The Great Recession left Hernando County battered and bruised like a patient on life support. Through the trauma of record high unemployment, however, the county's health care sector prevented a catastrophic economic flat line.
The rate of job growth in the field slowed, but it never went backward.
"In 2006, there were two rocks in the economy: health care and construction" said Dave Hamilton, program manager for the Pasco-Hernando Workforce Board. "The construction industry crumbled, but the health industry remained."
To get a sense of how critical the industry is to the county's economic health, consider some numbers from the federal government's quarterly census of employment and wages.
• In June 2006, Hernando County had a total workforce of 38,505 in 20 categories.
• In June 2012, the workforce was 35,092, a loss of 8.9 percent.
• In the same time period, the number of workers in the health care and socials services sector increased 18.2 percent, to 7,257.
"If every industry had grown 18.2 percent, we'd all be smiling," Hamilton said.
By comparison, the construction labor force nearly reached 5,000 in the summer of 2006. Six years later, the number had fallen to less than half that.
Two of the county's other significant sectors, retail and food service and accommodation, also lost jobs, though the declines were not nearly as drastic.
Just about every category is showing signs of rebounding, and the county is making strides to grow the manufacturing sector at Brooksville-Tampa Bay Regional Airport.
But the health sector remains the steady pulse that keeps the county's economic lifeblood pumping.
"The important thing is not just the gross numbers," said Mike McHugh, the county's economic development manager. "They're high-skill jobs with above-average wages."
The county's three hospitals have been major contributors to the county's economic pulse as the economy soured.
In 2006, Oak Hill Hospital employed 861 people, said spokesman Rich Linkul. By the end of last year, that number had grown to 1,070.
The average salary is now nearly $65,000, and the payroll over the last six years has grown from $48 million to $69 million.
Owned by Tennessee-based HCA, the hospital in the last six years has added 20 new cardiac care rooms, opened a new pediatric emergency room and, just this year, celebrated the completion of a $50 million expansion.
"We are paying house payments, we're buying groceries at local stores, we're purchasing cars at local dealers," Linkul said. "Pretty much across the board, we've grown as an organization."
In the same period, Brooksville Regional and Spring Hill Regional hospitals have invested in technology and bought a sleep clinic, an outpatient surgical center and the Good Shepherd Medical Clinic in Spring Hill.
"One of the reasons (the sector) stays strong is our population continues to age," said Patrick Maloney, chief executive officer of both hospitals, which are owned by Health Management Associates of Naples. "We still have a lot of snowbirds who come down in the winter, and they have medical needs."
The industry faces some challenges moving forward.
As the cost of private insurance increases, consumers with higher deductibles are putting off elective procedures, Maloney said.
"They find out they have to pay $250 out of pocket for a colonoscopy and they hold off," he said.
The uncertainty created by new quality control requirements and changes to Medicare are among the reasons Access Healthcare is growing, said CEO Dr. Pariksith Singh.
Founded in 1996, the company now boasts 500 employees and 163 providers in more than 60 locations in Hernando and four other counties. About 400 of those employees are in Hernando, Singh said.
Many physicians who have brought their practices into the Access fold sought the security and improved efficiencies that come with being part of a larger group, Singh said.
"How do you keep low overhead and provide the best services? It's a give and take," Singh said. "Working as a team together is more and more of a requirement."
Local health officials said one of their biggest challenges is finding qualified employees, especially nurses. Hernando providers compete for applicants with other Tampa Bay-area businesses, and the competition recently ramped up some more with the opening of Medical Center of Trinity and Florida Hospital Wesley Chapel, both in Pasco.
Pasco-Hernando Community College is trying to meet the need with plans next year to launch a four-year bachelor's degree program in nursing. And an increasing number of visitors to Career Central's offices are going for skilled health care certifications, said Hamilton, the workforce board manager.
Some are young adults just starting out. Others are older workers who watched as "their industry left them," Hamilton said.
"They're chasing opportunity," he said, "and it's right there in front of them."
Reach Tony Marrero at firstname.lastname@example.org or (352) 848-1431. Follow @tmarrerotimes and @hernandotimes on Twitter.