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Seeking cures for health care employment.

Alaska's health care industry battles to retain workers in face of national shortages and unique Alaskan challenges.

Occupational therapist Linda Glick opened Alaska Hand Rehabilitation in Anchorage six and a half years ago. With the swelling number of work-related repetitive-motion injuries, the clinic has experienced double-digit growth in clients and revenues every year. She decided she needed extra hands to help meet the demand.

Glick began advertising in professional journals, networking through personal contacts across the country and posting notices at professional conferences. Then she waited. And waited.

"I started looking for two additional occupational and hand therapists in December of 1990," she recalls. "By March of '91, I had found only one."

Glick rewrote her ad copy, and waited some more. "It wasn't until June of this year, 15 months later, that I finally found the second person to round out my team," Glick reports. "It was a long haul, but the number of occupational therapists out there is just really limited, which means the supply of qualified people I want working with my clients is even more limited. Plus, when you get somebody good on the line, then you have to start talking them through all of their stereotyped impressions of life in Alaska. It's a big deal for them."

Stories like Glick's are common in Alaska's health care industry. Not only does the state suffer from the same staffing shortages that plague the rest of the country, but medical facilities here, both large and small, face special challenges in recruiting and retaining adequate staff to meet needs. In rural Alaska, medical staffing is an acute problem.

"We've got a hiring advantage in Alaska," says Richard Mandsager, a physician and director of the Alaska Native Medical Center in Anchorage, referring to the attraction of many to Alaska's unique lifestyles. "But on the other side, especially for families, are concerns about winter and a host of unfamiliar factors such as schools, job opportunities for spouses and the cost of traveling Outside to see family members."

On a national level, shortages of medical personnel are resulting from rapidly expanding medical specialization and technology. Driven by increased demand and an expanding base of medical knowledge, new therapies and machines are being developed faster than people are being trained to apply them.

While the vacancy rate for nursing positions averages 10 percent nationwide -- and appears to be moderating thanks to higher school enrollments and innovative retention strategies -- vacancy rates for other key positions are even higher and still are increasing, according to the American Hospital Association. Among such key positions: physical therapist, 16.6 percent vacancy in 1991; occupational therapist, 14.2 percent; radiation-therapy technologist, 12.9 percent; cytotechnologist, 12.8 percent; and physician's assistant, 12.8 percent.

The hospital association predicts the skill-shortage trend will continue, in part due to insufficient openings in underfunded public schools that train for these positions.

The Alaska Department of Labor reported in 1991 that shortages of dental assistants, medical assistants, medical technologists, licensed practical nurses, registered nurses, physical therapists, occupational therapists and respiratory therapists are the most serious in the Alaska health care industry. But medical experts note current or projected problems in retention for a host of other positions, including physicians, pharmacists and administrators.

Although nursing vacancy rates are as low as 1 percent for some urban Alaska facilities, the statewide picture is more bleak. A 1991 report by the Alaska Native Health Board states: "Simply put, Alaska is not producing enough nurses to fill current need, not enough qualified nurses from Outside are willing to endure the harsh conditions found in rural Alaska for pay that is little better than they can make in the Lower 48."

According to the 1990 Alaska Hospital Survey, published by the Department of Health and Human Services, nursing positions accounted for a substantial percentage of vacancies in every region of the state for both acute-care and long-term care hospitals. Nursing vacancies range from approximately 30 percent of the total vacancies in Southeast and the northern region, to nearly 50 percent in Southcentral (both urban and rural facilities).

Alaska's nursing turnover rates, which provide an indication of how often recruiters must go into action and expend resources to check attrition, range from the national average of 15 percent to as high as 30 percent.

State labor economist Neal Fried predicts that a nationwide emphasis on job retraining following the recession, other long-term economic developments and widespread recognition of employment opportunities in the health care industry will prevent a prolonged shortage in any of the health fields. "It's considered one of the hot areas, so I think before too long the shortages should be diminished. The nursing shortage is much less of a problem than it was five years ago," he says.

Noting that fewer jobs than ever are considered really secure, Fried says a perception that health care positions are both lucrative and relatively more stable will help alleviate current shortages.

Demand & Delivery. The health care industry is big business in Alaska. In 1991, about 11,000 health care workers, from physicians and dentists to home health workers, drew nearly $304 million in salaries and benefits. Average monthly earnings for the fourth quarter of last year were $2,392.

While decent salaries are seen by many recruiters across the country as a reliable way to address staffing shortages, some analysts blame labor costs for dramatic health care cost increases. Nationally, labor costs represent 50 percent of acute-care hospital operating costs and have grown dramatically in recent years in comparison to other sectors, these observers say.

They accuse hospitals of wasteful staff management practices and say health care workers take advantage of growing demand for medical services and labor shortages by bargaining hard, playing facilities against each other. The analysts say increased specialization encourages workers to push for certification laws that tend to restrict their numbers, thus artificially pinching the supply and driving up wages.

But others strongly disagree, noting that increased medical costs are attributable to many interrelated issues, including the rising cost of medications, insurance expenses, increased reliance on high-tech equipment, the high cost of dealing with extraordinary medical problems such as AIDS and cancer, the aging of the population and the rise in malpractice suits.

Some factors, such as the proliferation of new technology, are pushing labor costs up because they require trained technicians. But trends such as these can hardly be blamed on health care workers, some experts say.

Alaska Native Medical Center's Mandsager contends that Americans have a love affair with specialization, because they assume that it results in better care. He points out, though, that much specialized care is actually unavailable to many consumers and that specialization is one of the major causes of health care cost increases.

"The trend toward specialization is increasing rapidly," Mandsager says. "I think that, and the fact that every hospital has to have the same equipment as every other hospital, (pushes costs up). I don't think competition is going to be the savior in containing health care costs."

At Alaska Native Medical Center, labor costs are 67 percent to 70 percent of operating costs, including salaries and benefits for physicians, according to Mandsager. He notes that while some health worker salaries are indeed growing rapidly, many job categories are simply playing catch-up. He says salaries in the last decade have been driven far more by real market forces than by unions or other worker initiatives.

"Salaries are just on an inexorable rise and in many respects that's long overdue. Employees are getting a better share of return than 10 years ago, even without a heavy union presence," Mandsager explains. Until recently, some positions had been chronically underpaid, including physical therapists and radiation technicians.

Mandsager warns against the tendency to confuse dramatic salary growth rates with overpayment, and says the real value of many workers in the hospital or clinical setting is actually increasing as medical knowledge grows and treatment becomes more sophisticated. He cites ultrasound technicians, who must safely and competently operate very complex machines, and pharmacists, who must monitor a proliferation of new drugs and their potential interactions, as examples of health care workers whose expertise has become indispensable in today's health care environment.

Coming Up Short. Regardless of where they stand on salaries, experts generally agree that there is a shortage of certain kinds of health care workers and that compensation is only one way to address chronic shortages.

Mandsager notes that the reasons for shortages are complex. "We're having trouble finding some of the trained people, such as licensed practical nurses and pharmacist technicians, because we don't have the kind of education in Alaska for the one-year technical courses anymore. We don't have any community colleges anymore. That's where they'd come from in most states," Mandsager says.

Furthermore, Mandsager notes, some health care positions, traditionally the domain of women, who increasingly are turning to other careers, hold little interest for men. Also, many specialized technical positions in health care are perceived as lacking advancement opportunities. "You master a career, then what do you do?" Mandsager asks rhetorically.

Finally, despite improvements in working conditions at many acute-care facilities, nursing is still a high-burnout profession, Mandsager says. Eventually, many who enter nursing tire of the strange hours and intense environment and seek employment with insurance companies, clinics or other jobs with more traditional schedules.

Against this host of circumstances, Alaska hospital recruiters and personnel directors must contend daily. And it's an expensive proposition.

Outside, it can cost up to $8,000 to recruit one nurse. While one Virginia hospital, with roughly 325 beds, recently has been spending $75,000 to $100,000 a year on recruitment, Fairbanks Memorial Hospital, with 177 beds, spend $180,000 on recruitment in the first half of this year alone.

Jan Buist, Fairbanks Memorial's first recruiter, says that includes her salary, advertising, sign-on bonuses, preparation of packets and a video for distribution to job candidates. She notes that salaries and benefits represent about 55 percent of hospital operating costs.

"Our facility is not unlike the national trend and the biggest shortage we have is in physical therapists. Both here and Outside, they're among the hardest to recruit, although I'm optimistic we can fill the positions," says Buist.

Specialization in nursing has created a shortage for more highly skilled nurses, such as those employed in operating rooms or other intense positions. According to Buist, it's also difficult to recruit occupational therapists, pharmacists, respiratory care therapists and ultrasound technicians. She hopes that associate degree-level training for medical technicians and accredited records technicians, which reportedly will soon be available in Sitka, will help alleviate some of the shortfall.

"That's encouraging, that we can kind of grow our own. Education is a big part of what we need to do in the future to attract health care workers," says Buist.

Touting Career Assets. The Fairbanks Memorial recruiter conducts hospital tours and classroom presentations for high school students to help generate interest. "The return may not be direct but I think the return will be real for the future of the hospital," she adds.

The Fairbanks hospital also supports scholarship programs for students interested in the medical field and willing to commit to a term of employment, Buist points out.

To meet immediate staffing needs, Fairbanks Memorial advertises and Buist networks aggressively. "Advertising is the most costly element of recruiting for me. The other big expense is relocating people, so we are trying to negotiate an efficient package," she says.

According to Buist, newspaper ads don't work, but professional journals and word-of-mouth communication are effective. Her efforts recently have been bolstered by production of a video sent to serious prospective hires to acquaint them with the facility and the community. Buist says the video is proving valuable in overcoming hesitation about moving to Alaska. Even those who are drawn here have questions about schools, climate, job opportunities for spouses and numerous other subjects.

"We don't do all this in one week. We make sure that they're really sure. We're pretty confident with the people we choose that they want to come here," Buist says.

She explains that an important part of the presentation to applicants is the flexibility of scheduling. "That is a major, major part of recruitment for us, whether we have flexible schedules. That has proven over and over again to be important to everybody, not just nurses. We try to keep their hours up for them and meet the needs of the hospital."

Elizabeth Bryson, assistant administrator for human resources at Providence Hospital in Anchorage, says. "We're having problems with those positions that require formal schooling beyond entry level or certification. Nurses aren't on our list, and they haven't been for awhile."

Her recruiting list does include many other positions that are chronically underfilled elsewhere in Alaska, including biomedical technician II, cardiovascular technician, pharmacist, registered respiratory therapist, occupational therapist, ultrasound technician and radiation therapy technician.

"Providence is attractive, we're in the urban setting," Bryson notes. "People coming to Alaska are interested in being here. We have a lot of different types of positions to offer here. I happen to believe we're competitive in benefits and wages and we spend time and effort making sure we stay that way."

Bryson says salaries and benefits make up 53 percent of operating costs at Providence. Recruitment costs are stable, running about $335,000 annually. That includes recruiter salaries, advertising, flyers and other outreach activities.

"We're not paying bonuses, though. In terms of advertising costs, we tend to target where we spend those dollars," says Bryson.

Which is not to say there aren't recruiting hassles. Bryson cites relocation as a major challenge even for a large urban facility such as Providence, as well as just keeping up with new developments in medicine. "The health care industry is going through so many changes," says Bryson. "And Alaska is unique. Making the decision to come here can be difficult. We do a lot of front-end talking about winters."

But Bryson freely concedes that recruiting is relatively easy in Anchorage, compared to rural areas of the state. While it may take Providence two months to recruit a medical technician, it can take up to a year and a half for smaller regional hospitals and clinics to hire for the same position.

Debbi Gorder, director of personnel for Central Peninsula General Hospital in Soldotna, says recruiting is always time-consuming and often expensive. She says the facility posts an overall 20 percent turnover rate. Most recently, Central Peninsula has had trouble attracting qualified people for physical therapy and dietitian positions.

Creative Solutions. According to Gorder, many small facilities have to find innovative ways to meet staffing needs, such as combining positions. This can be a boon once a person is found, but advertising for a combined nuclear medicine/ultrasound technician -- to cite one recent example -- can complicate or prolong recruitment. "That proved to be difficult, those positions would not be combined in a larger hospital," Gorder notes.

She says another staffing solution is to hire temporary medical staff from one of the numerous contract dispatch companies throughout the country. While the dispatcher is paid a fee, Gorder says it's a cost-effective way to plug the gap, especially during the summer when demand for hospital services rises and staff vacancies also are highest.

The Soldotna hospital has experimented with extending business loans to licensed practical nurses to attend school and earn their registered nurse certification. Under the program, loans are incrementally forgiven in proportion to employment time at the hospital. If the nurses quit, they repay the balance of the loan. "There's definitely something solid to build on there," says Gorder, noting that the program graduated four registered nurses this year.

Recruitment and retention problems are solved less easily in other smaller or more rural facilities. Despite keen interest in Alaska by some prospective workers Outside, the cost and barriers to finding, hiring and keeping them seem to increase in direct proportion to the facility's distance off the beaten path.

Unlike most other states, Alaska offers very little medical training for residents. While the University of Alaska Anchorage nursing programs graduated 90 students this year, it won't be enough to meet the serious needs felt throughout the state.

The shortage of important health care workers to fill key positions means that unlike some large metropolitan areas, where labor-management tensions run high in medical facilities, Alaska managers and workers will continue a more collaborative relationship.

Mandsager of the Alaska Native Medical Center in Anchorage says he makes a point of including union shop stewards in management meetings. "We in management know we'd better not make them mad or we're going to lose them," he says, only half in jest. "Our labor force is pretty valuable."
COPYRIGHT 1992 Alaska Business Publishing Company, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:shortage of personnel in Alaska's healthcare industry
Author:Richardson, Jeffrey
Publication:Alaska Business Monthly
Date:Sep 1, 1992
Previous Article:Western Region: Bethel, Nome & Wade Hampton census areas.
Next Article:Poised for growth.

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