"Ambulatory care employment has been largely protected from the recession, likely due to its cost advantage over hospital care. So, as cost became a greater consideration for insurers and providers, they were more like to use ambulatory care in place of hospital care."
In 2013 the pace of hospital job growth slowed to a crawl.
"We are seeing significantly lower job growth for hospitals this year than we did year-to-date in August 2012 and year-to-date August 2011," says Caroline Steinberg, vice president, health trends analysis at the American Hospital Association.
"Last year at this time job growth was about 44,500 by August and this year it is only 7,000, but that is not surprising given the mounting payment cuts to hospitals, particularly the 2% cuts to Medicare mandated by the sequester."
While ambulatory services created most of the jobs in healthcare, Steinberg says hospitals had been holding their own until this year. "The trend in terms of employment is really due to the cuts," she says.