How network analysis reveals hidden health care career pathways

Understanding health care worker transitions among and between occupations is vital for strengthening career pathways, improving workforce mobility and addressing staffing shortages across the sector.

The Indiana Business Research Center (IBRC), as part of a federal Workforce Data Quality Initiative (WDQI) grant from the U.S. Employment and Training Administration, recently concluded research seeking to answer a few seemingly simple questions:

1. How do workers in the health care sector move between jobs?
2. What kinds of job transitions yield the greatest income boosts?
3. Which health care career pathways support worker mobility and career advancement?

A fair amount of workforce research relies on what workers say they'll do (surveys) or what experts think they should do (prognostication). We wanted to know what actually happens within Indiana’s incumbent health care workforce. Working with anonymized longitudinal wage records from the Indiana Department of Workforce Development (DWD) spanning from 2017 to 2024, we observed workers as they moved between specific occupations from quarter to quarter. This was made possible thanks to detailed standard occupational classification (SOC) codes that employers voluntarily submit with each wage record.¹

What we discovered both aligns with and challenges conventional wisdom about health care career progression. While there were some predictable career ladders — nursing assistants to registered nurses was the most common transition — there were many examples that diverged from our expectations. Indiana’s health care workers move through a complex network where some jobs act as major hubs connecting dozens of career paths, while others serve as stepping stones to higher-paying roles (see Figure 1). These patterns illuminate leverage points where targeted investments can deliver the biggest returns for both workers and employers.

Figure 1: Example of the health care occupation network graph

Source: IBRC and author’s calculations, using DWD wage records

Three types of health care jobs

We determined that the best way to analyze worker transitions from one job to the next was by building a network graph to connect the data and reveal the pathways. Visualizing the transitions in this way allowed us to spot trends and calculate various network metrics. In doing so, we observed three broad, not-mutually-exclusive types of health care jobs:

1. Hub jobs: Highly connected roles that serve as gateways into health care and launching pads to other jobs. Examples include health care support workers, nursing assistants and registered nurses.
2. Stepping-stone jobs: High-turnover roles where workers frequently transition into other positions. Examples include personal care aides, secretaries/administrative assistants and health care support workers.
3. Periphery jobs: We identified two sub-types of periphery jobs: (1) specialized, high-barrier-to-entry roles requiring several years of advanced training that workers typically stay in longer term, and (2) generalist support roles that exist across multiple industries. Examples of (1) include general internal medicine physicians, emergency medicine physicians and orthodontists; examples of (2) include security guards, financial managers and driver/sales workers.

We identified these categories using both quantitative network measures and qualitative analysis of transition patterns. The following sections explore each type and what they reveal about Indiana's health care workers and their career pathways.

Hub jobs

Hub jobs are situated near the center of the network and have the highest degree centrality, meaning they are connected to a lot of other jobs in the network. This indicates these jobs are frequent entry points into the health care sector and gateways to other jobs. The jobs in Table 1 have the highest degree centrality, which is calculated as in-degree centrality plus out-degree centrality. In-degree centrality is the count of transitions into the job, and out-degree centrality is the count of transitions out of the job.

Table 1: Network centrality metrics for the ten jobs that are most central in the health care sector

Source: Author’s calculations and the IBRC, using DWD wage records

The dominance of support roles reveals something important about health care career pathways. Health care support workers, nursing assistants and personal care aides, among other support roles, serve as the system’s main on-ramps, where workers gain hands-on experience, build professional networks and may decide to further their education. This makes them natural launching points for advancement into nursing or specialized roles. Supporting transitions out of these roles for more experienced workers, while also encouraging new entrants for early-career health care professionals, can both improve retention and expand the nursing pipeline.

Registered nurses, while also highly connected, represent a different type of hub: They’re both a common destination for career enhancement and a platform for further specialization into areas like emergency medicine, pediatrics or health care management and administration.

Stepping-stone jobs

Stepping-stone jobs are typically high-turnover roles that have relatively many outbound transitions. We identified stepping-stone jobs with a novel but simple measure we call the job switch index (JSI), defined below. For occupation :

So, for example, say there are a total of 100 workers with the occupation home health aides (SOC 31-1121) in the health care sector over the eight-year period. If 75 workers transition out of this job into 20 different jobs, then the JSI for home health aides would be:

We calculated the JSI for the nearly 250 unique occupations² observed in the health care sector over the study period. See Table 2 for the ten jobs with the highest JSI.

Table 2: Job switch index and related metrics for top ten stepping-stone occupations in the health care sector

Source: Author’s calculations and the IBRC, using DWD wage records

As you can see, there’s quite a bit of overlap between the hub and stepping-stone occupations, particularly for entry-level roles like nursing assistants, medical assistants, personal care aides and home health aides. Intuitively, this makes sense: Entry-level jobs are plentiful and highly connected (contributes to “hub” status), but they are also often high-turnover, jumping-off points to higher-paying jobs (contributes to “stepping-stone” status).

Periphery jobs

These are jobs located at the periphery of the network and have little overlap with the previous two types. Periphery jobs have high eccentricity, low closeness centrality and a low JSI, and we qualitatively break them into two sub-types: high-barrier-to-entry, specialized jobs and general support jobs. Eccentricity measures how far a job is from the center of the network; high eccentricity means fewer connections to other health care occupations. Closeness centrality measures how quickly a job can reach all other jobs in the network; low closeness means longer, more indirect pathways to other health care roles.

Table 3 shows the top periphery jobs by sub-type, along with their values for eccentricity, closeness centrality and JSI.

Table 3: Top periphery jobs and related metrics by sub-type in the health care sector

Source: Author’s calculations and the IBRC, using DWD wage records

The highly specialized roles, such as physicians and psychologists, require extensive education and credentials, which naturally limit the number of transitions into and out of these occupations. While they are critical to health care delivery, their isolation in the network suggests limited short-term mobility for workers without significant training. The generalist support roles, on the other hand, don’t require as much training, but are not tightly integrated into health care-specific career pathways. Their peripheral position may indicate that workers in these roles are just as or more likely to exit the health care sector entirely, rather than transition within it.

Which job switches yield the greatest wage increases?

Key to developing health care career pathways is understanding which job transitions result in the highest wage increases. Switching jobs, particularly under uncertain economic conditions, can lead to pay disruptions for workers and workforce capacity challenges for employers. Understanding which transitions deliver wage gains helps workers make strategic career decisions and helps employers and policymakers focus their training investments.

Figure 2 shows the wide range of wage outcomes we observed among job switchers in the administrative wage records. The bubble chart shows the number of transitions between occupation pairs on the X-axis, the average annualized wage change resulting from the transition on the Y-axis and the percent wage change as the bubble color. Most transitions yield wage gains, but several result in wage losses.

Figure 2: Health care job transitions volume and wage impact, 2017-2024

Note: Quarterly wages are annualized and adjusted to 2023 dollars.
Source: IBRC and author’s calculations, using DWD wage records

The volume of transitions from nursing assistants to registered nurses shouldn’t surprise anyone, but the wage increase of nearly $26,000 (106%) is substantial. It’s notable that medical assistants to registered nurses doesn’t yield as much of an increase, but medical assistants had an average wage about 55% higher than nursing assistants. Note that the wage records don’t currently track hours worked; part-time and full-time workers are comingled in our data set, which makes the wage comparisons a little fuzzy.

Observations where the destination occupation is one of three “hub” jobs are labeled: registered nurses, nursing assistants and health care support workers, all other. You can see that the vast majority of transitions to one of these jobs resulted in a wage bump. The transitions to registered nurses generally yielded the greatest wage gains.

Figure 3 provides further evidence of the transition to registered nurses being among the most lucrative in the data set. The heat map shows origin occupations along the left-hand side, destination occupations along the bottom and the number of workers who made the transition in the boxes, while the coloring represents the average annual wage increase.

Figure 3: Career transition pathways heat map

Note: Quarterly wages are annualized and adjusted to 2023 dollars.
Source: IBRC and author’s calculations, using DWD wage records

From a policy perspective, these origin jobs can be targets for upskilling to equip workers with training to gain employment in the destination jobs. The number in each cell shows how many workers actually made that transition over the eight-year period, indicating both the scale of opportunity and existing demand for these career pathways.

Multiple pathways lead to registered nursing, not just from nursing assistants, but also from medical assistants, home health aides and other support roles. This suggests that RN training programs could draw from a diverse pool of experienced health care workers. Indiana has a well-documented nursing shortage: This spring, the Indiana Hospital Association found that Indiana had 4,300 nursing job openings, and that it will need to fill all these positions plus hire an additional 5,000 nurses by 2031 to meet projected demand.³

Indiana can leverage its existing health care workforce by creating targeted pathways to nursing for these workers already gaining experience in hospitals, doctor’s offices and home care settings. By investing in career pathway programs that recognize and build on this experience, the state could make a dent in its nursing shortage while creating advancement opportunities. One example of this is Ivy Tech’s Transition to Associate of Science in Nursing (ASN) degree program, which is designed for students who are licensed practical nurses, certified medical assistants and paramedics who want to become RNs. These students can earn an ASN in about three semesters. Expanding these accelerated health training programs at Ivy Tech and other Indiana colleges and universities, while preserving academic quality, could help the state build the nursing workforce it urgently needs.

Conclusion

If you’re a passive follower of the field, it may seem that economic developers tend to focus more heavily on prospective employers and workers than the companies and workers who are already here. In the most high-profile cases, it’s not a surprise to hear that a state economic development agency has offered tens or even hundreds of millions of dollars in tax incentives to try to land this or that Fortune 500 company, data center or AI startup.

While this article isn’t debating the merits of using tax instruments to lure companies, we bring it up as a contrast to our approach, which, by virtue of using administrative wage records, focuses on the incumbent workforce: those who already work in Indiana. In an era of increased belt-tightening and austerity, it’s never been more important to devise creative approaches to growing your own workforce.

In the context of our network analysis of the health care workforce, “growing your own” asks Indiana policymakers to take a few actions that could be momentous for the future of the sector:

1. Support employment in entry-level but foundational health care jobs, such as nursing assistants, medical assistants, personal care aides and health care support workers. Supporting these jobs creates ripple effects throughout the entire health care system. Investments to upskill nursing assistants, for example, don’t just fill nursing assistant roles; it creates pathways to several other health care careers.
2. Invest in these foundational roles by providing training dollars for workers to continue their education and transition into higher-paying, in-demand health care jobs. Rather than spreading training resources thin across all health care jobs, target the pathways that combine high volume with wage gains, as revealed in the heat map in Figure 2.
3. By building clear advancement pathways, Indiana can retain health care workers who otherwise might leave the sector or the state. The data suggests many workers use accrued experience to leave health care for other industries; better pathways, supported by training dollars for high-demand roles, could help keep talent in the state and in the sector.

The network approach suggests that Indiana’s health care workforce challenges are also opportunities. By understanding how workers actually move through jobs, policymakers can make strategic investments that strengthen career pathways, address staffing shortages and boost workers’ earnings. This data-driven approach to workforce development offers a roadmap for cultivating a more robust health care sector while maximizing returns on public investment.