occupational health specialists has created room for nurses to step into higher roles and greater responsibility, as long as they meet the right criteria. Here are three ways that RNs and other nurses can best improve their career prospects amidst the transitioning model of occupational health:

1. Earn an advanced degree. Nurses who want to move into a management and leadership role should become NPs. The opportunities nationally will only continue to grow with the ACA, but if an RN is on the fence about continuing his or her education, the time is now to earn the qualifications many organizations are searching for and take advantage of the scarcity of talent.

2. Seek out certifications in occupational health. Given the shortage of OH&S nurses and the growing need for proactive employee health and wellness programs, a NP with the proper certifications is an attractive candidate in an evaporating talent pool. The American Board of Occupational Health Nurses (ABOHN) offers Certified Occupational Health Nurse (COHN), COHN-Specialist, and casework credentials. Updating skills in hearing, vision, DOT drug testing specimen collection, and other areas can make candidates more competitive for positions.

3. Recognize where your skills are most applicable. Certain regions of the country are focused on certain industries, and OH&S follows suit. For example, in Houston, oil and gas companies take center stage, while in San Francisco, technology companies are the norm. Nurses who know which industry matches their career focus or where their skills are best applied can guide them to the region where they might be most in demand. If tendonitis from repetitive motion is more their calling card, San Francisco is likely a good fit, whereas if their skills are better applied to trauma from serious burns or chemical exposure, Houston might be a better choice.

Changing Industry, Changing Profession
The ACA has shifted the health care landscape dramatically and will continue to do so for the foreseeable future. The move toward preventative care and health and wellness programs has incited new demand for OH&S professionals even as trained OH&S specialists become increasingly difficult to find.

The shortage of physicians, tasked with handling the millions of Americans newly insured, is also trickling back to OH&S programs, with NPs and physician assistants gaining new clout as demand for physicians surges. Nurses who take the right steps now through education, certification, and a strategic look at how their skills match particular industries can position themselves to ride the wave of the ACA to new career heights while also ensuring that the future of every workforce is rooted in health.

This article originally appeared in the September 2014 issue of Occupational Health & Safety.

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