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The health care industry will remain a reliable engine for job growth in coming years, but the pace is expected to slow as government and insurers seek to control costs and rein in reimbursement levels.

The impact of the changes sweeping the industry was felt last year, with the closing of hospitals in North Adams and Quincy, and major layoffs at UMass Memorial Medical Center in Worcester.

“We’re going from a rapid growth in employment and salaries in the first decade of the 21st century to moderate and modest growth in the second decade,” said Boston health care consultant Jon Kingsdale, the founding executive director of the Health Connector, the state’s insurance marketplace.

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So much for the sobering news. On the plus side, new opportunities are arising as the health care system adapts to reforms. More important, the aging population is increasing demand for nurses, physical therapists, nursing assistants, and home care workers.

“The wave of the future is going to be geriatrics,” said Tammy Retalic, chief nursing officer at Hebrew Rehabilitation Center in Roslindale, a division of Hebrew SeniorLife, a Boston elder care provider.

In general, state and federal efforts to overhaul health care are driving providers to emphasize preventive services and lower-cost settings. In its two-year forecast for 2013-2015, the state projects 6.8 percent job growth in outpatient health care services, compared with just 1.4 percent for hospitals. Meanwhile, the shortage of primary care physicians is increasing demand for nurse practitioners and certified midwives.

Bowdoin Street Community Health Center in Dorchester, a subsidiary of Beth Israel Deaconess Medical Center, exemplifies the new face of health care. Nurses play a greater role in managing the care of patients with complex medical conditions, helping to reduce trips to the emergency room. Medical assistants are more engaged in preventive work, following up on patients who may need mammograms or other services.

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Two newly defined positions, which pay in the range of $35,000 to $55,000, don’t require extensive medical training: Certified application counselors help residents navigate the complicated process of selecting health insurance. Community health workers spread out into the neighborhood; they may visit asthma sufferers to check their homes for possible allergens or diabetics to make sure they’re sticking to medical and dietary regimens (even sneaking a peek in the fridge).

“We are focused very much on the patient-centered medical home, more of a team-based approach to care delivery,” Adela Margules, executive director of the Bowdoin Street center.

The one sure place to find a health care job is in home care. The Home Care Alliance of Massachusetts, a trade group, provides links to a job bank on its website, thinkhomecare.org.

“You name it, in home health care we can do pretty much anything besides surgery and imaging,” said James Fuccione, director of legislative and public affairs at the Home Care Alliance.

Hebrew SeniorLife, which has rehabilitation facilities in Roslindale and Dedham, is undertaking a major initiative to expand its home-based services. Retalic, the chief nursing officer, envisions recruiting health aides, nurse practitioners, therapists, social workers, and others to serve on care teams for patients with chronic conditions or in hospice.

At the other end of the health spectrum, hospitals are making maximum use of employees’ certified skills, so that, say, a doctor isn’t performing tasks that a nurse is qualified to do. “We’re making sure everybody is working at the top of their license,” said Joanne Pokaski, director of workforce development at Beth Israel Deaconess Medical Center.

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While noting that it’s easier to fill jobs than a decade ago, she said the medical center is seeking nurses for general medicine and intensive care. She also cited opportunities in clinical documentation, medical coding, billing, and information technology.

The workers in greatest demand, she said, are in the lower skilled ranks, ranging from entry level jobs such as food service and custodial workers, to positions that require one-to-two years of training, such as patient care and pharmacy technicians.

These jobs can become the first rungs on the health career ladder. Many providers — from home care agencies to hospitals — offer training and tuition reimbursement programs to help employees advance to better and better-paying jobs. “If you’ve got great employees who fit with the culture here, it’s great to invest in them,” Pokaski said.


Steve Maas can be reached at stevenmaas@comcast.net.