Training the Health Workers We Need

Students of Color Merit the Best from For-Profit and Not-for-Profit Colleges Alike

Julie Morgan explains why for-profit and not-for-profit colleges need to serve students of color better in health care education.

Una estudiante de enfermería de la Universidad de Southern Mississippi saca medicamento en el Hospital Forrest General en Hattiesburg como parte de su capacitación. (AP/University of Southern Mississippi, Steve Rouse)
Una estudiante de enfermería de la Universidad de Southern Mississippi saca medicamento en el Hospital Forrest General en Hattiesburg como parte de su capacitación. (AP/University of Southern Mississippi, Steve Rouse)

There is an undeniable allure to the idea of working in health care, whether it’s the fast-paced environment of an emergency room; the opportunity to care for others; or, best of all, the access to job opportunities in a time when unemployment hovers around 9 percent. For-profit colleges offer students a path into health care but CAP’s recent report shows the path may not be the same one offered at not-for-profit institutions such as community colleges or public and private four-year institutions.

The findings of this report are particularly important for students of color who make up a large proportion of the student body at for-profit institutions. For-profit colleges concentrate on educating students primarily in lower-paying, lower-skilled health support fields. With so many students of color in their student bodies, that means many minority students will end up in support positions such as medical assistants rather than as registered nurses.

Still, for-profit institutions are training a large percentage of students of color for health care jobs. About 25 percent of the health care degrees and certificates awarded at for-profit colleges in 2009 went to African Americans, compared to only 11 percent at not-for-profit institutions. And 24 percent of for-profit health care credentials went to Latino students compared to only 8 percent at not-for-profits. The upshot: For-profit institutions play a substantial role in training students of color for a career in health care.

Of course, it’s important to point out that not-for-profit schools offer a wider variety of health care education programs. And the overall number of students pursuing health care credentials at not-for-profit schools is far larger than at for-profits. Comparing percentages can obscure the fact that the number of students of color educated at not-for-profit institutions is not so different from the for-profits. For instance, for-profit colleges gave out more than 60,000 credentials in health care to African Americans in 2009, whereas not-for-profit institutions gave out more than 57,000.

Even so, for-profit colleges are educating more students of color relative to their size, and not-for-profits are educating more white students. This is certainly significant but we can’t understand what it means without looking more deeply at the individual education programs these institutions offer. Our report showed for-profit colleges primarily educate students in health care support positions like medical assisting, massage therapy, dental assisting, and medical billing where the average salary hovers around $30,000. In fact, more than 30 percent of the degrees and certificates in health care awarded at for-profits in 2009 were in one single program—medical assisting—and another 10 percent were in massage therapy.

In many of the support fields, for-profit colleges are the primary providers of postsecondary training. Not-for-profit colleges, in contrast, are the primary providers of education for health care practitioners and technicians such as nurses, doctors, physical therapists, and radiology technicians. And in contrast to the $29,000 median salary for medical assistants, registered nurses make around $60,000.

The for-profit colleges’ concentration on support programs and the diversity of its student body turns out to be an interesting combination. Since the more racially diverse for-profits concentrate almost exclusively on health care support positions and the less racially diverse not-for-profits focus on educating practitioners and technicians, the result is that support occupations will be more diverse than others. (see chart)

Medical assistants vs. registered nurses by race

It is easy to see from these charts that students of color, particularly Latinos and African Americans, are well-represented in medical assisting, yet the registered nursing credentials handed out in 2009 largely went to white students. The same is true across other occupations. New degrees in medicine, dental hygiene, and radiation therapy (top programs at not-for-profits) mostly went to white students, but degrees in dental assisting or pharmacy technician reflect more diversity.

What we learn from this is that for-profit colleges are a point of access into health care for students of color but they do not provide access to the same educational opportunities as community colleges or other not-for-profit institutions. For policymakers at Health and Human Services and the Department of Education, it is critical to look beyond broad categories like “allied health” and “health care” to see how for-profit colleges are serving students and whether the returns to education justify its high price. To encourage more diversity at all levels of health care education, three things must happen:

  • Not-for-profit colleges need to become more like for-profit colleges in their ability to attract a more diverse student body.
  • For-profit colleges need to become more like not-for-profits in getting students of color into high-demand health care educational programs.
  • We need policies that encourage students of color to pursue high-demand health care programs.

Each of these broad recommendations is a tall order in its own right. We do not know very much right now about why students choose more expensive for-profit programs over community colleges so it’s difficult to say what not-for-profit colleges need to do to attract students. The first step for not-for-profit institutions should be to stop thinking of marketing as a dirty word and consider how knowing their potential customers better can help them better serve their needs.

To encourage for-profit colleges to get more students into high-demand fields (and likewise to encourage students to pursue these fields), we need to better understand the barriers to entry, parsing out the effects of cost, accreditation, and the academic preparation and financial ability of incoming students. To engage more students, incentivizing study in high-demand health care fields through grant and scholarship programs would be a good first step.

These observations raise serious questions about the role for-profits currently play in educating students for the health care workforce. And we haven’t even reached one of the most important issues: What are students learning in these programs? The scary truth is that we just do not know very much about the quality of the programs provided by either for-profit or not-for-profit colleges. Without safeguards of quality, we can only safely say that students of color have access to college. But access to a good education? We’re not sure.

Julie Margetta Morgan is a Policy Analyst with the Postsecondary Education Program at the Center for American Progress. The report, “Profiting from Health Care,” examines how for-profit colleges contribute to educating the health care workforce.

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Julie Margetta Morgan

Director of Postsecondary Access and Success