Health systems are extending their recruitment reach as they look to continue to decrease the use of staffing agencies and mitigate persistent shortages.
Workforce constraints were a central theme of responses to Modern Healthcare’s annual Hospital Systems Survey, which polled more than 50 health systems this year about payer mix changes, service expansion, behavioral health and other topics. Organizations are trying to bolster the pipeline for high-demand positions and hire people earlier in their careers, along with retaining those already on the payroll.
“While the staffing situation has certainly gotten better than where it was a year ago, we are not exactly where we want to be,” said Dianna Sparacino, chief people officer at Evanston, Illinois-based NorthShore Edward-Elmhurst Health. “That leads us to continue to focus on long-term strategies.”
Here are five takeaways from the survey about healthcare staffing trends.
1. Use of staffing agencies is waning, but need remains.
Most health systems reported that their reliance on staffing agencies—both internal and external—has dropped over the past year.
Indianapolis-based IU Health, for instance, said it has had to use fewer travel nurses and physicians since the apparent peak in 2022. Still, it may take three more years for the system to rely minimally on travelers, said Adrienne Sims, chief human resources officer.
The sentiment aligns with industry forecasts. The overall healthcare temporary staffing sector reached $64.4 billion in 2022, more than triple the market size in 2019, according to an April report from workforce advisory company Staffing Industry Analysts. The report estimated the travel nursing industry will shrink by 25% in 2023.
But the projected demand for healthcare in Indiana outpaces the number of high school and post-secondary graduates interested in joining the field, Sims said.
“I think staffing shortages will spike again,” said Sims, noting the supply-demand imbalance. “We are going to find ourselves in another challenging place if health systems are not proactive, which is why we are trying to engage in workforce development across the state.”
2. Recruiters look to spark youth interest.
Health system human resources administrators are engaging middle- and high-school students to teach them about opportunities in the healthcare field.
NorthShore Edward-Elmhurst, for instance, has teamed with workforce development programs like Aspire and Naperville, Illinois-based KidsMatter to reach younger generations.
“We have brought in interns and high-school students to try to show them the joy of medicine and get them excited and interested,” Sparacino said. “We need to get them interested in the field in the very early stages of their education.”
Chesterfield, Missouri-based Mercy Health has reached out to middle-school students to try to show them the array of potential careers in the industry.
“Many students think of healthcare professions as solely nursing and physician roles. We are working hard to inform young students about the many facets comprised within healthcare, such as marketing, finance, IT and human resources, and the growth opportunities that are associated with this,” the system said in the Modern Healthcare survey.
3. Systems are focusing on high-demand roles.
Provider organizations are seeking to address high-demand roles through partnerships and internal workforce development programs.
IU Health is partnering with Ivy Tech Community College, among other schools, to bolster the staffing pipeline. Ivy Tech will receive grant funding from IU Health over a three-year period to hire teaching faculty and offer certification courses for phlebotomists, electrocardiograph technicians, certified clinical medical assistants, certified nursing assistants and emergency medical technicians. Certified students will be offered positions at the system.
It is also working with organizations such as Ascend Indiana, a job-matching platform, and Crispus Attucks High School, which specializes in healthcare and computer science, to connect with potential employees, Sims said.
Such partnerships “are still not enough, so we are thinking about how to expand our footprint with Indiana high schools and post-secondary institutions,” she said. “We’re also looking at what other states are doing ... because we recognize we have to do more.”
In addition to collaborations with external organizations, IU Health is training existing employees to become medical assistants, respiratory therapists, emergency medicine technicians, and other positions in high demand, Sims said.
NorthShore Edward-Elmhurst has laboratory science and nurse residency teaching assistant programs to help workers strengthen their skills, Sparacino said.
“We need more of an advancement structure to help staff grow from novice to expert,” she said. “We know that is critical to retention.”
Rush University System for Health in Chicago has a medical assistant apprenticeship program, which pays for students’ tuition and books while offering them experience, hourly pay and benefits. The COVID-19 pandemic compounded the search for the roles, said Marcos DeLeon, chief human resources officer at the health system.
The program exemplifies "just some of the thinking that healthcare is going to have to embrace," DeLeon said.
Employment of medical assistants is expected to grow 16% from 2021 to 2031, outpacing the estimated 12% growth rate of all other healthcare support occupations, according to the Bureau of Labor Statistics.
4. Organizations are boosting pay and implementing flexible schedules.
Almost all of the 54 health systems that responded to the Modern Healthcare survey said that their organizations had increased pay, boosted referral bonuses and implemented more flexible schedules to improve recruitment and retention.
Some health systems reported increasing their referral bonuses to $10,000. Others said they've offered pay increases to nurses who pick up weekend shifts or benefits to part-time workers who claim hard-to-fill time slots.
“Remote and hybrid work options and additional flexibility have been essential for retaining and recruiting staff, especially nonclinical staff by expanding our applicant pool,” Carilion Clinic, a health system based in Roanoke, Virginia, said in the survey.
Sticking to typical 12-hour shifts for nurses and other clinicians isn't sustainable, health systems said.
IU Health is testing new care models and compensation packages through several pilot programs. Employees are asking for individualized benefits, such as loan repayments, tuition assistance or signing bonuses, rather than just a pension or 401(k), Sims said.
The programs are also experimenting with giving nurses more autonomy, automating administrative tasks and delegating more work to lower-level staff, she said.
5. Telehealth may provide some relief, especially for behavioral care.
Health systems are using virtual care in conjunction with team-based approaches to try to reach more patients in need of counseling, therapy or other mental health treatment. The strategy could limit the strain on some psychologists, psychiatrists, primary-care providers and other clinicians.
The demand for mental healthcare has spiked in recent years, leading to overcrowded emergency departments and delayed treatment. The U.S. would need more than 8,200 additional behavioral health practitioners to meet current demand, according to the latest estimates from the Health Resources and Services Administration.
Virtual treatment options, more diverse care teams and broader recruitment efforts have helped fill some of the access gaps, health systems said in the survey.
Cleveland Clinic’s team-based care approach includes placing a behavioral health social worker in each of its primary care service areas; sharing medical appointments with nurse practitioners and therapists; collaborating with guidance counselors, schools, primary-care doctors and parents; and partnering with community groups to ensure patients are getting appropriate follow-up care, the health system said in the survey.
It is also improving access by expanding its telehealth offerings, embedding social workers in all emergency departments and hiring more mental health specialists, Cleveland Clinic said.
Meanwhile, Johns Hopkins Health System in Baltimore was among the many systems that said telehealth has helped expand its reach.
"[Telehealth] saves the time and expense of travel or other obstacles such as lack of child care, access to transportation or physical disabilities that make travel difficult. It also allows us to provide care to underserved populations in rural areas where care is often not available," the organization said in the survey.
For the full survey results, click here. See the 2022 operating revenue of 25 participating health systems below.