Feb. 8 (Bloomberg) — Hospital jobs in the United States 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 yesterday. 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.

The job losses reflect an industry in flux as the 2010 Patient Protection and Affordable Care Act, also known as Obamacare, takes full effect. Reimbursements for Medicare, the U.S. health plan for the elderly, are being reduced to help cover the insurance expansion under Obamacare, and hospitals are contending with lower payment rates from insurers on the public exchanges. In addition, care once provided at hospitals is shifting to outpatient settings, lowering patient volumes.