For-Profit Colleges’ Health Care Training Examined

For-profit colleges play an important and growing role in training the country’s health care work force, but they could be doing a better job, researchers contend in a new study released last week.

Billed as the first comprehensive research on the issue, the Center for American Progress study “Profiting From Health Care: The Role of For-Profit Schools in Training the Health Care Workforce” suggests for-profit schools produce too few graduates in the most-needed professions, such as nursing and diagnostic technology, and too many in the support occupations, such as medical assistants and massage therapists.

The research grows partly from new scrutiny in Congress and by the Obama administration of the expanding for-profit education industry. New regulations proposed by the Education Department could add significant regulatory constraints to for-profit education. A trade group representing for-profit schools, the Association of Private Sector Colleges and Universities, filed suit Friday in federal court to block some of the new rules.

“There’s been a lot of heat around this issue but not a lot of light,” said Tim Bates, a program analyst for UC-San Francisco’s Center for Health Care Professions who served on a panel assessing the study when it was unveiled last week in Washington, D.C.

“In our work at UC-San Francisco, we’ve certainly come across these issues — graduation rates, high student debt burdens and likelihood of finding jobs. With for-profit education coming under so much scrutiny and the new need to increase the country’s health care work force coming together, the timing for this study is excellent,” Bates said.

Although it stems from similar concerns about the rapidly expanding for-profit education industry, researchers said the focus on health care training is separate and distinct from federal regulatory efforts.

“We want to make it clear that we’re not out to criticize or target for-profit colleges’ contribution in this area,” said Ellen-Marie Whelan, associate director of health policy at the Center for American Progress and co-author of the report.

“There is a huge need to increase the health care work force in this country, and we have to do it fairly quickly with this new law we just passed that calls for 32 million more people to come into the health care marketplace,” Whelan said. “Baby boomers are getting older and needing more care. We’re going to need a lot of workers to help care for all these people and for-profit colleges definitely have a role in filling this critical need.

“But so far,” Whelan said, “there hasn’t been a deep look at what’s really going on. We wanted to tease apart some of the numbers and try to determine what they mean and maybe where we should be headed.”

Findings, Recommendations

The report highlights three major observations about for-profit colleges and the health care work force:

  • For-profit schools are making only modest contributions to training the highest-demand health professionals. This is partly due to the very nature of the type of programs for-profit schools currently offer;
  • For-profit institutions are training health care workers who may have a hard time finding a job or will find work only in jobs at the lower end of the pay scale; and
  • Quality measures now in place make it nearly impossible for students to traverse the maze of health professional education programs to make informed decisions.

The report offers three specific recommendations:

  • Provide incentives for schools to offer and students to choose health career programs in fields that meet the nation’s future health care work force needs;
  • Help students choose the best course of health care study that will pay them a good wage; and
  • Improve quality measures to help students make better and more informed decisions.

For-Profit Education Industry Reaction

Although it praised the report’s “fairness and balance,” the Association of Private Sector Colleges and Universities issued a white paper the same day the report was released “to clarify certain statements” and “address points on which it disagrees.”

The trade group points out that private sector schools — an alternative moniker for for-profits — issue about 32% of the country’s health care credentials overall and that their share of nurse education is growing. The number of nursing degrees awarded nationally by for-profits grew from 4% in 2001 to 11% in 2011. During the same period, nursing degrees at public schools went from 78% to 70%, according to the trade association.

APSCU President Harris Miller, president of the private sector trade association, in a prepared statement said, “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.”

Online Courses Spark Growth

Online coursework has been a big factor in the rapid growth of for-profit education. While hundreds of “on-the-ground” for-profit institutions offer career training in traditional, usually small classes, online educational programs over the past two decades have created large new institutions.

Among University of Phoenix’s 443,000 students, about 300,000 of them are taking courses online. Kaplan University has more than 60,000 students enrolled in its online programs.

“Six years ago we were at a little more than 100,000 students,” said Manny Rivera, public affairs director of the University of Phoenix. “Online courses have definitely played a big role in our growth over the past few years. And it’s not just us. Traditional schools — Stanford, the UC system and others — have all been growing online as well.”

California Perspective

Bates from UCSF’s Center for Health Care Professions said the study’s findings are generally reflected in California schools.

“I think it’s no different in California — for-profit schools are concentrating on training entry-level support workers,” Bates said.

He also said it’s important to understand and appreciate that for-profit educational institutions often reach a different population than public and not-for-profit schools — in California as well as elsewhere in the country.

“A lot of people want to demonize the for-profit industry but we have to remember that for-profit schools are often serving a population that might not be served otherwise. A lot of students are students of color, students from the inner cities, people who might not have an opportunity to attend public schools,” Bates said.

“It’s really important to get the details right on this issue — and I think research like this will help move us in that direction,” Bates said.

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