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Attracting the best and the brightest

Few sectors of the economy have matched healthcare's impact and resiliency over the past few years. Healthcare spending made up 17.8% of the country's gross domestic product in 2015 at $3.2 trillion, according to the CMS.

A large chunk of the country's job creation has also been within healthcare, where the sector since 2007 has added 2.5 million jobs and has accounted for 35% of total job growth, more than any other single industry during that period, according to an analysis posted in a March Health Affairs blog.

“Healthcare job growth has been very steadily positive for many years,” said blog co-author Ani Turner, co-director of the Center for Sustainable Health Spending at the Altarum Institute.


Turner said healthcare manages to remain mostly insulated from the economic downturns that sharply affect other industries in part because of the way it is financed through public and private insurance programs.

In many ways, healthcare job growth has been responsible for both reducing the economic impact of the Great Recession and with helping to quicken the recovery. The sector added 600,000 jobs between 2007 and 2010, while the rest of the economy lost 9 million jobs, according to Turner.

Nonhealthcare jobs didn't return to pre-recession levels until November 2014. By that time, healthcare had added 1.7 million jobs. And, Turner found, by this past January, healthcare jobs had jumped 19% over nine years. Some of that growth can be attributed to increased demand resulting from expanded healthcare coverage through the Affordable Care Act.

But healthcare's job growth has also been a source of contention, especially among critics who argue that a persistent rise in healthcare spending promotes waste and inefficiency without providing incentives that would significantly improve health outcomes.


Stemming the rising cost of healthcare has been one of the forces driving Republican lawmakers to repeal and replace the ACA. But critics of repeal efforts have argued that such actions would have resulted in the loss of many thousands of jobs.

Whatever the regulatory outlook for the coming years, the demand for healthcare will continue to rise, which will be a key factor for a market where the services of clinical professionals such as doctors and nurses are projected to be in even shorter supply.

An estimated 82,000 additional physicians will be needed by 2025 to meet the demand, according to the Association of American Medical Colleges.

Healthcare's employment boom though is about more than the supply and demand of clinicians. It involves the expansion of an entire industry due in large part to the explosion of information technology.

As has been seen in other industries, the digital transformation experienced in healthcare has opened doors to a whole crop of new workers to enter a field that was traditionally limited in terms of the variety of career paths it offered.

“For years and years, if you went to pre-med, you sort of had two options coming out of school—you either went the administrative route or you could be a clinician,” said Travis Singleton, senior vice president at physician staffing firm Merritt Hawkins. “If neither one of those tracks jumped out at you, there really wasn't a world in between.”

Singleton said rapid IT advances have created a need among healthcare providers to develop roles that lay outside of the administrative or clinical track.

Healthcare providers have more recently begun to use IT as a means of discovering patients' needs and wants much like how the retail industry has used such analytics to determine customer satisfaction to improve service or products. That has spurred hiring from other industries.

“They're finding that they can teach the healthcare part, but the other part that healthcare doesn't teach, that's what I think is attracting people not just to large health systems but to all parts of healthcare, and that's exciting,” Singleton said.


Beware of high turnover

The booming growth in healthcare jobs likely also contributes to another issue employers have to face: turnover.

According to an analysis conducted by Compdata Surveys, the total average turnover rate among healthcare jobs in 2016 was 19.9%, up from 17.7% in 2014 and 15.6% in 2010. Among other industries, the turnover rate in healthcare ranks second to only the hospitality industry, compared to 2010 when it ranked fifth.

While other sectors such as hospitality have come to accept high turnover as a part of doing business, it can have a much greater impact on a hospital or health system, where losing skilled professionals in an increasingly competitive job market can hurt quality and patient safety.

A 2016 report on the economic impact of nurse turnover by recruiting firm NSI Nursing Solutions estimated that losing a single nurse can cost a hospital between $37,700 to $58,400. The average hospital will lose $5.2 million to $8.1 million annually due to nurse turnover.

Despite the numbers, many providers still struggle with how to address turnover. “That is a new thing for healthcare because they have not had to worry about it to the level they do now,” Singleton said.

Among clinicians, healthcare's expansion has created an array of employment opportunities outside of hospitals. From such alternatives as urgent care, telehealth and concierge medicine to federally qualified community health centers and consulting, the expansion of the job market has made it harder for health systems and hospitals to hold onto their clinical staff beyond a few years.


As with most other professions, the average tenure of a healthcare professionals at one job has been declining in recent years, standing at 5.6 years in 2016 for hospital workers, according to the U.S. Bureau of Labor Statistics, compared to six years in 2012. Nonhospital healthcare workers had an average tenure of just 3.4 years in 2016, down from 3.9 years in 2014.

Singleton said such statistics highlight the need for providers to learn how to create the kind of workforce culture that inspires a high level of engagement from their employees to keep turnover rates low.

Among providers and insurers on this year's Best Places to Work in Healthcare list, 92% of employees said they planned to stay with their employer for at least two years; 90% of employees at suppliers and vendors were committed to continuing with their firms.


A new culture

The competition to recruit talented healthcare professionals in Texas has been an increasingly tough proposition in recent years as expansion has led to the state having the most hospitals in the U.S.-more than 370.

For providers like Texas Health Presbyterian Hospital Flower Mound, the ability to retain its staff has helped the hospital to garner a reputation as an attractive place to work among candidates when new positions become available. Flower Mound has reduced its annual turnover rate from 50% when it began operations in 2010 to 4% two years later and has maintained a rate within the single digits for the past seven years.

The hospital garnered the top spot on this year's Best Places to Work list among providers and insurers.

“We have little need to utilize huge companies to place our positions because we really staff from word of mouth,” said Nicole Schweigert, human resources director at Flower Mound, which is a part of Arlington-based Texas Health Resources. Schweigert felt a big part of Flower Mound's appeal has been the culture of openness and community the system has developed between management and staff.

“We found that the better we treated our employees, the better patient care they delivered,” Schweigert said.


Part of the effort toward treating their employees better has included emphasizing the importance of providing a healthy work-life balance. Flower Mound offers flexible work schedules and rewards employees with a gain-sharing program for meeting certain quality improvement measures. It also offers rewards for employees that provide innovative ideas toward improving hospital performance.

Every quarter the hospital's CEO has open forums with staff where he explains the organization's financial status and discusses whether the hospital is meeting its care delivery performance goals. It's an environment that stresses transparency between the leadership and staff, which Schweigert said has translated into high employee satisfaction ratings and an average tenure of 5 to seven years.


“We've had people leave and come right back,” Schweigert said.

The effort among healthcare providers like Flower Mound to find and hold onto capable workers is based on creating an environment where hiring the right employee is not just a matter of answering whether they can do the job effectively but rather if they can fit well within the culture.

Other organizations have begun to take that recruitment strategy a step further.

Healthcare recruiting expert Peter Burke—president and co-founder of Best Companies Group, which conducts the Best Places to Work survey for Modern Healthcare—said companies can create their own “funnels” through outreach programs that generate interest among candidates while they're still in school.

He said such initiatives are an example of how healthcare organizations are trying to develop the kind of branding strategies that have made companies like Apple and Google household names.

“They're creating a reputation for themselves,” Burke said. “For years, we've all been focused on marketing our products and services, and now there's almost as much focus on marketing yourself as an employer—so the employer brand has become a focus and a real effort—and it's paying off.”


Steven Ross Johnson

Steven Ross Johnson has been a staff reporter for Modern Healthcare magazine since 2013 and covers issues involving public health and other healthcare news. Johnson has been a freelance reporter for the Chicago Tribune, Progress Illinois, the Chicago Reporter and the Times of Northwest Indiana and a government affairs reporter for the Courier-News in Elgin, Ill. He received a bachelor's degree in communications from Columbia College in Chicago and a master’s degree in journalism from the Medill School of Journalism at Northwestern University.

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