Just over a generation ago, tens of thousands of Baltimore workers were set for life (or so they thought) with well-paid unionized jobs and benefits at leviathan companies like Bethlehem Steel and General Motors.
Yet by the 1980's, as industrial jobs and corporations withered, employment opportunities for many of the region's residents began to vanish, too.
At its peak in 1959, Beth Steel employed 31,000 people at its Sparrows Point factory, says Bill Barry, director of labor studies at the Community College of Baltimore County's Dundalk campus. Today, the recently sold plant has only 2,300 union workers (though they're producing nearly the same amount of steel). General Motors employed more than 6,000 people at its Broening Highway plant at its height in the 70's, company spokesman Dan Flores said. By 2004, fewer than 1,000 worked there; the next year, the plant closed for good.
But unlike so many of the rust-belt cities that were crippled by the loss of the manufacturing sector, Baltimore happened to have an ace up its sleeve. It had the building blocks for what would become one of the 21st century's most important businesses: healthcare. The city's two major hospitals—Johns Hopkins and the University of Maryland Medical System (UMMS)—blossomed, as did regional medical centers, like Greater Baltimore Medical Center. Traditional medical institutions evolved into healthcare industry behemoths, and the engines that now propel much of Baltimore's economy.
"Healthcare is our strongest industry," says Donald C. Fry, president and CEO of the Greater Baltimore Committee.
Of course, laid-off factory workers didn't march straight to well paying hospital jobs. Baltimore's transformation from manufacturing Mecca to healthcare hub came as the economy changed, too, adds CCBC's Barry. A generation ago, unionized factory workers expected full-time work and lifetime employment in a "high-benefits" economy. Many hospital jobs today offer low wages, part-time hours, limited benefits, and little job security—think janitors and security guards, not doctors and nurses.
"An unskilled hospital worker struggles to make $9 an hour," Barry says. That's less than $19,000 if working full time, compared with a steel worker in Baltimore who today earns around $100,000. Still, while many of the new jobs created in the hospitals are not high-paying, some of the ancillary jobs are: lab technicians, administrators, and even skilled construction workers for new buildings.
The ascent of hospitals and the decline of factories occurred independently of one another, like ships passing in the night.
The growth of hospitals was encouraged by sweeping regulatory changes in the 1980's. The next decade brought new technology that transformed how people cope with serious illness, Maryland Hospital Association spokeswoman Nancy Fiedler says. Medical conditions that were once nearly always fatal (like breast cancer and heart disease) became chronic, manageable conditions—conditions that require lots of doctor visits and support procedures like MRIs and radiology work, Fiedler adds.
By 2006, healthcare had gained more than 26,000 jobs, while manufacturing shed nearly 46,000 positions, according to the U.S. Bureau of Labor Statistics. State officials see Maryland adding 58,000 healthcare jobs between 2004 and 2014.
"There's no question that we've seen a transformation over the last couple of decades away from industry," says Ronald Peterson, president of The Johns Hopkins Hospital & Health System. "Healthcare has become one of the mainstays for this economy." Peterson started at Johns Hopkins Hospital as an administrative resident back in 1973, a time when the hospital employed 4,200 people; now, Johns Hopkins Medicine employs 16,000 people at three hospitals. Hopkins Health System—which excludes the medical school and university—has an operating budget of $2.5 billion for 2007, and that's not counting the $429 million being spent locally this year on new construction.
In 1984—the same year Hopkins bought and absorbed the city's hospital system—the University of Maryland Medical System changed from a public institution to a private not-for-profit corporation. UMMS began to work to become a competitor to Hopkins.
Today, UMMS is an eight-hospital system awash in new buildings, profitable balance sheets, and beefed-up cardiology and transplant programs. The system spends $1.9 billion a year in salaries and purchases of medical supplies and drugs, says Robert A. Chrencik, the system's executive vice president and chief financial officer.
"Across the state," says UMMS's Chrencik, "it's a pretty potent economic entity."
Today, in East Baltimore, Hopkins is the major player in an 80-acre bioscience park that's expected to create 4,000 new jobs. The University of Maryland in Baltimore, meanwhile, is building an eight-acre biotech park that will create 2,000 new jobs.
And while Hopkins and Maryland are the obvious big boys of Baltimore healthcare, four other city hospitals (Bon Secours, Mercy, Sinai, and St. Agnes) are among the city's largest employers, each with 1,000 or more workers.
Across the state, the number of hospital employees has more than doubled since 1972 to 84,000 today.
"That number," says the Maryland Hospital Administration's Fiedler, "is only going to continue to increase."