Health care employment rose by only 2,500 jobs in July 2013, well below the 24-month average of 22,000, and the lowest increase since July 2003, according to the Altarum Institute.

Hospitals lost 4,400 jobs in July, and downward revisions wiped out most of June’s gains. Over the last three months, hospitals have lost 13,000 jobs.

Ambulatory care employment continues to rise (up by 6,600), but this is well below the 24-month average of 15,600, and nursing and residential care job growth is essentially flat.

“In addition to moderation in ambulatory health sector job growth, our data show hospitals actually shedding jobs over the past three months. This jibes with reports of unexpectedly low hospital utilization rates and belt tightening in anticipation of very low Medicare payment rate increases,” said Charles Roehrig, director of Altarum Institute’s Center for Sustainable Health Spending. “We will be watching hospital jobs closely in the next couple of months to see if this is the start of a longer term trend.”

The health sector share of total employment fell slightly to 10.71 percent in July, barely below its all-time high rate of 10.73 percent, first reached in December 2012.