Planning for the Future: Proven Recruitment Strategies to Avoid Shortages

 Steve is a Senior Vice President at Corazon, Inc., offering consulting, recruitment, interim management, and IT solutions for hospitals and practices in the heart, vascular, neuro, and orthopedics specialties.  To learn more, call (412) 364-8200 or visit www.corazoninc.com. To reach the author, email sgeyer@corazoninc.com.

Over the past few months, the biggest news regarding the Affordable Care Act (ACA) has been the fact that the website and other entry points did not initially work. Yet in the healthcare industry, the real focus should be on what happens now that the website and entry points do work. The anticipated shortage in the healthcare workforce has been long been an area of concern, but now, with the possibility of an estimated additional 32 million Americans with medical insurance becoming a reality¹, hospital and health system leaders must strategically and tactically plan for an inevitable influx of patients. Ensuring an adequate physician, nursing, staff, and leadership complement will be essential, as all clinical specialties are expected to experience increases in patient and procedure volume.  

Corazon believes this patient increase will affect every area of the workforce, from physicians to extenders and nursing staff. The difference between those service lines that fail and those that succeed may lie in the foresight of planning for the storm before it hits by having a well qualified, experienced clinical and leadership team in place. 

Corazon also strongly encourages planning for the backfilling of experienced cardiovascular nursing staff. RNs have increased opportunities under healthcare reform, as they are asked to serve as care coordinators, case managers, patient educators, and chronic care specialists.² In order to meet the needs of long-term patient care, current staff could end up transitioning to a navigator role, as each state health insurance exchange is required by the ACA to establish a navigator program to help people make informed decisions about enrolling. 

If we examine the physician workforce, the ‘storm’ may not be that far off. The Association of American Medical Colleges estimates there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025, along with over 15 million patients reaching eligibility for Medicare.³ In addition, the increasing overall age of the healthcare workforce is coupled with too few residency spots for graduating MDs. In 2011, more than 7,000 were left with MD degrees, but no place to continue their education, according to the National Residency Matching Program.⁴

Nursing professionals, often groomed for clinical leadership positions, are also an area of concern.AMN Healthcare’s 2013 Clinical Workforce Survey reported the nationwide vacancy for RNs at 17%.⁵ Where will these management-level providers come from? And, with already-existing staffing shortages, will providers have the capacity to provide quality care? Meanwhile, the American Association of Colleges of Nursing reported that in 2008, applicants were turned away from nursing education programs due to shortages of nursing faculty.⁶

Given these startling statistics, the time to change your recruitment and retention strategy is now. From initial contact to phone screenings, to the first time a candidate is on site, the process of attracting professionals should be well thought out, and efforts must be made to “woo” each candidate deemed a match for the organization. With our clients, we advocate that the goal of each and every step should be convincing the (qualified) candidate to join your organization.   

Understanding the current needs of the physician through a listening exercise must be practiced and perfected. Gathering as much information as possible about the uniqueness of the candidate’s financial, family, and clinical requirements should be a top priority. In this way, the organization can customize the questions throughout the screening process, during meetings with the medical staff, and most importantly, with the itinerary of the first on-site visit. In Corazon’s experience, all of this information can be instrumental in crafting an offer that is accepted, rather than one that receives a “no, thank you” response.

For nursing leaders in management and oversight roles, a position change can often seem like a lateral move, making the idea of change less appealing. The top three indicators listed by most industry sources for attracting nursing leadership are salary, workload, and the cost of healthcare. An organization seeking a nursing or cath lab leader with an elevated skill set must be well aware of what the competitive national landscape looks like from a compensation viewpoint. 

Whether working with an internal recruiter or a firm, the search resources should include up-to-date and accurate data on current compensation packages being offered in the marketplace nationally, regionally, and locally. The cost of the recruitment efforts could be lost if you are investing in a candidate pipeline that abruptly stops because the compensation package is off the mark compared to national benchmarks. This scenario can be the downfall of a recruiter or firm initiating a search for these difficult-to-find candidates who are also much more elusive for placements.

Finding a candidate who meets a majority of the requirements is a ‘win’ in the search process. Yet flexibility is a key component in seeking to fill nursing leadership and management roles. Corazon’s recruiters have found that a strong work history and positive references are the foundation for best-fit placements for our clients. Passing on proven leaders because of the lack of a nursing degree, as opposed to vast technical experience with a stellar work history and glowing references, is most definitely short sighted. Paired with an unrealistic view of the overall candidate pool, this approach can unnecessarily prolong a search and leave a key clinical or operational area without consistency at the helm, which can cause productivity or quality issues, or both, along with a loss of team morale and/or program momentum. Also, consider the options this kind of flexibility can bring to staffing strategies. For example, according to NationalFamilyPlanning.org, “To help address the needs of underserved communities, some states have regulations that specifically allow public health nurses to perform some functions that would normally be outside of their license.”⁷ In a similar way, there can be benefits to considering existing training as a means to add team flexibility. For instance, a cardiac cath lab nurse or technologist may have the ability, after receiving appropriate training, to work in other interventional platforms, such as transcatheter aortic valve replacement or abdominal aortic aneurysm repair. Utilizing a cross-training strategy may be the difference between staying afloat and drowning for some organizations when attempting to find an employee for a hard-to-fill position.

One of the keys to ensuring patient access to necessary healthcare services is to make sure that not only are there enough providers, but that there are enough systems in place to employ those providers, along with enough incentives available to encourage providers to work where they are needed most, especially in the cath lab, where lack of immediate access can equate to mortality. And, with many labs operating 24/7, there can be no lapse in coverage, regardless of the increases in a newly-covered patient population. While the ACA promises to provide healthcare coverage for approximately 94% of U.S. citizens by 2020⁷, the reality is that coverage without access means little for patients seeking care — and may result in disastrous effects for organizations that fail to plan for this significant, albeit necessary, change to the healthcare paradigm. 

References

1. Affordable Care Act decision increases need to train more doctors. Association of American Medical Colleges. Available online at  https://www.aamc.org/initiatives/aca/. Accessed June 23, 2014.
2. Robbins PS, Waligora K, Abramson R, Kovach A. The Affordable Care Act Post Enrollment – Illinois Maternal & Child Health Coalition. April 10, 2014. Available as a pdf download online at https://www.ilmaternal.org. Accessed July 15, 2014.
3. Mann S. Addressing the physician shortage under reform. Association of American Medical Colleges. Available online at  https://www.aamc.org/newsroom/reporter/april11/184178/addressing_the_physician_shortage_under_reform.html. Accessed June 23, 2014.
4. Wilson J. Your health care is covered, but who’s going to treat you? CNNHealth. June 29, 2012. Available online at https://www.cnn.com/2012/06/29/health/doctor-shortage-affordable-care-act/. Accessed June 23, 2014.
5. AMN Healthcare survey: hospital executives see continued shortage of physicians, nurses and advanced practitioners. AMN Healthcare News. December 12, 2013. Available online at https://www.amnhealthcare.com/latest-healthcare-news/2147484592/1033/. Accessed June 23, 2014.
6. New AACN data confirm that too few nurses are entering the healthcare workforce. American Association of Colleges of Nursing.  February 26, 2009. Available online at https://www.aacn.nche.edu/news/articles/2009/workforcedata. Accessed June 23, 2014.
7. Policy Brief: National Familiy Planning & Reproductive Health Association. Available online at https://www.nationalfamilyplanning.org/document.doc?id=382. Accessed June 23, 2014.