• September 1, 2015

For-Profit Colleges Could Do More on Shortage of Health-Care Workers

For-profit colleges educate a growing share of the nation's health-care workers, but graduate relatively few students in the highest-need fields and may be producing too many medical assistants and massage therapists, according to a report released on Thursday by the Center for American Progress.

The report's release comes amid growing scrutiny of the expanding for-profit sector. For-profits have touted their role in training health-care workers in their fight against the Education Department's proposed "gainful employment" rule, warning that the proposal—which could shut down hundreds of high-cost programs—would worsen shortages of health-care workers. One advertisement opposing the rule, by the Association of Private Sector Colleges and Universities, features a nurse who returned to college after her husband became ill, and bears the message: "It's my education and my job—it should be my choice."

But the report, "Profiting From Health Care: The Role of For-Profit Schools in Training the Health-Care Workforce," says that for-profits conferred only 11,000 degrees in registered nursing, a field with one of the worst job shortages, in the 2008-9 academic year.

The report says for-profit colleges tend to focus on "support" occupations, like medical and dental assisting, rather than "practitioner" and "technician" fields, like registered nursing and diagnostic technology. Though support occupations are growing, the field is less than half the size of the practitioner and technician fields, and the jobs tend to be lower-paying.

In the 2008-9 academic year, for-profit colleges produced 247,480 degrees and certificates in the health professions, according to the report. Roughly a third, or 77,000, of them were in "medical/clinical" assistant programs and 25,000 others were in massage therapy.

By 2018 the nation is expected to need an additional one million nurses, but only 218,000 more medical assistants, according to the report. The Bureau of Labor Statistics projects that there will be only 39,500 job openings in massage therapy from 2008 to 2018. The report warns that some graduates of medical-assisting and massage-therapy programs may have trouble finding jobs in the future.

The report recommends that Congress create incentives for colleges to offer degrees in high-demand areas by expanding the Smart Grant program to cover more job titles and to work with colleges and the Department of Labor to help prospective students make better decisions. It also suggests that Congress require colleges to provide students with information about job placement, average salary, and graduation rates prior to enrollment, and direct accrediting agencies to develop standards around outcome measures.

The Association of Private Sector Colleges and Universities praised the report for its "fairness and balance" but issued a white paper "to clarify certain statements" in the report and "address points on which it disagrees."

Its response notes, for example, that for-profits award 32 percent of all health-care credentials and educate a growing share of nurses. From 2001 to 2009, the percentage of nursing degrees awarded by for-profits grew from 4 percent to 11 percent of the national total, while nursing awards from public colleges shrank from 78 to 70 percent, the association says.


1. 11180655 - January 20, 2011 at 04:14 pm

The impact of private career colleges should be analyzed geographically, rather than globally. These colleges do have a significant impact in their communities, and especially where the colleges have a focus on the 'higher-need' medical fields. Clearly the need for all healthcare workers is growing, and there are areas of the country where private career colleges do have a significant impact in producing higher-need field graduates.

2. jesor - January 20, 2011 at 04:17 pm

So, from this article it would appear that if the current graduation rate continued through 2009-10, we already have at least a 10 year supply of massage therapists and about a 6 year supply of medical assistants just from the for-profit sector alone. So much for the invisible hand of the market helping to allocate capital efficiently

3. alancox - January 20, 2011 at 05:14 pm

Good chance of state nursing boards accepting this idea!

4. onlineasllou - January 20, 2011 at 05:27 pm

Who does the Center for American Progress represent? And what do they know about nursing?

Where I live, the for-profit Associate Degree and Bachelor's Degee programs in nursing are growing at an alrming rate -- pouring hundreds of new grads into a saturated market. The hospitals have recognized that most of these graduates are "poor quality hires" and don't hire them. In fact some hospitals (including my own) have stopped allowing their students to come to the hospital for clinical education. Many nursing leaders (not just faculty members, but State Board officials and employers) are very concerned about the poor quality of education being offered by many of these schools.

In my state, the drive is to shut down these sleezy for-profit nursing programs that lure students in with promises of professional careers (and professional salaries). Too often, the students get deeply into debt, then flunk out of the program just prior to graduation so that the school can maintain a decent pass rate on the RN state board exam. I know some programs in which it is routine for only 20% of the students admitted to graduate. Those that do face a bleak job market that is saturated with new grads right now, and at the bottom of the list due to their school's poor reputation. Those that don't graduate end up with just a lot of debt.

Yes, there will be a nursing shortage in the future. But there is NOT one now -- and the answer to our long-term problem is not to over-produce poorly educated nurses or to take advantage of those gullible individuals who don't know the difference between a real education and a sham.

5. willynilly - January 20, 2011 at 05:39 pm

Why would anyone want to expose these critically impportant health care providers to a financial rip off? Send them to a higher educational institution that will put student welfare in front of the profit motive.

6. forprofited - January 20, 2011 at 08:14 pm

The industry flagrantly misleads students, especially those seeking health care certifications. Specialized accreditation and licensing requirements are grossly misrepresented, especially in for-profit AAS in "Health Science" programs claiming they lead, among other things, to certification as a Radiology Technician. All states require Radiology Technicians to be licensed, and this usually requires the program to be accredited by the Joint Review Committee on Education in Radiologic Technology and/or CAAHEP. The for-profit colleges market their fully online "health science" programs as a means to these specialized certifications, when these online "health science" programs are nothing but a time consuming debt burden with an extremely low graduation rate.

Example: http://www.southuniversity.edu...

Which states: “These careers include medical assistant, pharmacy technician, radiology technician/ X-Ray technician, and ultrasound technician.”

Also, for example: http://radiologytechnicianscho...

They lure first-time low income students uninformed about certification requirements into useless online programs, strapping the students with federally guaranteed debt. This is appalling.

7. forprofited - January 20, 2011 at 08:15 pm

Links in prior post were clipped.



8. mkant69 - January 20, 2011 at 09:21 pm

This is the last year of the National SMART Grant. Congress is extremely unlikely to fund it for another year, let alone expand it beyond STEM to nursing. Keep in mind that the National SMART Grant was tied to Pell Grant eligibility and so addresses only undergraduate students. Budget deficits will add a lot of pressure on Congress to reduce student aid funding, not increase it.

A more effective and less expensive approach would be to classify primary care physicians as eligible for the public service loan forgiveness program.

A better approach would involve cutting military spending by 5% and using the savings to invest in higher education. We are no longer in an arms race, but a brains race.

9. panacea - January 20, 2011 at 09:42 pm

It may be part of why my state is pushing for NLN accredittation. Poor quality schools like ITT won't be able to meet the standards.

10. davidperuski - January 21, 2011 at 08:54 am

I agree quite a bit with onlineeasllou but would also like to add a couple of other thoughts. Indeed, we need to maintain practice standards. Pushing people through without the proper knowledge, skill and experience is not who we want working on us. In addition, I want people who CARE about people and not just want a job.

It does not make sense to continue to expand programs without controls because all it does is cause access issues for programs that are established. If people would really talk with the clinical sites they are feeling overwhelmed and they do not feel that all of these people are going to find jobs.

So how is having a student to pay more for an education through a for-profit institution and then not able to find a job helping the healthcare industry?

Unfortunately, it is the dollar that is controlling this situation and not the proper motive of an excellent education and educating well-intentioned students in all cases. We truly need to examine what we value in education and healthcare.

11. notusip - January 21, 2011 at 09:15 am

Who among these respondents wants to be treated in the ICU by one of the graduates of a career school? For example, the standards of their accrediting unit, the Accrediting Council for Career Schools and Colleges, state that in order to teach in a field an instructor must have a master's degree (in anything) and 15 hours, UG or G, in the field "or a related one." This means that an MBA with a year of biology and a year of chemistry can be teaching the budding nurses.

In addition, at many schools, faculty are under great pressure to avoid failing too many students. A friend of mine, teaching physiology to RN students at a career school, was told that surely she could require knowledge of only the most important organs on her exams so that more students could pass.

The expansion of career school nursing programs could cut health care costs by keeping fewer patients alive.

12. seraphpendragon - January 21, 2011 at 09:34 am

Jesor, you misread the results. If there are people graduating in any field, it's because they chose to study it. It's not uncommon for today's youth to do massage therapy, athletic medicine or whatever, etc. Just because that doesn't fit the needs of what some blue-ribbon commission members thing, or what a bunch of government officials want, doesn't mean people should be funnelled into something. We have a free society where people can study what they wish to and follow their dreams. If you're going to mandate that a college have x health care workers, then x number of students are going to have to settle for that. Maybe you're comfortable in a world where the individual cedes their future to the state, but I'm not.

Of course, I see a lot of "profit is bad!" in these comments, so even our secondary education system apparently needs a lot of work. >_>

13. 22063319 - January 21, 2011 at 10:03 am

Seeing more specificity regarding RN degree program types at for-profit schools would be interesting. My guess would be they are doing land-office business in transitional programs enabling students who are already RNs to earn higher degrees. To some nurses with a little money in the bank, the "success culture" of the for-profits probably looks appealing compared to more rigorous and less flexible programs at public and private non-profit institutions.

Regarding commenter #11, I agree with your concerns but I have to believe that state licensing boards and RN-specific accrediting agencies are holding for-profits to standards higher than those imposed by the career college accrediting agencies.

14. evenhanded - January 21, 2011 at 10:04 am

What's this? A regionally-accredited, government-run, free of the profit motive community college hid its loss of nursing accreditation from its students?


How can this be? Yes, it's a few years old, but it happens; this was just one such occurence in my neck of the woods. "Profit" can be measured in many ways. Government-run schools tend to measure it, like other government bureaucracies, in the size of their budgets, staff, and expanse. Actual measurements of quality and effectiveness are either too hard or to be avoided.

Let's stop lumping institutions into categories based on tax status and look at what each offers in terms of program quality and student outcomes. Institutional quality in those terms varies among all types of institutions.

15. onlineasllou - January 21, 2011 at 10:45 am

To poster #13, 22063319: You write that you "have to believe that state licensing boards and RN-specific accrediting agencies are holding for-profits to standards higher than those imposed by the career college accrediting agencies."

Unfortunately, you are mis-guided in that belief. That's not how most State Boards operate. The State Boards are composed of volunteers who are paid little, if anything for their efforts. They are woefully underfunded and often have little actual authority. They do not have the political clout to establish many standards and they have virtually no resources to address this issue. Much of their time is spent reviewing the cases of individual nurses who have been reported their for practice violations and/or drug problems.

Their ability (and mandate) to oversee the quality of education is almost non-existent. They rely on the educational accreditation agencies to do that. Their ability to fight the lawyers (and graduates) of the educational institutions (of any type) is virtually non-existent.

Do some research on the topic before making dangerous assumptions about your family's health care.

16. onlineasllou - January 21, 2011 at 10:55 am

I forgot to add to my previous post #15:

And as for the RN-specific accrediting agencies: A lot of these career schools don't seek that accreditaion. So those organizations are not involved with those schools.

Also, the organization that accredits the ADN programs (NLN) needs the support of those career schools to survive. Most 4-year "accademic" colleges left that organization years ago and formed a new one that only accredits Bachelor's Degree programs and graduate programs. I don't know the whole story there, but those colleges/universities were obviously dissatified with that organization and some of the directions it was taking.

It's like other accrediting agencies. The members of the organization establish the standards and provide the resources for the processes that accredit themselves. The fox is guarding the henhouse.

17. dburton - January 21, 2011 at 01:53 pm

onlineasllou--There are accrediting bodies for the specialty of nursing that have highly regarded standards. They are accepted by CHEA (www.chea.org) Students need to do their howork before enrolling in a school. I realize it puts the burden on the student, but that is where it belongs. They need to verfiy the school is the quality they need.

18. duncan59 - January 21, 2011 at 03:04 pm

The commentary following this article is grossly uniformed and opinonated.I operate a number of for profit nursing schools and I can tell you that our Licensure pass rates exceed the national average of ALL nursing schools,our grad rates are in the high 80"s and our job placement rates which we monitor monthy are in the 90% range.Our facilities are state of the art in terms of labs and use of simulation tools and yes we hold our faculty responsible for their student outcomes.Because we are not part of the "establishment" the triad of regulators at the State and National level are constantly looking over us with a "guilty until proven inocent" attitude despite very clear evidence of the excellence of our student outcomes.In order to start a new nursing school we need to rent space with a 10 year lease commitment,build the entire facility inlcluding all the equiptment, hire the faculty all before we know if our initial liscense to operae will be approved! We get no funding or incentive from the federal or state government for this risk.Instead of having some impartial organisation to go to for initial mentoring we face the threat of restrictions or shut down at every juncture.Unless this country takes the future shortage of nurses seriously we will be importing thousands of nurses from from the philipines and china just like we did with IT workers in the 90's.The crime is that the humnan intellectual capital is right here we should not need to import these people but we most certainly will if people don't dramatically change their attitudes and aproach to this problem.

19. 12096136 - January 21, 2011 at 03:30 pm

The medical assistant program at the for-profit that I am familiar with is in "for-profit" not to train medical assistants. Most of the medical offices do not even read an application from a graduate from this school. They are poorly trained and a risk for the office to hire them.

20. viwap - January 21, 2011 at 04:18 pm

Onlineasllou: You are misinformed and make gross generalizations that do not contribute to the dialogue. Before dismissing state nursing boards, come to New Jersey, where you can't make the slightest change to a nursing curriculum without their permission and the program license depends on the graduates' performance on their first attempt at the licensing exam. Before you dismiss national accrediting agencies while accepting programmatic ones recognized by CHEA, learn that ACICS, an agency that accredits many for-profits, is recognized by CHEA. Nationally accredited institutions are accountable for retention and job placement rates and must abide by clear definitions of semester and quarter credit hours. How does that compare with regional accreditation? I must clarify that I am not dismissing regional accreditation--that's the ultimate goal for many good reasons, but there is no need to trash national accreditation.

There are good and bad things happening in non-profit and for-profit areas of the education sector. If we had the right dialogue, they could complement each other for the benefit of students and society.

21. onlineasllou - January 21, 2011 at 05:16 pm

I am only reporting what is happening in my local area. The for-profit "career colleges" have a terrible reputation among the reputable hospitals. Their students are being turned away and not allowed to do clinical rotations there and their graduates are not being hired. The State Board is very concerned about the poor quality of these schools (and a few non-profit ones as well), but doesn't have the resources or clout to do much about it.

I know this from my personal involvement with these schools, the hospitals, and through private conversations with the reviewers from accreditation agencies and the State Board.

It may be different is other parts of the country, but that is the status where I live and work. There probably are some for-profit ADN programs that are't so bad ... but we don't have any of those here.

And as for it being the prosptective student's job to figure out the web of accreditation levels and agencies, that's just ridiculous. Not even professional educators understand it all. The targeted students are often from underprivileged groups and totally unaware of what questions to ask.

22. diabolical_machine - January 22, 2011 at 02:58 pm

I disagree in that I think it is the responsibility of the prospective student to do the research and be knowledgeable about the field they're going into. At a minimum they should be able to do some basic research and come up with a starting point for asking the right questions.

As a consumer, it's our responsibility to be informed about the products or services we buy. Education is no different. The schools still need to do their part on providing as much information to the prospective student as they can, especially regarding accreditation. However it's still up to the student to do their research.

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