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Feb. 7 (Bloomberg) — Hospital jobs in the U.S. declined in back-to-back months for the first time in three years as medical care increasingly moves to outpatient facilities and hospitals anticipate reimbursement cuts under Obamacare.

Hospitals lost 4,500 jobs in January, after dropping 4,700 jobs in December, the first consecutive two-month decline since February 2011, according to Labor Department figures released today. The health-care industry as a whole also reported a slowdown in employment, with 400 jobs lost in January compared with an average of about 17,000 jobs gained a month in 2013.

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