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- Health associate professionals: skills opportunities and challenges (2023 update)
Health associate professionals: skills opportunities and challenges (2023 update)
Summary
The healthcare sector is one of the mainstays of the European economy, accounting for about 11 per cent of European GDP expenditure in 2020 (Eurostat). In 2021, health associate professionals, who worked mainly in the health sector, accounted for around 3 per cent of all employment in the EU. These workers have been at the forefront in coping with the recent Covid-19 pandemic and are important in facilitating the living conditions of Europe’s ageing population.
Health associate professionals form a significant part of the health sector’s workforce. They provide support to medical, veterinary, nursing and other health professionals in the diagnosis and treatment of illness, disease, and various kinds of injuries occurring in humans and animals. Jobs within this group include medical laboratory, pharmacy, nurse, and dental assistants, radiation therapists, dental, veterinary, and homeopathy technicians, maternity support workers, community health workers, food safety inspectors, and ambulance workers.
Key facts
- Around 6.1 million people were employed as health associate professionals in 2022, which accounts for 3 per cent of total EU employment.
- Between 2012 and 2022 employment for health associate professionals increased by almost 14 per cent. Over the same period employment across all occupations in the EU had increased by almost 8 per cent.
- Employment increased by 990 thousand workers between 2012 and 2019.
- Between 2019 and 2020, when the EU experienced economic lockdowns, close to 150 thousand health associate professional jobs were lost. Employment recovered almost completely in the following year, and by the end of 2021, it was only 4 thousand workers short of its 2019 level.
- Most health associate professionals – 76 per cent in 2021 - are employed in the health sector.
- More than half of health associate professionals have attained a qualification level of ISCED 3 (i.e., upper secondary education) and 4 (i.e., post-secondary non-tertiary education) in 2021. The qualification level of the occupation is not expected to change significantly over the period to 2035.
- Health associate professionals are mainly women (almost 80 per cent in 2021).
- By 2035, more than 600 thousand new jobs are expected to be created in this occupation. In addition to the new job creation, many health associate professional jobs will need to be filled in over the same period to cover those leaving the occupation due to retirement, estimated at almost 3.4 million persons. This means that an estimated 4 million job openings filled in between 2022 and 2035.
- Future demand for health associate professional skills will be affected by population ageing (which increases the demand for healthcare and the prevalence of diseases associated with older people), the emergence of new diseases brought by the changing European climate, and digital technologies (such as digital records) facilitating the work of health associate professionals.
Employment and job demand
Employment trends for health associate professionals were similar to all technician and associate professional jobs in the past decade. Employment slightly decreased at the height of the Covid-19 pandemic, but returned to the pre-pandemic growth trend in the next years.
Figure 1: Year-to-year employment change for health associate professionals (2013-2022)
Source: European Labour Force Survey. Employed persons by detailed occupation (ISCO-08 two digit level) [LFSA_EGAI2D__custom_7778289]. Own calculations.
About half of health associate professionals (45 per cent) are engaged as nursing and midwifery associate professionals. People employed in these jobs provide basic nursing and personal care to those physically or mentally ill, disabled or infirm, as well as to people in need of care due to potential risks to health including before, during and after childbirth.
More than a third of health associate professionals (36 per cent) are engaged as other health associate professionals. These workers provide support services in areas of medicine related to dentistry, optics and physiotherapy, while they also work in medical records administration, community health, environmental health, and emergency medical treatment.
Overall, 17 per cent of health associate professionals are engaged as medical and pharmaceutical technicians. These are workers who perform technical tasks (such as testing and operating radiographic, ultrasound and other medical equipment, administering radiopharmaceuticals, performing clinical tests on specimens of bodily fluids and tissues, and preparing medications) to assist in the diagnosis and treatment of illness, disease, injuries and impairments.
A few health associate professionals are engaged as veterinary technicians and assistants, who care for animals under treatment and in temporary residence at veterinary facilities. They assist veterinarians in performing procedures and operations through, for example, preparing the materials used in the examination of animals and getting animals ready for examination or treatment.
A small share of health associate professionals is engaged as traditional and complementary medicine associate professionals, who use herbal and other therapies based on theories, beliefs and experiences originating in specific cultures to prevent, care for and treat human physical and mental illnesses, disorders and injuries.
Over time, the share of other health associate professionals – those mainly working in dentistry, optics and physiotherapy – has increased slightly.
Figure 2: Employment in health associate professional jobs (in %)
Source: European Labour Force Survey. Microdata. Own calculations.
Nursing and midwifery associate professionals and other health professionals represent the highest share of OJAs for this occupation, corresponding with their dominant share of the occupation’s employment.
For more details on skills demand and job openings for this occupation, please access the Cedefop’s Skills OVATE tool.
Figure 3: Online job advertisements for health associate professionals (2022, in %)
Source: Skills in Online Job Advertisements indicator based on Cedefop’s Skills OVATE. Own calculations. Note: Online job advertisements are by definition not equivalent to job vacancies. See Beręsewicz (2021) or Napierala et al. (2022).
The health sector employs the majority of health associate professionals – over 75 per cent, although their employment in the trade and public administration sector has increased slightly in the past years.
Figure 4: The top sectors employing health associate professionals (in %)
Source: European Labour Force Survey. Microdata. Own calculations.
As regards the share of health associate professionals within sectoral employment, these workers form a significant portion of the workforce in the human health and social work activities sector. In 2021, health associate professionals constituted the second largest occupation within this sector (the first being health professionals), accounting for 21 per cent of its employment.
Germany is the leading country with the employment share of health associate professionals (over 6 per cent of the country’s employment). In most countries though, this share is usually somewhere between 1 and 2 per cent.
Figure 5: Health associate professionals as a share of overall country employment (2021, in %)
Source: European Labour Force Survey. Microdata. Own calculations.
Note: Data for CY, EE, IS, LV and LU have lower reliability because of the small sample size.
LFS data for MT are not available.
The workforce is composed mainly of women (almost 80 per cent in 2021). Slightly more health associate professionals are aged over 50 years old compared to the average across all occupations. In 2021, 30 per cent of health associate professionals were aged 50 to 64 years compared to 28 per cent across all occupations.
Figure 6: Health associate professionals’ workforce by age (in %)
Source: European Labour Force Survey. Microdata. Own calculations.
Health associate professionals are often employed part-time, much more frequently than what is the average for all occupations. However, only a small share of health associate professionals report having either part-time or temporary contracts involuntarily. Labour turnover in 2021 is close to the all-occupations average amounting to 8 per cent.
Figure 7: Contract and hiring trends for health associate professionals (in %)
Source: European Labour Force Survey. Microdata. Own calculations.
Skill needs and future trends
Health associate professionals’ work depends on strong interpersonal skills. They are also more frequently exposed to hazardous working conditions. They report only average digital skill needs as compared to all occupations average, aside from using digital devices for work.
Because of that, health associate professionals have on average lower digital upskilling needs, while their overall upskilling needs are relatively high. However, most health associate professionals seem to have good access to job skills training.
As one of the jobs facing difficult work conditions, it is remarkable that workers report above-average job satisfaction. Very few health associate professionals report concerns about losing their jobs – it correlates with their low unemployment rate and is likely related to significant job shortages.
Figure 8: Skills, training needs and job perception of health associate professionals (in %)
Source: European Skills and Jobs Survey. Microdata. Own calculations.
Unless stated otherwise, it is a share of people reporting that a task/skill is part of their job.
*Always or often
** Share of workers reporting these needs to a great or moderate extent.
Employment for health associate professionals is expected to increase by one-tenth over the period 2022 to 2035.
Employment growth will occur in most of the analysed countries in the future, but its level will vary country by country. 12 countries showed growth in the past decade, and it is forecast to do so in the next decade as well. Poland, Ireland, and Denmark are among those with the highest past and expected future growths, while Austria represents the opposite trend.
Figure 9: Past and expected future employment trend of health associate professionals
Source: European Labour Force Survey. Microdata. Cedefop Skills Forecast.
Note: Data for CY, EE, IS, LV and LU have lower reliability because of the small sample size.
LFS data for MT are not available.
New job creation is, however, not the main driver behind the job demand. Most job openings are a result of people leaving them for other opportunities, or those leaving the labour market completely (retirements; parent leave, etc.). This replacement demand for health associate professionals is estimated to be more than five times larger than the new job creation. Meeting this future demand may be challenging given the level of labour shortages currently reported for some jobs within this occupation.
Overall, when the expansion demand is added to the replacement one, an estimated 4 million job openings for health associate professionals will need to be filled in between 2022 and 2035.
Figure 10: Future job openings for health associate professionals (000s)
Source: Future job openings indicator based on the Cedefop Skills Forecast. Own calculations.
More than half of health associate professionals held medium-level qualifications in 2021 (i.e. at ISCED levels 3 or 4). This is not projected to change much by 2035. The share of workers with low levels of qualification (ISCED level 2 or lower) is projected to remain almost stable from 2022 to 2035, while the share of highly qualified workers (i.e. those qualified at ISCED level 5 and over) is projected to increase to 44 per cent within the same period.
Looking forward
The majority of health associate professionals (76 per cent in 2021, see previous sections) are occupied in the healthcare sector. A recent Cedefop (2023) report examined the evolving skill requirements for the care sector – which is a subset of the healthcare one - and identified various key factors that are likely to shape future employment demand in this sector. These factors are those that, to a certain extent, will also shape future skillsets for health associate professionals.
- Digitalisation and technological development have had a significant impact on the jobs of health associate professionals. The Europe’s Digital Decade policy programme includes a commitment to digitalise public health by providing access to digital health records for all Union citizens by 2030 (Decision (EU) 2022/2481). Access to clinical information through digitalisation and data sharing are key tools for the European healthcare systems. The European Commission recently presented a proposal for a regulation on the European Health Data Space, which aims to streamline health data sharing across Member States. Digital literacy will be a must in the future for health associate professionals in order to be able to access, update and share patients’ health data to improve the accuracy and accessibility of medical records. At the same time, they will need to know how to pay attention to data protection frameworks when dealing with sensitive patient data (Entzeridou et al, 2018).
- Technological changes also drive the heath sector towards more personalised healthcare. Personalised medicine aims to harness big data and digital tools to offer more precise treatment, by taking into account the individual characteristics of each patient (Aptekar et al, 2019).
- The potential of artificial intelligence’s (AI) application in medicine carries with it great promises if handled properly by tech-savvy staff (Cedefop, 2023). Increasingly large datasets of patient health records can fuel deep learning algorithms to perform specific tasks (Kulkarni et al, 2019). For example, digitalisation in radiology turns large amounts of data into insights for more precise diagnosis, targeted treatments, and greater patient satisfaction. New technologies include intelligent imaging, AI-powered clinical decisions and better streamlined operations (e.g. remote scanning software) (Siemens Healthcare, 2023). The use of telemedicine has allowed health associate professionals to provide remote care and consultations, which has become increasingly important during the Covid-19 pandemic. This has required professionals to adapt to new technologies and communications methods to be able to provide healthcare virtually and from a distance (WHO, 2022). While new technologies and digitalisation offer wide opportunities to improve the quality and accuracy of medical care in Europe, health associate professionals must be able to critically assess these innovations to understand how the algorithms, probabilities and datasets are used for automated diagnoses and care (Arora, 2020).
- Environmental and climate emergencies are major threats to public health, as human well-being is shaped by air pollution, heat waves, floods, water shortages, infectious diseases, respiratory and cardiovascular diseases, under-nutrition and mental ill-health (European Public Health Alliance, 2020). Sustainable healthcare is at the core of sustainable development goals, which in the EU are set within the framework of the European Green Deal presented in 2019. To foster greater sustainability, workers in the healthcare sector will have to ensure a better treatment of medical waste, including the segregation of hazardous and non-hazardous waste, as well as increasing recycling rates (Health Care Without Harm Europe, 2020). Measures advocated within the Commission’s Circular Economy Action Plan (2020) (such as pushing for technology development that will minimise the presence of harmful substances in recycled material) aim to achieve such targets. Circular healthcare is a sustainable framework to promote reuse, repair and recycling of toxic-free products and materials to minimise waste generation and exposure to harmful chemicals (Health Care Without Harm, 2023).
- Changing demographics in Europe – including an ageing population – will increase the need for staff in the healthcare sector. The share of very old people (aged 80 or above) is projected to have a two and a half fold increase between 2021 and 2100 (Eurostat, 2022). This will increase demand in areas of healthcare like long-term care (LTC) and chronic disease management (especially diseases that affect older people, like arthritis, mental health/dementia and sensory impairment), and palliative care (Eurostat, 2020). It is also projected that about half of Europeans will develop cancer at some point in their lives. Cancer is nowadays the leading cause of death among Europeans under 65 (JRC, 2022). This implies that nurses will increasingly be taking care of cancer patients as they are involved in direct and indirect care of people at risk. Considering the lessons learnt from the COVID-19 pandemic where nurses had to quickly adapt to various modes of treatment (e.g., involving multiple different prescriptions and coping with negative-pressure capsules), nursing professionals would further benefit from continuous professional development to be able to provide increasingly complex and personalised cancer treatments, nurse-led models of care and transitions to out-patient-based care (Drury et al, 2023). Health associate professionals will continue to work in environments that are increasingly taking care of older people, while applying novel technologies and interpersonal skills necessary for such specific conditions.
- A shortage of health associate professionals potentially threatens the possibility to fill in all the projected job openings to 2035. A recent report by the European Labour Authority found shortages in nursing associate professionals across 11 (i.e., a 40 per cent of the EU) Member States. Four of these countries mentioned the occupation as being in severe shortage. As nursing associate professionals belong to the largest sub-group of this occupation (comprising 45 per cent of occupational employment), shortages arise as an important issue that needs to be tackled.
The increase in the need for healthcare implies a rise in the need for health associate professionals. Slightly over half of health associate professionals have obtained a higher education diploma to work in their respective fields. Health associate professionals will develop their skills and knowledge in initial education, which is obtained through higher or vocational education – such as in nursing, physiotherapy, occupational therapy or medical laboratory science.
In some countries, like Germany, vocational education is the primary pathway for health associate professionals. The vocational training in Health & Nursing (ausbildung in Gesundheits- und Krankenpfleger/in) will combine theoretical knowledge with practical experience in the field. By the end of the three year study programme, the certification proves the ability to look after patients (administer medication, check for vital signs, and washing) and undertake organisational tasks (including provisioning of hygienic measures).
In other countries like Finland, health associate professionals must obtain higher education certificates. For example, the Midwifery Programme for Hospital Nurses at Tampere University trains future experts in nursing sciences in an international context by developing competences through theoretical studies and practical hospital trainings in the students’ home country. The training in Finland crosses themes on gynaecological nursing, sexual and reproductive health, ante- and postnatal care, and midwifery during normal and abnormal childbirth.
In addition to initial training, health associate professionals will need to upgrade and develop their skills in the changing workplace throughout their careers. Continuous learning can be achieved through various methods, offered by multiple stakeholders like education providers, sectoral alliances, or European projects.
For example, the ENhANCE project encompassing stakeholders from six EU countries aimed to develop a professional profile for Family and Community Nurses (FCN), who will be increasingly sought after in the context of an ageing population in Europe. In collaboration with higher education institutions, the project developed pilot courses/curricula for FCN, such as the FCN Curriculum developed at the University of Eastern Finland. The piloted learning experience is a 12 month online postgraduate course foreseeing 30 ECTS. Across eight modules, expertise in family and community nursing is developed through modules on health promotion, equality, equity and participation in health promotion, communication and interaction, health promotion and management, and prevention of health problems in different ages.
Meanwhile, the Healthcare Transformation Academy, run by the European University Hospital Alliance (EUHA) has designed a variety of courses and modules to ensure that healthcare professionals are equipped with adequate skills and knowledge necessary to keep up with innovation in medicine. In previous years, the Academy has developed courses with relevance for health associate professionals such as High Value Care or Digital Health Transformation. The course catalogue is updated on a yearly basis.
Micro-credentials are certified short-term learning experiences that allow to develop skills, competences, and knowledge on a specific topic for personal and professional development. For instance, the International Confederation of Midwives runs an e-learning platform that hosts a set of interactive and online resources/modules for upskilling (e.g. a module on Respectful Maternity Care). The course catalogue is accessible upon registration. An example of an e-learning opportunity for upskilling in intercultural geriatric nursing is presented below. The learning course has been developed by the GNurseSIM project, which addresses skills development in geriatric nursing.
E-learning course in intercultural geriatric nursing Europe is undergoing a demographic shift as the populations are moving more than ever nowadays and it is predicted that older adult population will considerably increase in the near future. Those social, demographic, and cultural phenomenons are making a high impact on the European countries’ health organisations and therefore health professions education and competencies should be adapted within the European context. Providing learners with the opportunity to engage and care for patients, not only from the clinical perspective but also from the social and cultural one, by considering their cultural background understood as: diverse ethnic heritages, gender roles, cultural characteristics, values, traditions, practices, lifestyles and religious beliefs is crucial to preparing them for the realities of their professional careers especially within the European Union where mobility of students and professionals is promoted. On the other hand, High Fidelity Healthcare Simulation is an effective educational tool in nursing education that allows students from different countries and cultures to master the principles of both Nursing Care and skills; and Culturally Competent Care. This type of simulation allows the learners’ contact with other cultural realities even when mobility is not either recommended or forbidden and may contribute to overcome future potential mobility restrictions and lockdowns, such as the ones recently experienced due to the COVID-19 pandemic or political conflicts. In line with this, we present numerous high fidelity simulation scenarios which could benefit Geriatric Nursing Care Simulation programs by including additionally such diversity-based training in their permanent curriculums throughout replicating real-world scenarios from different cultures in a controlled and nonthreatening environment due to the high-fidelity perspective. The GNurseSim Project Partnership major assumption is that by using Healthcare Simulation to educate and train for cultural competence, the research evidence is overwhelmingly clear as the potential exists for the use of high-fidelity patient simulation as an effective teaching strategy for cultural competency training. Source: GNurseSIM |
How to cite this publication:
Cedefop (2023). Health associate professionals: skills opportunities and challenges. Skills intelligence data insight.
Further reading
Aptekar, J., Donoghoe, N., Fleming, E., Reichert, M., Stanzl, E., Webster, K. (2019). ‘Precision medicine: Opening the aperture’, in McKinsey & Company: Life Sciences, article, published 6 February 2019
Arora, A. (2022). ‘Conceptualising Artificial Intelligence as a Digital Healthcare Innovation: An Introductory Review’, in Medical Devices; Evidence and Research, Vol. 13, pp. 223-230
Beręsewicz, M. and Pater, R. (2021). Inferring job vacancies from online job advertisements, Luxembourg: Publications Office, 2021. https://ec.europa.eu/eurostat/web/products-statistical-working-papers/-/ks-tc-20-008
Cedefop (2023). Skills in transition: the way to 2035. Luxembourg: Publications Office. http://data.europa.eu/doi/10.2801/438491
Decision (EU) 2022/2481 establishing the Digital Decade Policy Programme 2030, Official Journal of the EU, L323/4
Entzeridou, E., Markopoulou, E., Mollaki, V. (2018). ‘Public and physician’s expectations and ethical concerns about electronic health record: Benefits outweigh risks except for information security’, in International Journal of Medical Informatics, Vol. 110, pp. 98-107
European Commission (2020). A new Circular Economy Action Plan. COM(2020) 98 final
European Commission (2022) proposal for a regulation on the European Health Data Space. COM(2022) 197 final
European Labour Authority (2021). Report on labour shortages and surpluses.
European Public Health Alliance (2020). ‘A Healthy European Green Deal? Putting public health at the heart of the transition to sustainability’, briefing, July 2020
Eurostat (2020). Ageing Europe: looking at the lives of older people in the EU. Publications Office of the EU: Luxembourg
Eurostat (2022). Statistics Explained: Population structure and ageing.
Health Care Without Harm Europe (2020). ‘Sustainable healthcare waste management in the EU Circular Economy model’, position paper, November 2020
JRC (2022). ‘Cancer in Europe: 5 things the data tells us.’ News announcement, published 13 January 2022
Kulkarni, S., Seneviratne, N., Baig, M. S., Khan, A.H.A. (2020). ‘Artificial Intelligence in Medicine: Where Are We Now?’, in Academic Radiology, Vol. 27(1), pp. 32-70
Napierala, J.; Kvetan, V. and Branka, J. (2022). Assessing the representativeness of online job advertisements. Luxembourg: Publications Office. Cedefop working paper, No 17. http://data.europa.eu/doi/10.2801/807500
Data insights details
Table of contents
Page 1
SummaryPage 2
Employment and job demandPage 3
Skill needs and future trendsPage 4
Looking forwardPage 5
Further reading