Expanding Registered Apprenticeships in Health Care


Tim Bates, Susan Chapman and Joanne Spetz.

September 4, 2018

Registered apprenticeships (RA) – programs that have formal standards and are regulated by both federal and state agencies – have a long history in the United States. Health care-related RA programs account for a small fraction of overall apprenticeship training activity, but would seem to be a natural fit for meeting the workforce training needs of the health care industry. The basic structure of apprenticeship training entails practical, hands-on learning that occurs concurrently with classroom-based learning, and apprentices work closely with a mentor who supervises their on-the-job experience. In these ways apprenticeship training resembles a health professions residency program. This paper presents findings from a series of interviews with key informants who were asked to share their views on the perceived value of RA programs, as well as challenges and opportunities associated with RA programs in health care.

Key Findings

  • The RA model challenges the widespread “culture of professionalization” in the health care industry. Because apprenticeship training is historically associated with the building and construction trades, many health care professionals view it as appropriate only for “blue collar” occupations.
  • Given scarce resources, investing in the right occupations is critical. Key informants viewed technologist and technician occupations that typically require a 1-2 year certificate or associate degree as the best opportunities for RA programs in health care.
  • Opportunities for RA programs are driven by employer workforce needs, but some scenarios are more conducive to apprenticeship training than others:
    • The skillset is defined by on-the-job experience to the extent that it is more efficient for the employer to invest in the training.
    • A new federal or state standard for the occupation is implemented and the employer’s incumbent workforce must meet that new standard.
    • The employer needs to define standards and competencies for a new occupational role within its organization.
    • The institutional system that trains new entrants to the workforce cannot meet demand.


  • Encourage rigorous evaluation of RA programs to build up an evidence base that can demonstrate return on investment. 
  • Develop champions in industry, education, and state government to encourage the adoption of RAs in the healthcare sector.
  • Strengthen support for workforce intermediaries who are engaged in RA program development.
  • Provide support for the substantial investment of time and effort required for RA program planning.
  • Strengthen the integration of apprenticeship and higher education to support the creation of degree-based apprenticeships.