The old guard of employee health professionals are working deep into their careers, providing a critical safety net for healthcare workers as a possible demographic chasm looms.

Results of the annual Hospital Employee Health Salary Survey and Career Report show that 80% of respondents have worked in healthcare for 25 years or longer, though most of them not strictly in employee health.

Employee health professionals responding to the survey were primarily female nurses with a median age in the 55-60 range and a median income of $70,000-$79,999. Overall, 70% reported receiving a 1%-3% raise in the last year, but 15% reported their compensation unchanged.

With only 20% of respondents age 50 or younger, the HEH survey raises the question of whether there will be sufficient numbers to replace retiring employee health professionals in the twilight of their careers. Considering this question, Amber Mitchell, DrPh, MPH, CPH, president and executive director of the EPINet International Safety Center, gave a blunt, unvarnished answer: “No.”

“We have done a terrible job making employee and occupational health a ‘sexy’ field to enter,” she says. “We have to do better with our own sales and marketing. We have to show our younger colleagues, that well and fit employees make well and fit hospitals, businesses, communities.”

In danger of losing relevance in the shifting demographics of workers and patients in a healthcare system that is literally “re-forming,” employee health professionals need to know their value and make sure others know it.

“They are an army of practitioners that make working Americans their patients,” Mitchell says. “Without them, the machine — the economy — just doesn’t run. Without rallying behind our own paradigm shift — making ourselves relevant in discussions about our contribution to the economic viability of our nation — we are dooming our own profession.”

As reflected in past surveys, many employee health professionals come to their positions with years of healthcare experience. About half of survey respondents have worked in employee health 10 years or longer, with 38% in the field less than a decade.

Indeed, the demographic shift may be more ongoing than impending, as open jobs for employee health professionals are getting harder to fill.

“Occupational medicine recruiters are incredibly busy lately with open positions and not enough docs or nurses to fill them, and that has been the case for at least two years,” says William G. Buchta, MD, MPH, medical director of the Employee

Occupational Health Service at the Mayo Clinic in Rochester, MN. “The lack of training opportunities for occupational medicine providers is crucial with no quick answer on the horizon, and the same is true for nurses in general. Look at the demographics of your survey. Half of the respondents will be gone from the field in 5 to 10 years. There is a void, and it is only widening.”

The Ebola factor

The Ebola outbreak — particularly since two Dallas nurses were occupationally infected with the deadly virus — raised the profile and perceived importance of hospital employee health programs.

“Clearly, the populace became aware of the hazards involved in healthcare but also how effective appropriate PPE and procedures can be to protect them,” Buchta says. “Employee health certainly played an important role, such as in symptom monitoring for potentially exposed employees, immunization updates, and medical clearance to wear the PPE.”

While Ebola certainly put a spotlight on healthcare worker health, it also revealed problems with personal protective equipment that continue to be a challenge.

“Our memories are short,” Mitchell says. “While the Ebola crisis increased awareness broadly at the time and the months following, according to International Safety Center EPINet data, compliance with PPE use is lower than ever.”

Mitchell recently reported that in the last three years the percentage of blood and body fluid (BBF) splashes and splatters — mucocutaneous — exposures incidents among nurses compared to all other healthcare workers has increased from 47.7% in 2012 to 54% in 2014.1

In particular, high-risk eye exposures have increased from 60% in 2012 to 68% in 2014. A troubling corresponding trend is that use of goggles and face shields is falling. According to Mitchell, healthcare workers reporting BBF exposures to their eyes were wearing either goggles or face shields only 8.5% of the time in 2013 — and only 2.8% of the time in 2015.

The wildcard

The wildcard that could change this landscape dramatically is a possible landmark regulation to protect healthcare workers from infectious diseases by the Occupational Safety and Health Administration. OSHA has been considering regulating worker protection against infectious diseases in healthcare settings for several years and now has some potent political currency in the aftermath of Ebola. As outlined thus far a proposed OSHA rule would add new requirements for hazard identification, exposure control, and documentation. (See the December 2015 issue of Hospital Employee Health.) Such a regulatory requirement could empower employee health departments, improving wages and job security in an environment of heightened compliance demands.

Beyond infectious disease threats, there are a litany of other challenges that must be addressed if employee health is to remain a vital and attractive field for new professionals.

“I think we have gotten a handle on most of the infectious risks, and chemical risks are present but controllable,” Buchta says. “With a diminishing supply of workers, we need to retain the ones we have and to keep them healthy. We need to minimize burnout from overwork and the devastating effects of patient violence -- mostly unintentional but just as psychologically and physically impairing as when it is intentional. I would also focus on the unmeasurable but prodigious negative effect of presenteeism from employees struggling with their own health issues, putting patients at risk for medical errors.”

Still, there’s no question — from the perspective of sheer volume — the biggest ongoing threat to healthcare workers is exertion injuries due to patient handling and lifting, he says.

“We need to change the expectations of both healthcare workers and patients so that neither one is put in a compromised position when there are ample preventive measures for exertion injuries,” Buchta says. “The healthcare industry is loath to portray patients as hazards, but how can we claim that a semi-conscious, thrashing, asymmetrical, 300-pound bundle of flesh and bone is comparable to an inanimate 50-pound box? If our expectations of what is acceptable patient handling are more realistic, then we will retain healthcare workers and be able to attract more into the field.”

No HCWs, no healthcare

In the meantime, employee health professionals must continue to make the business case for the critical role they play in keeping a hospital or other setting up and running. If healthcare workers are not protected there will be a cumulative snowball effect on their facilities, Buchta warns.

“Injuries lead to absences, restrictions, and eventually job changes, putting more pressure on the remaining coworkers in an environment that is already understaffed,” he says.

Simply put, without healthcare workers, there is no healthcare, Mitchell says.

“Employee health professionals need to draw business parallels to administration in their facilities,” she says. “They need to beef up their ability to market and sell themselves. Draw direct lines to their impact and importance. Imagine a hospital running without a CEO. Maybe they could go a day or two or a week or two. Now, imagine a hospital running without its nurses and doctors and technicians because they are all out with occupational illness or infection or injury. Maybe the hospital could go a minute or two.”


  1. Mitchell, AH. Occupational Risk on the Rise: Turning a Blind Eye. November 14, 2015: