A Shrinking Workforce

The rising number of America’s uninsured, Obama’s ambiguity for universal provision and the government clampdown on retrogression are all putting further strains on the healthcare recruitment industry. Julie Brooks explains the challenging trends in these tumultuous times.

“I’m very much in favor and agreement with Obama when he talks of the American need to have affordable healthcare – it’s very frustrating to have so many people that do not have insurance”
-Julie Brooks

As president of the National Association of Healthcare Recruiters (NAHCR), Julie Brooks activity within the organization spans for over a decade, and it is her wealth of experience that provide her with the insight into the challenges currently dominating the healthcare recruitment industry.

One of the NAHCR’s primary roles is to be a source of educational information for its members, providing them with the tools that will teach them how to become successful. Brooks explains that depending on which country the members wish to recruit from there are many obstacles to the process – the requirements change, the visas differ and so on – and therefore need to know what guidelines they must comply with in each individual instance. NAHCR plays a role in informing its members how to employ staff from one country and license them into the US via a multitude of educational materials. 

Challenges
However, this process is not a simple black or white decision. She advises that enforcing the correct compliance requirements are challenging, specifically when recruiting from abroad. “It depends on the health system,” she explains. “We have some large healthcare systems that have 10 or 12 hospitals within a system. We have other hospitals that are in smaller systems, depending on what the needs are and those types of things. The other thing that’s very challenging right now is the retrogression and immigration issue as the US government is currently only allowing so many visas per country and they only allot for so many positions.

“For instance in order for nurses to fall under certain criteria for the H1B visa or similar, a bachelor’s degree in that specific field is required. So there are a lot of things that have to work within. We have several immigration attorneys that have worked with NAHCR, one being Sarah Tobocman who works out of Miami and who has written the immigration piece in our recruiter’s handbook. So we try to give them the tools and the resources so that they can be successful – doing the research before they venture out into recruiting nurses from another country,” Brooks explains.

She notes that the problem of recruiting from abroad has become a huge issue only recently, due to the clamp down on the allowance of visas by the US governmental authorities, what’s referred to retrogression. “They’re trying to keep illegal people out of the country,” Brookes explains.

“They have stopped a lot of the immigration process, and unless somebody is in a high priority specialty area, they’re not granted visas. Several of our hospitals throughout the country have got orders in for workers from other countries, but they’re not able to get those workers because they can’t get them the visas that they need to get here. And so it’s quite a challenge, and until the Congress lifts that ban on retrogression our hands are tied.

“The difficult part is that many of the companies that participate in international recruitment are struggling because they can’t get the workers here. Their business depends upon the immigration process and them being allowed to come into the country, so it’s been a real challenge for them as well. We are hopeful that at some point this year it will be lifted, but there have been so many issues that make this look even less likely, such as the illegal aliens entering across the border and the issues we’ve seen out in Arizona and New Mexico. That’s really put a clog in the system.”

Outsourcing is an increasing trend found across all verticals, but the benefits it provides in other industry will not necessarily provide the answers to healthcare recruitment’s problems. “Working at an institution whereby I’m housed at the hospital that I work at, I become an intricate part of the management of this facility as well as with the employees, and in order to build relationships with people you have to be onsite. They have to put a face with a name and they have to know that you will act upon the things that you say that you’ll do,” she expounds.

Universal coverage
The refusal of the government to allow free movement of healthcare workers seems to be a direct antithesis to Obama’s proposal of universal and affordable healthcare cover. An expectation in healthcare work is bound to place pressure on those health institutions themselves that are already struggling to fill the amount of workers needed due to the immigration issue. Brooks advises that the president’s ambiguity regarding the actualization of the healthcare expansion policy is a problem, as there is no indication of what the impact will be. The infrastructure still suits the previous system; universal coverage is not what the current system is ready for.

“I’m very much in favor and agreement with him when he talks of the American need to have affordable healthcare – it’s very frustrating to have so many people that do not have insurance. We have a lot of the indigent care, people that don’t have any health insurance at all, who don’t have the means to pay for it, and those people get sick just like people with insurance. Under the current laws and regulations, if somebody truly comes to the hospital and they are in an emergent situation and they need care, and we have to treat them regardless of whether they have the means to pay.

“The problem is that we have many illegal people that are here and even though they’re here illegally, they still fall under that criteria of treatment. If they have an emergent care situation, for instance they’ve had a heart attack or have cancer, we still have to treat them regardless of their means of ability to be able to pay, and that’s part of what is impacting the healthcare system, not just here but across the nation.

“All of my recruiters across the nation are all dealing with those same types of things. With the economy the way it is there are so many people that have lost their jobs; their working hours have been reduced. A lot of companies have scaled back their benefits or they’re asking the employees to pay a lot more of their portion of the benefits, and so it’s a whole system that matriculates downhill from there,” she explains.

“Several of our hospitals throughout the country have got orders in for workers from other countries, but they’re not able to get those workers because they can’t get them the visas that they need to get here”
-Julie Brooks

Industry trends
However the good news for recruiters is that the economy’s fluctuation is forcing physicians to stay within their current placements. The insecurity of the market means that when a good position is found, it is generally now long-term. “A lot of the travel assignments, like in nursing, pharmacy or physical therapy for instance, are pretty much disappearing or being scaled back. The cost of having a traveler as opposed to hiring your own staff member is significantly lower to the organization. We’ve also had a lot of people that have worked in what’s called a per diem status, or a temporary status – rather than commit to working 36 to 40 hours a week, they’ll maybe work one 12-hour shift a week.

“However, due to the state of the economy, people are leaving that type of temporary position and are taking fulltime positions, because they need to know that they’re going to be able to get at least 36 hours of work a week and when you’re in that per diem status there is no guarantee. Of course, there’s no guarantee when you have a fulltime job if you don’t have the patient census to support it.

“Per diem staff members are the first people that are called off if our census falls down; fulltime staff are the last people to be called off. We might rotate them through different departments, often referred to as ‘floating’: registered nurses may be hired to work in a med-surg unit but may be transferred to another unit if the census is low in one area versus another.”

Brooks notes another concerning trend as applicable to the financial downturn. Despite there being a need for more physicians, a large number of new graduates are entering the workforce but are unable to gain employment. “The problem is that because of all these other workers have converted from per diem to fulltime, the new graduates are having a challenging time finding positions,” she explains.

“One of the things that concerns me is that people have got into nursing and healthcare because there was a great need. There was a high demand and people felt that it was very steady employment. The problem that we’re running into this year is that many institutions aren’t even hiring new graduates at all. Now we are still hiring a few, but we’re not hiring nearly as many as what we have hired in years past.

“We’ve also had a lot of healthcare workers that are trying to reenter the workforce – maybe they’ve retired or they’re partially retired but because of the economy and the crash in the stock market we have a lot of people that are trying to reenter the workforce. This is just a temporary situation and soon we’ll be back to where we were five years ago where we’re scrambling to find people because our workforce, in all actuality, is shrinking. That’s one of the things that is frustrating – nobody is addressing the fact that we don’t have as many people entering the workforce as what we did 50 years ago because the demographics are very different,” she concludes.

Brookes final note is the belief that the current emphasis on permanence and job retention is itself a very temporary thing. The rising of share prices, the reversal of redundancies and the reinvestment in insurance plans look likely to solve the current recruitment problems, but when the façade of success fades, the current problem of a shrinking workforce will remain. 

Julie Brooks is President for the National Association of Healthcare Recruiters and has over 24 years of healthcare experience. She has spent the last 14 years working in recruitment.