Acute Care Career Overview


Introduction

Acute 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.


Career 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.

Due 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.

Each 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:


Hospital Highlights

Types of Hospitals

Hospitals 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.

In 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.

Hospital Statistics

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

Although 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

Hospital 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


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:

  • The 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.
  • Hospitals 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 important.
  • New 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.
  • Costs 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.
  • An 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.
  • Improved 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.

American College of Healthcare Executives

American Hospital Association

U. S. Department of Labor Bureau of Labor Statistics


Notes

  1. Delaware Healthcare Association Glossary of Health Care Terms and Acronyms.
  2. Table 1, Selected Community Hospital Statistics: 1999-2003, Centers for Medicare and Medicaid Services.
  3. Table 7, Selected National Economic Indicators: 1999-2003, U.S. Department of Commerce, Bureau of Economic Analysis: Survey of Current Business.
  4. Hospital Statistics, 2004 Edition, Health Forum, LLC.
  5. “By the Numbers,” Modern Healthcare, December 23, 2003.
  6. Table 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.
  7. “By the Numbers,” Modern Healthcare, July 31, 2000.