PITTSBURGH -- While most of the nation is still trying to claw its way out of the deep economic crater left by the recession, this one-time steel capital is already out -- thanks largely to the relentless growth in health care jobs.

Partly because of the outsized ambitions of the University of Pittsburgh Medical Center, the health care industry has replaced manufacturing as the regions powerhouse. About 1 in 5 private-sector employees in the Pittsburgh area today work at a hospital, a doctors office or in some other health services business.

But even as the health care boom sped up Pittsburghs recovery, the economic transformation has left many people worried about the side effects.

Among the concerns: overdependence on a rapidly shifting industry, huge nonprofits that dont generate much in tax revenue, and a business model that exacerbates the disparity in income among workers.

And thats not just in Pittsburgh.

This is the U.S. in a microcosm, Eileen Appelbaum, a senior economist at the Center for Economic and Policy Research, said about the rise of health care and the issues that has wrought.

Through April, health care services have added about 770,000 to their payrolls since the start of the economic recovery in June 2009 -- about one-third of all new jobs, according to the U.S. Labor Department.

But, spending for medical care is nearing one-fifth of the U.S. economy, much more than in other developed nations and beyond what governments, businesses and consumers can afford.

Health care has fueled job growth for a generation. When Pittsburghs steel industry began its collapse in the early 1980s, health care employment was a third of manufacturings.

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Health care boosts Pittsburgh