When it comes to top employers, health care is taking the place of financial firms that once dominated the local scene.

Virginia Commonwealth University Health System ranked No. 1 for the first time on the Top 50 list of private area employers this year, increasing the number of full-time equivalent workers by 1.32 percent to 7,082 employees.

As in past years, three health-care organizations -- VCU Health System, HCA Inc. and Bon Secours Richmond Health System -- had places among the top 10 spots.

All three added positions to keep up with the demands of aging baby boomers.

"We're all expanding," said Dr. Sheldon Retchin, chief executive of VCU Health System and vice president for health sciences at the university. "As boomers started to age, the demand heated up."

Three financial institutions remained in the Top 10 as well, but each reduced the number of full-time employees.

Capital One Financial Corp., Wachovia Corp. and Sun Trust Banks cut their total work forces by the equivalent of nearly 1,000 full-time employees, or 6 percent.

Five years ago, the same players were involved but their roles were swapped.

In 2003, the top three financial firms combined had the equivalent of 17,414 full-time employees, while health care at the time had 15,707.

Today, health care firms in the top 10 account for 19,315 workers.

"The Richmond economy continues to be dominated by finance and health care firms with health care continuing to increase in employment," said Christine Chmura, president and chief economist for Chmura Economics & Analytics.

"The health care industry, in general, doesn't respond much to the business cycle," she said.

The Richmond area is home to 22 hospitals and has more than 5,700 hospital beds, according to a community profile from the Virginia Economic Development Partnership.

Statewide, 11 of the 20 occupations projected to grow by 2014 are in the health care field, the state agency said.

In the Richmond area, 15 of the 20 growth occupations are projected to be in health care, the partnership reports.

Home health aides and personal and home-care aides top the list. Occupational therapists and substance abuse and behavioral disorder counselors also are included.

The other five occupations on the list were in non-health care jobs relating to computer and technology industries.

Demand for dentists, hygienists, physical therapists, pharmacists and nursing home staff also is expected to increase. "It doesn't take a rocket scientist to think about what the elderly are going to need," Retchin said.

All that need could spell trouble for the industry.

"There's a potential shortage out there," said Patrick Farrell, president of the HCA Richmond Health System, which operates six area hospitals.

By 2020, the U.S. may need an additional 200,000 doctors and 800,000 nurses, according to the Council of Physician and Nurse Supply, a new organization based at University of Pennsylvania's Leonard Davis Institute of Health Care Economics. The group was formed to address staffing shortages in the industry.

A 2004 report by the State Council of Higher Education predicted that Virginia will be short 22,600 more full-time registered nurses by 2020.

"One of the greatest limitations is the work force," VCU's Retchin said.

Mindful of that, VCU Health System, HCA and Bon Secours report that they focus on retention and training, as well as education.

VCU Health System includes five schools -- for dentistry, medicine, allied health professionals, pharmacy and nursing -- and Bon Secours has a nursing school that graduates 120 nurses every year.

"Our goal is to hire 100 percent of these nurses into our organization," said Bonnie Shelor, senior vice president for human resources at Bon Secours.

Perks, such as offering on-site day care, continuing education opportunities and signing bonuses, are often part of the deal. HCA, for instance, offers a $1,500 bonus for a one-year commitment and $3,000 for two years.

Quality leadership also helps. "Leadership definitely attracted me to the job," said registered nurse Adam Schwer who moved to Virginia to work as a critical-care nurse at Bon Secours' St. Francis Medical Center after a hospital where he worked in New York began laying off nurses.

The Top 50 private area employers added the equivalent of 2,540 full-time workers, or 2.3 percent.

In all, 31 companies reported that they added employees between Jan. 1, 2007 and Jan. 1, 2008.

Northrop Grumman made it on the list for the first time, placing No. 33, thanks to a contract with the state to maintain computer and communications systems from a site in southeastern Chesterfield County.

Seventeen companies or firms -- six of them financial services -- reported a drop in the number of employees in 2008 compared with the prior year.

For instance, despite a new research center, Philip Morris USA also lost employees, starting the year with 7.7 percent fewer workers. A smaller, declining cigarette market has limited the company from replacing workers who left for other work or because of retirement, a spokesman said.

Four companies -- Northrop Grumman, Southern States, Performance Food Group and YMCA of Greater Richmond -- are new to this year's list.
Contact Emily C. Dooley at (804) 649-6016 or edooley@timesdispatch.com.