Care Career Overview
care involves assessing and treating sudden or unexpected
injuries and illnesses. Acute care facilities, typically general
or specialty hospitals, provide care for patients who have
sustained life-threatening injuries or who have conditions
that may lead to deteriorating health status. Increasingly,
acute care and related services are provided within the complex
environment of health systems. Saving lives and restoring
health remain the primary objectives, but hospitals and health
systems are also expected to lead efforts to improve the health
and well-being of their communities.
Opportunities in Acute Care
It is expected that hospitals will continue to employ the
greatest proportion of managers among all healthcare sectors.
Some who enter the acute care sector will come from a background
of management education or experience. A significant number
of individuals with a clinical background will transition
into acute care management after they obtain the appropriate
training and credentials.
to the growing size and complexity of the acute care sector,
hospital managers at many levels have more opportunities.
As hospitals continue to consolidate, centralize, and diversify
functions, competition for managerial positions will increase
at all job levels. Medical and health services managers with
experience in large facilities will enjoy the best job opportunities.
However, managers looking to climb the executive ladder to
the top will likely face intense competition because the number
of chief executive officer positions available in the acute
care sector is limited. Furthermore, while the number of opportunities
for managers in acute care settings will continue to increase,
the number of jobs will grow at a relatively slower rate compared
with other healthcare settings such as medical group practices
and residential care facilities.
management level in the acute care sector has its own responsibilities,
qualifications, salary range, and typical work hours. To find
out what to expect as an entry-level manager, mid-level manager,
and senior-level executive, click on the links below:
are generally classified as freestanding facilities, sole
community facilities, or members of multihospital systems.
Freestanding hospitals are not affiliated with any other hospitals
or health systems. They are totally dependent on the community
for operational support. Sole community hospitals are the
only source for inpatient services in a particular area. Designation
as a sole community hospital hinges on the hospital’s
geographic location and distance from other acute care facilities
and healthcare providers.1
Multihospital systems are made up of facilities that have
agreed to share the provision of healthcare services. These
systems can therefore provide a wider range of services to
a larger number of people and may be able to reduce expenses
by capturing savings from economies of scale and by integrating
services to avoid wasteful duplication.
addition, hospitals are classified according to other criteria,
including ownership, length of patient stay, and conditions
treated. Hospitals range from investor-owned or proprietary
facilities to federal or public facilities to faith-based
or nonsectarian facilities. Based on the length of time patients
receive inpatient care, hospitals are classified as “short
stay” or “long stay.” Long-term facilities
are usually identified as those with an average length of
patient stay greater than 30 days. Some facilities, known
as specialty hospitals, treat only specific conditions, such
as burns, cancer, eye disease and injury, heart disease, and
behavioral health problems.
Acute care is an important sector of the U.S. economy;
therefore, employment opportunities abound. According to the
Centers for Medicare and Medicaid Services, total hospital
revenue was more than $457 million in 2002.2
This figure represented 4.4 percent of the total U.S. gross
domestic product ($10,481 billion) in 2002.3
U.S. community hospitals had nearly 4,154,000 full-time employees
and trainees in 2002, providing salaries and benefits totaling
more than $216 billion.4
The number of full-time and part-time hospitals employees
has grown by about 7.5 percent and 6.6 percent, respectively.5
the number of U.S. community hospitals declined from 5,015
in 1998 to 4,915 in 2000, that total is climbing again, up
to 4,927 by 2002. (This figure excludes federal hospitals
and long-term care facilities, which totaled 1,047 in 2002.)
The size of these hospitals is varied. In 2001, 46 percent
of nonfederal community hospitals in the United States had
between 1 and 99 beds. Of the remaining hospitals, 25 percent
had 100-199 beds, 13 percent had 200-299 beds, 7 percent had
300-399 beds, 4 percent had 400-499 beds, and 5 percent had
more than 500 beds.6
admissions also continue to increase. In 1994, there were
roughly 33,125,000 admissions to U.S. community hospitals.
By 2001, this number had grown to 35,644,440, an increase
of 7.6 percent. In addition, outpatient visits to hospitals
in 1994 totaled 382,924,000; by 2001, this number jumped to
538,480,000, an increase of 40.6 percent.7
in Acute Care
Managers in an acute care setting constantly contend with
powerful and persistent forces for change. An annual environmental
assessment for acute care managers, Futurescan
identifies these forces for change and describes the implications
that leaders will face in the next six years. Following are
the key trends:
level and nature of demand for acute care services is changing.
After years of declining demand for inpatient services,
hospitals are facing dramatic increases in utilization,
especially for highly specialized services. Why? The U.S.
population is aging, and the elderly consume more acute
care. In addition, many people lack health insurance and
therefore use hospital emergency rooms as their only source
of care. In response to this increased demand, hospitals
have begun building and renovating to add capacity, but
finding the capital to pay for expansion is a serious challenge.
Simultaneously, consumers’ expectations have risen.
They increasingly expect convenience and quality of service
from hospitals to match what they receive in other areas
of their lives.
face increasing competition in delivering acute care services.
Hospitals used to compete only with other hospitals
based on the range of services they offered. Now they must
compete with physician groups that seek to increase revenues
by offering services once available only in hospitals. In
addition, the growth of specialty hospitals, which treat
only one kind of condition, can take away profitable business
from full-service hospitals. Competition is also based on
published rankings of hospital excellence. As consumers
gain more influence in deciding where they will obtain acute
care, being a “Top 100” hospital becomes critically
technology offers advantages and challenges. Acquiring
and applying technological advances can improve patient
safety and treatment results. But new technology is expensive,
and hospital leaders may have trouble finding the financial
resources to pay for advances. Experts recognize that the
expense of acquiring new technology is only the first cost
involved. The costs of implementing and operating these
innovations can be even greater, so hospital leaders must
be careful to calculate the actual return on investment
in new technology. This calculation can be controversial
because competition frequently exists between opposing champions
of different technologies.
grow while available capital may be shrinking. Hospitals
must not only have adequate financial resources to cover
current expenses but also amass sufficient investment capital
to acquire new technology. Hospitals are facing rapidly
increasing costs for wages and pharmaceuticals, a challenge
that makes it harder to generate profits. If hospitals are
not profitable, they lose the ability to acquire new technology
and replace outdated facilities.
adequate workforce is not guaranteed. Labor is
the biggest expense for hospitals. Already troubling to
acute care executives, labor shortages are expected to grow.
The most visible categories of workers in short supply are
nurses, pharmacists, and medical technologists. Hospitals
must compete to hire and retain these scarce resources—competition
that involves creating favorable working conditions as well
as offering favorable compensation packages.
quality and safety are musts. For years, it was
considered adequate to allow acute care clinicians to measure
and manage how hospitals performed in providing patient
care. Following the publication of a stingingly critical
report from the Institute of Medicine, patient safety and
quality of care became urgent concerns of new stakeholders,
including acute care executives, the public, employers,
government agencies, and insurance organizations. Hospital
performance is now being evaluated and publicized with straightforward
report cards. Higher-performing hospitals may be rewarded
with greater-than-usual reimbursement. Inferior performance
will be penalized.
College of Healthcare Executives
S. Department of Labor Bureau of Labor Statistics
Healthcare Association Glossary of Health Care Terms and
1, Selected Community Hospital Statistics: 1999-2003,
Centers for Medicare and Medicaid Services.
- Table 7, Selected National Economic Indicators: 1999-2003,
U.S. Department of Commerce, Bureau of Economic Analysis:
Survey of Current Business.
- Hospital Statistics, 2004 Edition, Health Forum,
- “By the Numbers,” Modern Healthcare, December
106, Hospitals, Beds, and Occupancy Rates, according to
Type of Ownership and Size of Hospital: United States, Selected
Years 1975–2001 (PDF), Health United States, 2003.
- “By the Numbers,” Modern Healthcare,
July 31, 2000.