California’s Community Colleges train a substantial share of the state’s health care workforce. They also provide pathways for students to demonstrably improve their economic outcomes. Recently, policymakers at the state and national levels have devoted attention to career pathways in vocational programs, also known as career technical education (CTE). Although these pathways are of great policy interest, and health training in particular holds much promise, they are not clearly defined and there is little information about their prevalence or success. To fill this informational gap, we assess the likelihood of health students in California’s Community Colleges obtaining multiple credentials with a focus on those who earn successively more valuable credentials. Our aim is to identify health training pathways or stackable credentials that students are pursuing and isolate the economic gains to completing them.

• Most students (87%) who complete health CTE programs earn only one award. The rate of reenrollment does not vary substantially across demographic groups, though men and historically underrepresented minority groups are slightly less likely to reenroll than other students.
• Nearly half of health students earn a short- or long-term health certificate as their first award. Earning an additional credential could substantially improve these students’ economic outcomes, but relatively few do go on to receive another credential-this share has risen from 18 percent to about 23 percent in the past decade.
• The most common pathways in health begin with either a long-term certificate in licensed vocational nursing or a short-term certificate in a certified nursing assistant, medical assistant, or emergency medical services program. The vast majority of completed pathways lead to an associate degree in nursing.
• The long-run wage returns to students with multiple credentials who start with relatively short-term ones that offer low economic returns are similar to those of students who initially earn high-return credentials. But multiple-award pathways take more time, and students forego earnings along the way or may fail to complete a pathway for various reasons.
• Among those who do reenroll to pursue a second credential, rates of completion are lowest among male, Latino, and African American students, as well as students identified as academically disadvantaged. Improving access to full-time course-taking and increasing use of financial aid are the most consequential levers for increasing completion of a health pathway.

These findings suggest that many of the ongoing efforts to boost student success and close achievement gaps in the community college system are likely to improve completion for students in health pathways. However, targeted efforts could address the needs of students who set out on health pathways. These efforts may involve reaching out to students-and engaging their employers-once they have earned a credential, as well as addressing the challenge of balancing training and career-level employment. Our findings suggest that such outreach could have sizeable economic returns for students. Finally, given the small share of students who earn multiple credentials and the limited number of programs they are in, developing pathways in other valuable health programs could maximize the economic mobility of California’s CTE students.