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Executive Summary

Q4 HWS Labor Market Pulse® Index

LMPI Composite Index (historical)

January 2010

HWS is pleased to announce the release of Q4 results for the HWS Labor Market Pulse® Index (LMPI). The HWS LMPI is a leading indicator of local health care labor market demand as it is derived from announced expansion and contraction plans, among other data. The Index measures where near-term demand for health care workers is strongest based on a number of tracking variables including temporary health workforce shortages and surpluses, facility and bed closures, announced layoffs and expansions, and local economic trends.

2009 Fourth Quarter LMPI Highlights

• Near-term demand for health care workers is growing fastest in Sacramento, Riverside/San Bernardino, Pittsburgh, Cleveland and Dallas, indicating broadening strength across a number of regions.

• Much of the growth is being fueled by newly announced expansion plans and larger facility openings at organizations including Mercy San Juan Medical Center in Sacramento, the University of Pittsburgh Medical Center, the Cleveland Clinic and University Hospitals in Cleveland, and Texas Health Resources in Dallas.

• Of the 30 major markets tracked by the HWS Labor Market Pulse Index® (LMPI), the slowest area for the quarter, the New York metro/Northern New Jersey area, remained relatively flat, dropping just 4% from the prior quarter.

• The LMPI composite index, a representative basket of the 30 largest markets, posted a robust 19.5% increase in the fourth quarter of 2009 from the third quarter of 2009 and was up 17.3% compared to the fourth quarter of 2008.

• For the fourth quarter ended 12/31/09, 21 markets of the 30 tracked by the LMPI showed signs of accelerated expansion (vs. 16 in the prior quarter)

2009 Fourth Quarter LMPI Market Highlights

Atlanta-Sandy Springs-Marietta, GA
The demand for health care workers in the Atlanta metropolitan area remained strong during Q4. Of note were large announced expansions at Tanner Health Systems and Kaiser Permanente. Tanner, which expects to invest $200 million to double its ER capacity and boost surgical capacity by two thirds, expects to create up to 350 jobs with its project. Kaiser Permanente is also planning a $400 million expansion expected to create 500 new jobs in the ATL in the coming years.

Baltimore-Towson, MD
The demand for health care workers in the Baltimore metropolitan area remains somewhat strong despite a slight drop-off from the prior quarter, which was marked by a notable announced expansion at Sinai Hospital.

Boston-Cambridge-Quincy, MA-NH
The growth in near-term demand for health care workers in the Boston metropolitan area remained steady for Q4. Of note, Beth Israel Deaconess completed a $30 million expansion in Needham, which will add 19 patient bays and special pediatric facilities designed to handle as many as 20,000 patients annually.

Charlotte-Gastonia-Concord, NC-SC
The demand for health care workers in the Charlotte metropolitan area improved significantly during Q4 and continues to remain strong. The number of workers required to meet announced expansion plans will likely exceed the number of announced positions eliminated or deferred. Of note were announced expansion plans at Carolinas Medical Center- NorthEast, which announced a three phase plan that will add a 32-bed second surgical floor, energy plant upgrades, and a new tower at the Concord campus. This comes as CMC-Mercy completes a $95 million upgrade that added a 150,000 square foot medical office building and a dozen state of the art operating rooms.

Chicago-Naperville-Joliet, IL
The near-term demand for health care workers in the Chicago metropolitan area held steady during Q4 for the second consecutive quarter, after a notable downturn during Q2. Of note during the quarter, Alexian Brothers Health System announced plans to build a $117 million extension of its Hoffman Estates facility that would convert all 230 beds into private rooms.

Cleveland-Elyria-Mentor, OH
The near-term demand for health care workers in the Cleveland metropolitan area improved considerably during Q4 driven by notable job expansion announcements from the areas largest employers. Of note, the Cleveland Clinic announced plans to add 1,800 jobs ranging from doctors to support staff in 2010. This announcement came on the heels of a similar announcement from University Hospitals, the region’s second largest health system, which said it would add 550 workers in 2010, including many physicians.

Dallas-Fort Worth-Arlington, TX
The demand for health care workers in the Dallas-Fort Worth-Arlington metropolitan area grew in the fourth quarter of 2009 and the number of workers required to meet announced expansion plans remained inadequate. The HWS Labor Market Pulse TM Index points to a likely continued increase in the rate of near-term health care employment growth in the DFW area into the spring. Fueling much of this growth were recent announced expansions at Texas Health Harris Methodist Hospital, Texas Health Arlington, Continuum Rehabilitation Hospital, and Baylor, as well as new facility openings at Texas Health Presbyterian and Methodist Charlton.

Denver-Aurora, CO
The demand for health care workers in the Denver metropolitan area continued to hold steady during Q4 and the number of workers required to meet announced expansion plans will likely exceed the number of announced positions eliminated or deferred. Of note, the Eating Recovery Center, a behavioral hospital, opened 12 new inpatient and residential beds during the quarter.

Detroit-Warren-Livonia, MI
After a difficult year the demand for health care workers in the Detroit metropolitan area finally appears to be improving. Of note during the quarter, William Beaumont Hospitals opened a new outpatient infusion center; Henry Ford Health System, Sinai-Grace Hospital and Nephron Associates announced plans to collaborate on a dialysis center; and the Von Voightlander Foundation gave the University of Michigan Health System a $15 million gift to help fund construction of a women’s hospital, scheduled to open in 2012.

Houston-Baytown-Sugar Land, TX
The near-term demand for health care workers in the Houston-Baytown-Sugarland metropolitan area remained strong during the fourth quarter of 2009 despite a slowing from the prior quarter. Of note during the quarter were a number of announced expansions including a new $60 million, 60,000-square foot Christus Health hospital and 40,000-square foot medical office in Alvin that includes a 26-bed, 60,000 square foot hospital and a 40,000 square foot medical office building. Additionally, Memorial Hermann announced plans to break ground during the first half of 2010 on a new seven-story patient tower on it 20-acre medical cam pus in the Woodlands, north of Houston.

Kansas City, MO-IL
The demand for health care workers in the Kansas City metropolitan area improved during Q4, driven primarily by newly announced plans by Childrens Mercy to build a 73-room patient tower on its Hospital Hill campus and an outpatient clinic in Independence, continuing a master plan announced two year ago. Also of note, the Kansas City University of Medicine and Biosciences could boost its enrollment by nearly 60 percent through a plan the school is developing with Missouri Southern State University in Joplin. Finally, the University of Kansas ceremonially launched a new school in Wichita to turn out more rural pharmacists.

Las Vegas-Paradise, NV
The near-term demand for health care workers in the Las Vegas metropolitan area improved slightly during the fourth quarter of 2009, despite no major workforce-related announcements.

Los Angeles-Long Beach-Santa Ana, CA
The near-term demand for health care workers in the Los Angeles metropolitan area improved during the fourth quarter of 2009. Of note during the quarter, the UC Regents approved plans to provide doctors and residents for Martin Luther King Jr. Hospital and will fully reopen the facility by 2012, restoring ER and inpatient services to the estimated 600,000 people in the area. Also of note, Miller Childrens in Long Beach opened its new inpatient pavilion in December, a four-level 124,000-square foot building that houses a pediatric surgery center - the only one in South Los Angeles County - 24 additional NICU beds and a state-of-the-art pediatric imaging center.

Miami-Fort Lauderdale-Miami Beach, FL
The near-term demand for health care workers in South Florida during the fourth quarter remained steady from the prior quarter. Of note, Joe DiMaggio Childrens Hospital is now its own entity, as Memorial Healthcare System, its parent, broke ground in October for a new 5-acre $130 million new facility. The new facility will have 160,000 square feet of medical space and connect to the current facility that Joe DiMaggio Children’s Hospital shares with Memorial Regional Hospital. On a disappointing note, Jackson Health System announced plans to lay off 150 employees although only 93 will actually lose jobs.

Minneapolis-St. Paul-Bloomington, MN-WI
The near-term demand for health care workers in the Minneapolis-St. Paul metropolitan area held relatively steady during Q4 despite notable news. Maple Grove Hospital opened, the first Twin Cities hospital to open in a decade. The $138.0 million, 225,000-square foot facility has 30 private patient rooms and a staff of 200 that is expected to double to 400 by the end of 2010. Also noteworthy, Children’s Hospitals and Clinics of Minnesota opened a new neonatal intensive care unit at its Minneapolis campus. On a negative note, Hennepin County Medical Center announced 150-200 jobs cuts during the quarter as part of a new budget designed to save $15 million. It also announced the closure of the Senior Clinic at its main Minneapolis campus, as well as its outpatient cardiac rehabilitation program. Finally, Gillette Children’s Hospital announced plans to begin construction on a $42 million expansion in St. Paul that would house several outpatient services.

New York-Northern NJ-Long Island, NY
The near-term demand for health care workers in the New York metropolitan area slowed during the fourth quarter but the number of workers required to meet announced expansion plans will likely exceed the number of announced positions eliminated or deferred. Notably during the quarter, St, Vincent’s Hospital announced it was laying off 180 citing severe financial shortfalls stemming from the recession and a series of significant funding cuts. Also, after years of struggling financially, Lenox Hill Hospital-one of the last independents in the city- is finally closing and has issued a request for proposals in the hope of arranging either a merger or an affiliation with one of its stronger rivals.

Orlando-Kissimmee, FL
The Orlando health care labor market remained stronger than much of the rest of the country during the fourth quarter and continued to grow. Unlike most major markets in the country right now, the number of workers required to meet announced expansion plans in Orlando remains inadequate. Notably during the quarter, South Lake Hospital announced plans to issue $50.9 million in bonds to fund construction of a $47 million patient tower that will add eighteen inpatient rooms, a new lobby and an expanded pharmacy, lab and diagnostic services, and treatment areas. Florida Hospital also announced plans to increase the number of operating rooms on its campus by 50% to six. Celebration Health began construction on a new five-story patient tower that will double its current capacity and include 128 new beds, 24 new ED bays, three operating rooms, and a number of renovations. Finally, Gentiva Home Health, announced plans to hire 75 people in the area next year.

Philadelphia-Camden-Wilmington, PA, NJ, DE, MD
The near-term demand for health care workers in the Philadelphia metropolitan area got big a boost during the fourth quarter of 2009 from a number of major expansions plans and openings announced during the quarter. The number of workers required to meet announced expansion plans will likely exceed the number of announced positions eliminated or deferred. Of note, the Rothman Institute, the region’s largest orthopedic practice, opened a 60,000-square foot specialty hospital in Bucks County that has six operating rooms, 24 patient beds, and ER, a lab and imaging capabilities. Temple University also announced the opening of its new medical school building in October. Additional growth in the area came from a number of Chester County Hospitals that announced notable expansions as well. These include Jennersville Regional, Phoenixville Hospital, Brandywine Hospital, and Paoli Hospital, which is part of Main Line Health.

Phoenix-Mesa-Scottsdale, AZ
The near-term demand for health care workers in the Phoenix metropolitan area continued to remain strong during the fourth quarter of 2009 and the number of workers required to meet announced expansion plans will likely exceed the number of announced positions eliminated or deferred. Of note during the quarter, M.D. Anderson Banner Cancer Center broke ground on a new 120,000 square foot outpatient center in Gilbert, adding to the region’s growing cachet as a cancer research and treatment hub. The University of Arizona is also moving ahead with its own $140 million cancer center on the Phoenix Biomedical Campus. Additionally, United Surgical Partners International also began construction on a $57 million orthopedic specialty hospital that will employ 140 people when it opens in 2011.

Pittsburgh, PA
The near-term demand for health care workers in the Pittsburgh metropolitan area continued improved considerably during the fourth quarter of 2009. Of note, UPMC announced plans to hire 6,000-8,000 new workers during 2010 depending on the outcome of health reform. UPMC, Excela Health, MedExpress and Heritage Valley are also each planning new urgent care centers. Additionally, Cedars of Monroeville is expecting to open an $8 million inpatient hospice on its campus during the first quarter of 2010. The 16-bed center will be the first of its kind in Pittsburgh’s eastern suburbs.

Portland-Vancouver-Beaverton, OR
The near-term demand for health care workers in the Portland metropolitan area held relatively steady during Q4 with no notable workforce-related news.

Riverside-San Bernardino-Ontario, CA
The demand for health care workers in the Riverside-San Bernardino metropolitan area improved considerably during the fourth quarter of 2009 after a couple of flat quarters. Of note, the state agency that oversees hospital construction gave final approval to plans for Temecula’s first medical center, planned for a vacant site off Temecula Parkway. The 320-bed hospital, long sought by city officials, is expected to break ground early this summer. Also of note, work progresses on a new hospital in Fontana, one of two hospitals Kaiser is building in the area, including a 224-bed facility slated to open in 2011 in Ontario. The combined capacity of the Fontana and Ontario hospitals will result in a new increase of 114 patient beds in the area.

Sacramento-Arden-Arcade-Roseville, CA
After a fairly challenging year, the Sacramento health care labor market is finally strengthening. Of particular note during the quarter, Mercy San Juan Medical Center opened a six-story patient tower in December that added 100 beds and will create 300 new jobs in northern Sacramento County by the time the tower reaches capacity. Also of note, Kindred Hospital expects to complete its current expansion next spring, which will boost capacity by 50% and bring at least 50 new jobs to Folsom.

San Diego-Carlsbad-San Marcos, CA
The growth in near-term demand for health care workers in the San Diego metropolitan area remained steady for Q4. Of note, Premier Inc. plans to cease operations in San Diego in 2011, its longtime headquarters, and consolidate in Charlotte.

San Francisco-Oakland-Fremont, CA
The near-term demand for health care workers in the San Francisco metropolitan area improved notably during Q4 after a poor Q3 marked by significant layoffs at Kaiser Permanente. Of note during the quarter, three major Oakland hospitals (Kaiser Oakland, Alta Bates Summit, and Alameda County) are moving forward with expensive rebuilds as Children’s Hospital in Oakland weighs its options as well. San Ramon Regional broke ground on a $10.7 million ER and clinical lab expansion project. This comes on the heels of celebrating the opening of its renovated Breast Cancer Center that opened earlier in October. And perhaps most notably, a new nine-story San Francisco General Hospital broke ground in October and is expected to open in time for the 2015 deadline set by the state for hospitals to meet seismic requirements.

San Jose-Sunnyvale-Santa Clara, CA
The demand for health care workers in the San Jose metropolitan area remains somewhat strong despite a slight drop-off from the prior quarter. Of note during the quarter, Menlo Medical Clinic opened an 18,000-square foot second location where and estimated 75,000 patients will be seem in 2010 for primary care and outpatient surgical procedures.

Seattle-Bellevue-Everett, WA
The near-term demand for health care workers in the Seattle metropolitan area held relatively steady during Q4. Of note, MultiCare Health System filed plans to build a 58-bed $174 million hospital in Covington, in South King County, expected to open by 2015.

St. Louis, MO-IL
The near-term demand for health care workers in the St. Louis metropolitan area continued to remain steady during the fourth quarter of 2009. Of note during the quarter, SSM DePaul Health Center completed its first ever capital campaign by raising $2.2 million to expand and renovate its ER. SSM also announced a joint venture with Select Medical Corp., to provide expanded rehabilitation care to the Greater St. Louis area. The JV encompasses 80 inpatient rehabilitation beds, 33 outpatient physical therapy centers, 33 occupational medicine clinics and contract therapy and staffing services.

Tampa-St. Petersburg-Clearwater, FL
The near-term demand for health care workers in the Tampa metropolitan area notably improved during the fourth quarter of 2009 and the number of workers required to meet announced expansion plans will likely exceed the number of announced positions eliminated or deferred. Of note during the quarter, the new All Children’s Hospital in St. Petersburg opened in December. The newly constructed 10-story hospital has 259 licensed beds, mostly in individual rooms. Additionally, Tampa General Hospital received $7 million from the Tampa General Hospital Foundation to help with the completion of its new Jennifer Leigh Muma Neonatal Intensive Care unit scheduled for completion in summer 2011.

Washington-Arlington-Alexandria, DC-VA-MD-WV
The near-term demand for health care workers in the Washington D.C. metro area continued to strengthen during the 4th quarter of 2009 and the number of workers required to meet announced expansion plans remains inadequate. Of note during the quarter, it was announced that a new personalized-medicine research institute based in Fairfax County could bring 400 new jobs to the area. In addition, Holy Cross Hospital is looking to become the anchor tenant of a massive science and technology park on Montgomery College’s Germantown campus that could include a new hospital that will employ almost 600 people.

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