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The Bipolar World of Healthcare

February 15

When unemployment numbers were released for November 2010, the news wasn't good. General unemployment took a small hike to 9.8% and only 39,000 jobs were created. Unemployment for people who are college educated went from 4.4% to 5.1%, one of the biggest jumps in four years. It was reported that African-American workers had an unemployment rate of 16%, while Caucasian men were 10% and Caucasian women 8.4% unemployed. Asian workers were 7.6% unemployed.

We expected better for November. Recovery is painfully slow and businesses are not hiring, but rather capitalizing on workers' fear and asking for longer hours and higher productivity. Employee anger is mounting and much of senior management is looking the other way.

Things are different in healthcare and it is sometimes hard to balance the inequities of what we read in or hear on the news with our reality. For the record, healthcare created 19,000 jobs in November and for the first time in many months, jobs were created in acute care facilities—8,000 of them. Ten thousand more were created in long-term care, which has been posting good numbers all through the Great Recession, which started in December, 2007.

I spend much of every workday trying to figure out how to find candidates for good paying jobs, many of which have been open for months. We look at how to get their attention, how to respond quickly and how to sell them the opportunity. And, we do this while being bombarded with the news that other classifications of employees are barely keeping the lights on because they cannot find new jobs to replace the ones they lost six to 12 months ago. Two million people will lose unemployment benefits this month if they are not extended by Congress, and consequently many may go from no lights to no home.

Of course, the jobs for which we are recruiting are for skilled workers. We have shortages in healthcare, but not all the open positions demand exactly everything that we seek in a candidate. To be honest, we are a little inflexible in healthcare when it comes to the skill set we will and won't hire. I've never figured out exactly if it is the hiring manager or the lack of resources which causes hospitals to allow a job to stay open six months, as opposed to training someone with basic skills but not the optimum experience.

I have a client who currently has 34 Health Unit Coordinator positions open and another 17 Certified Nursing Assistant positions. Good candidates have presented but because they don't have two years' of hospital experience they aren't even considered.

One of the candidates came to plead her case: "I went to the Community College and took the courses to become a Health Unit Coordinator and I passed everything. I am certified by the National Association of Health Unit Coordinators, but I can't get a job in a hospital. They want experience. If I go to long term care, I'll never get into a hospital."

Registered Nurses (RN) without hospital experience are receiving the same explanation for why they are not being hired. Selecting long term care would not provide the appropriate experience so we are graduating RNs with no place to go. It is a little better for students coming out of imaging or respiratory programs and most acute care facilities will take any Physical Therapist or Occupational Therapist with a valid license, but there remains a big problem.

It is easy to see both sides. Healthcare systems need staff who can hit the floor running. They pour millions of dollars into training new hires, who, even with experience, present with less skills than they need. RNs routinely graduate, ill prepared to manage direct patient care, and it often takes six months before they are remotely able to carry a full load.

Patients have higher acuity and the skill mix of direct care providers are being lowered both because we can't find the right individuals and because we need to balance the budget. In many hospitals throughout the country, RNs who exit are being replaced by Patient Care Technicians or CNAs, thus making it even more important for them to enter with experience.

However, who is going to provide the experience to new graduates—in all healthcare fields—which will allow them to actually secure a job in an acute care setting? Should the schools be required to add more clinical rotations? Should candidates be willing to work for less pay while gaining experience, thus lowering the cost of training for hospitals? With the proliferation of the proprietary schools, who make a great deal of money from these students, should it be more of their responsibility not just to churn out graduates but produce graduates who can work along side any licensed professional?

It is probably the responsibility of everyone. Baby Boomers begin turning 65 in 2011 and it is estimated 7,000 a day will retire. With Healthcare Reform completely in place by 2014 and 38 million more people covered by insurance or a government program, healthcare will need everyone remotely skilled to join the team because business will be booming with the Baby Geezers.

The skills gap among workers looking for jobs in other segments is well known, but it is a bit of a myth, that because healthcare is creating jobs and there are shortages, if you are licensed you can find a job. Perhaps we should take a look at both the answers and the responsibilities.

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