Introduction

Jan Karazim loved her job as a radiologic technologist at W.A. Foote Memorial Hospital in Jackson, Michigan, but she kept seeing flyers in the break room advertising positions for registered nurses that piqued her interest. She decided to explore her options and see if she could make the leap to nursing. Instead, she ran headlong into a barrier that continues to shape who can and cannot access many well-paying health care careers today. Every nursing program she considered required hundreds of hours of unpaid clinical experience. For Karazim, that wasn’t feasible. “By that time, my new husband and I were 23, and we had bought a house on a land contract. I had a new car, and I had bills to pay,” she recalled. “I couldn’t just quit my job.”

Amy Lee encountered the same challenge while preparing for a career in radiological technology. Completing the required clinical hours while supporting her family meant juggling school, work, and caregiving responsibilities. “I had two children at home,” she said. “I would work the third shift on Christmas Eve and come home just in time to open presents, because I would have to go to school during the day, work the third shift at night, and then try to get up and do it all over again.”

Their experiences illustrate a challenge at the heart of America’s health care workforce crisis. The country faces acute shortages of nurses, allied health professionals, and behavioral health workers, yet many of the pathways into these careers remain difficult to access, particularly for working adults, parents, rural residents, and others who cannot afford costly training programs or to forgo income while completing required clinical components. What is often framed as a workforce shortage is also, in many ways, an equity challenge.

Karazim and Lee ultimately persevered. Both went on to earn doctorates and build careers in health care and academia. But neither forgot how difficult it was to get started. As established leaders in Michigan’s health care industry, they wanted to create better options than they had for getting started in the field. Today, they’re important contributors to Michigan’s emergence as a national leader in degree apprenticeship. Karazim is program manager for the Health Careers Alliance, an employer-led collaborative that helped develop the state’s first degree apprenticeships in registered nursing and surgical technology. In 2026, it convened leaders in respiratory therapy to create a national degree apprenticeship framework approved by the U.S. Department of Labor. Lee, president of the Michigan Workforce Training and Education Collaborative (MWTEC), brought community colleges together to make these opportunities available across the state, including in rural communities.

In a degree apprenticeship, learners are employed and paid as Registered Apprentices while earning a college degree that doubles as their technical training.¹ Apprentices complete structured on-the-job learning alongside coursework (often subsidized) that leads to the same credential awarded through traditional academic programs. Rather than forcing learners to choose between earning and learning, degree apprenticeship combines the two.

For Karazim and Lee, degree apprenticeship is more than a workforce strategy. It is the pathway they both wish had existed when they entered the profession.

Its promise extends beyond individual learners. Health systems across the country are struggling to recruit and retain workers in high-demand occupations. Degree apprenticeship offers a way to grow talent from within while reducing many of the financial and logistical barriers that have historically limited access to these careers. By embedding paid work into accredited degree pathways, degree apprenticeships can address both workforce shortages and the equity challenges that exacerbate them. 

Interest in the degree apprenticeship model is growing. Our research identified 107 degree apprenticeship programs across 15 health care occupations offered by 93 colleges and universities in 29 states. Yet growth remains uneven, with many occupations facing significant workforce shortages, but few or no degree apprenticeship opportunities.

This report examines the landscape of health care degree apprenticeships and explores both their promise and the factors limiting their expansion. We examine how degree apprenticeships can help address workforce shortages and equity challenges in health care, as well as the policy, accreditation, and implementation barriers that continue to constrain growth.