Health Care Opens Middle-Class Path, Taken Mainly by Women

HUNTINGTON, W.V. For Tabitha Waugh, it was another typical day of chaos on the sixth floor cancer ward.

The fire alarm was blaring for the second time that afternoon, prompting patients to stumble out of their rooms. One confused elderly man approached Ms. Waugh, a registered nurse at St. Marys Medical Center here, but she had no time to console him. An aide was hollering from another room, where a patient sat dazed on the edge of his bed, blood pooling on the floor from the IV he had yanked from his vein.

Hey, big guy, can you lay back in bed? she asked, as she cleaned the patient before inserting a new line. He winced. Hold my hand, O.K.? she said.

Ms. Waugh, who is 30 and the main breadwinner in her family of four, still had three hours to go before the end of a 12-hour shift. But despite the stresses and constant demands, all the hard work was paying off.

Her wage of nearly $27 an hour provides the mainstay for a comfortable life that includes a three-bedroom home, a pickup truck and a new sport utility vehicle, tumbling classes for her 3-year-old, Piper, and dozens of bright blue Thomas the Tank Engine cars heaped under the double bed of her 6-year-old, Collin.

Nicole Bengiveno/The New York Times Tabitha Waugh, 30, a registered nurse at St. Marys Medical Center in Huntington, W.Va., is the main breadwinner in her family of four. The daughter of a teachers aide and a gas station manager, Ms. Waugh, like many other hard-working and often overlooked Americans, has secured a spot in a profoundly transformed middle class. While the group continues to include large numbers of people sitting at desks, far fewer middle-income workers of the 21st century are donning overalls. Instead, reflecting the biggest change in recent years, millions more are in scrubs.

We used to think about the men going out with their lunch bucket to their factory, and those were good jobs, said Jane Waldfogel, a professor at Columbia University who studies work and family issues. Whats the corresponding job today? Its in the health care sector.

In 1980, 1.4 million jobs in health care paid a middle class wage: $40,000 to $80,000 a year in todays money. Now, the figure is 4.5 million.

The pay of registered nurses now the third-largest middle-income occupation and one that continues to be overwhelmingly female has risen strongly along with the increasing demands of the job. The median salary of $61,000 a year in 2012 was 55 percent greater, adjusted for inflation, than three decades earlier.

And it was about $9,000 more than the shriveled wages of, say, a phone company repairman, who would have been more likely to head a middle-class family in the 1980s. Back then, more than a quarter of middle-income jobs were in manufacturing, a sector long dominated by men. Today, it is just 13 percent.