Health Care Jobs Won’t Save Us

The ‘surefire path to American prosperity’ is mostly for educated women.

As manufacturing employment continues to lag, economic optimists have pointed to health care as a way to replace those jobs, often at similar or even higher salaries. Yet major structural barriers related to both gender and class will make this a difficult transition—if it can be carried out at all.

The Wall Street Journal, for example, reported earlier this month that health care, and nursing in particular, will become the “surefire new path to American prosperity” over the next decade, promising six-figure salaries and excellent benefits. In some respects the article is right: health care is projected to account for a huge share of job growth, especially for the working class. However, the picture it paints is incomplete.

Since the early 1980s, the United States economy has lost over 7 million manufacturing jobs. These positions have largely been replaced by jobs in service industries and especially health care, which is now America’s largest employment sector and only stands to grow in the future.

By my estimates, health care will account for roughly 35% of all job growth between 2025 and 2035. That growth is driven primarily by demographics: Baby Boomers are now elderly, increasing demand for health care services through sheer numbers alone, and they are retiring with significant wealth and generous Medicare benefits. Meanwhile, government and private industry are pouring over $200 billion into health care research every year.

WSJ is correct that nursing jobs are among the best in this growing sector: providing good wages, stability, and solid career prospects. But two important structural barriers complicate the picture of nursing as a model for prosperity. The first is gender, and the second is class.

The Gender Problem

Only 20% of health care jobs are held by men, a fact that matters enormously when considering what types of employment the sector is being tasked with replacing. Manufacturing, historically, was the primary source of middle-class jobs for workers without college degrees, and it was overwhelmingly male. Shifting to a health care-driven economy is therefore not a simple transition. It is a gendered one, coming at a time when men are less likely to pursue higher education than their female counterparts and workforce participation rates among men are declining.

Home health aid is the fastest-growing occupation in the United States, expected to add 740,000 jobs over the next ten years. This is a field that carries a strong female occupational identity, but given the projected increase in demand, employers must boost recruitment efforts to meet the needs of the workforce.

While high-profile efforts have been made to recruit racial and ethnic minorities into these fields, there are virtually no national initiatives aimed at getting more men into direct care work. This stands in sharp contrast to the sustained policy efforts that brought more women into male-dominated STEM fields. The federal government, as well as philanthropic and corporate funders, have made recruiting women into engineering and science jobs a national priority. The absence of any parallel effort for men in health care is telling.

Male representation in professional nursing has grown modestly, from roughly 5% in 2000 to between 11-15% today. But men remain a small minority, and male enrollment in nursing educational programs has plateaued in recent years. One initiative in Oregon—“Are You Man Enough to Be a Nurse?”—featured highly masculine imagery aimed at rebranding the profession by making men more visible. There has been no formal evaluation of the program, but my sense is that it was not particularly successful.

Research suggests that men resist entering female-coded occupations not because few men are visible in them, but because the skills associated with the work are perceived as feminine, particularly direct patient care. Trying to change the public face of health care jobs like nursing does little to address that perception.

Instead, a better rebrand could showcase the opportunity for traditionally masculine skills to flourish: emphasizing the technical dimensions of modern nursing such as medication management or the use of complex machinery. Men who enter nursing tend to gravitate toward disciplines like anesthesia that require technical skills. Evidence also suggests that men are drawn to these jobs when they can see genuine recognition and advancement potential—not simply when they are shown that other men do it. We must emphasize that health care jobs like nursing are stable and well-compensated.

Not only that, men who enter female-dominated fields like nursing are often disproportionately rewarded. The “glass escalator” effect—in which men are more likely to be promoted and tend to earn higher salaries than their female counterparts—is well documented. Research I conducted found that male nurses are more likely than females to become supervisors. This is the kind of messaging that might draw more men into the field: not that nursing is gender-neutral, but that it offers men promising career trajectories.

However, there is an important caveat. The glass escalator effect may not hold if a significant number of new men stream into the health care profession. As more men enter the field, they are more likely to be slotted into relatively low-paying positions that compare poorly with the manufacturing and transportation jobs that once anchored working-class male employment.

My research found that among men without college degrees, those employed in health care rank near the bottom in marriage rates. This suggests that these jobs, as currently structured, do not provide the economic or social foundation that blue collar men need to build stable lives.

This brings us to the second structural barrier that prevents health care from becoming a source of widespread prosperity: class.

The Class Problem

Even setting aside gender, nursing’s promise as a middle-class engine is complicated by its increasingly steep educational requirements. This matters in two distinct ways. At the top of the health care ladder, nursing is becoming more credentialed and therefore less accessible to those without a bachelor’s degree. Non-college health care jobs, which represent the bulk of growth in health care, are often simply not very good jobs.

Start with nursing itself. Unlike the manufacturing jobs it is notionally replacing, professional nursing demands extensive formal education. Apprenticeship programs no longer exist, and hospital-based diploma programs have essentially disappeared. Associate degree programs continue to produce nurses, but the dominant pathway is now a four-year bachelor’s degree.

That shift toward bachelor’s degrees has been deliberate: over the past two decades, the Robert Wood Johnson Foundation and others mounted a sustained campaign to make the BSN (Bachelor of Science in Nursing) the professional standard. The Magnet Recognition Program has reinforced that push by requiring 80% of nurses at Magnet-designated hospitals hold bachelor’s degrees; those that do not meet this requirement must offer a plan to reach the goal. For many workers looking for a path to the middle class, time, money, and circumstance rather than any lack of aspiration prevents the attainment of a bachelor’s degree. It is, for many, genuinely out of reach.

At the other end of the spectrum are jobs that do not require a college degree, which represent a majority of projected health care growth. Over 50% of today’s health care jobs do not require one, and over 60% of projected growth over the next ten years falls within non-college occupations. These are home health aides, nursing assistants, patient care technicians, and personal care workers—roles that do not carry the high wages or career trajectories that made manufacturing the backbone of the middle class.

Home health aide, the fastest-growing occupation in the country, typically pays around $15 an hour, with limited benefits and few pathways to advancement without a bachelor’s degree. The WSJ piece showcased how someone can rise from nursing assistant to nurse to nurse practitioner. While this is a promising pathway, it likely involves six or more years of formal university education—time that many working-class men simply do not have.

The Journal is right that health care, and especially professional nursing, is one of the best job categories in America right now and will power employment growth over the next decade. But a health care-centered growth strategy is not a one-for-one replacement for the manufacturing economy.

It is a female-dominated sector, and without deliberate efforts both to bring more men into the field and to raise wages for non-college jobs so that they provide a viable economic foundation, health care employment growth will do little to address the workforce detachment and economic marginalization that characterize too many working-class men today.

Resolving the class issue demands a two-pronged approach: first, we must find ways to make better health care jobs accessible to the working class. Second, we must make existing health care jobs better paths to flourishing.

Credential barriers make more and more health care jobs inaccessible to non-college employees, and should be removed where possible. In nursing, there is some evidence that bachelor’s-level education can modestly improve care quality—though much of this evidence is not causal. Hospitals with more BSN-prepared nurses may have better patient outcomes for reasons independent of their nurses’ education, such as institutional resources or staffing levels. What is clear is that requiring a bachelor’s degree makes nursing less attainable for many Americans. The tradeoffs are real.

Removing arbitrary credential barriers, allowing experience to substitute for credentials, and offering quicker and more affordable training could make entry-level health care jobs much more attractive for those looking to enter a growing field.

Solutions to the gender gap are more fraught, as it’s marked by intangible issues of social stigma and stereotypes. Ultimately, all of these problems return to the basic issue that good health care jobs are not widely accessible for working-class men.

Celebrating job growth numbers without confronting these structural realities risks mistaking sector growth for broad-based prosperity. They are not the same thing.