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Pharmacists, coders, and imaging among the hardest hit
Everyone knows about the nursing shortage, but for some hospitals, that may be just a precursor to shortages in a growing number of health care fields. Hospitals in some areas already are having trouble finding medical coders and pharmacists, and according to some research, the next five years could see high vacancy rates in everything from nutritionists to speech pathologists.
A study released in February by the Center for Health Workforce Studies at the University of Albany (NY) outlined the scope of the problem in New York, citing shortages of pharmacists, radiologic technicians, respiratory therapists, and LPNs becoming particularly acute over the next two years. (For a list of projected vacancies in New York in selected health care positions, see chart.)
The university isn’t alone:
On the surface, things are looking pretty good for hospitals anxious about the future supply of radiology technologists. According to the ASRT’s 2002 study of enrollments in radiography, radiation therapy, and nuclear medicine programs, enrollment is up for the third year in a row.
Based on those figures, the ASRT projects that there will be enough radiation therapists and nuclear medicine technologists to fill the number of job openings predicted by the BLS — 7,000 more radiation therapists and 8,000 more nuclear medicine technologists by 2010 than there were in 2000.
But factoring in the number of students who won’t graduate, then number of graduates who won’t pass their exams, and the number who will leave the profession, the ASRT figures the country will end up 30% short of the BLS’s estimates for our needs.
What might help fix that is an increase in the number of students the nation can accommodate. However, the study showed that 69.1% of responding radiography programs are at full enrollment, and nearly 14,000 potential students who wanted to enroll in radiography programs in 2002 couldn’t find spaces.
In pharmacy, things seem to be looking up, with vacancy rates down from 8.9% in 2000 to 6.9% last year, according to the ASHP 2002 staffing survey. That said, it’s still hard to find experienced pharmacy technicians, frontline pharmacists, and qualified pharmacy managers. In the latter category, nearly three-fourths of the respondents to the survey said they think there is a "severe shortage" of pharmacy managers, and a whopping 93% of them think there is a severe shortage in frontline pharmacists.
Whether a hospital has trouble filling pharmacy positions seems to be related to whether there is a pharmacy school in the area, explains Douglas Scheckelhoff, MS, director of the division of practice leadership and management at the society. Even if the situation is slightly better, he says it likely won’t stay that way. "Our sense is that the attrition rate hasn’t change — the same number of people are leaving the profession and retiring. And the number of applicants to pharmacy school and graduates is pretty stable."
The problem, he says, is that there just are not a huge number of graduates available in any given year. A typical pharmacy program might graduate 30 people, and the whole country only graduates 7,500 per year. Considering that New York State anticipates a yearly need of 460 pharmacists per year between now and 2008, it doesn’t bode well for the country as a whole.
"We have an aging population and an increased demand and need for prescription drugs," says Scheckelhoff. Indeed, there are an increasing number of prescription drugs on the market, too. "These are drugs that aren’t replacing something older, but are completely new, like Viagra," he says.
There is also an increasing trend for pharmacists to fill nontraditional roles in hospitals, health systems, and drug companies. A pharmacist might be a clinical education consultant that acts as a resource for prescribers or one may work as an adjunct to pharmaceutical sales representatives. "That means there are fewer pharmacists to fill the traditional roles," says Scheckelhoff.
Answers are many
So what’s a hospital to do? Scheckelhoff says part of it is to make sure you do what you can to retain the pharmacists and technicians you have. In its survey, the ASHP found that there is a statistically significant correlation between overall vacancy rates and the number of a series of retention factors implemented by respondents. (For a list of those retention factors, see box.) The more of them the hospital offered, the lower the vacancy rate, the survey notes. Hospitals should note, too, that among those retention factors, lifestyle considerations, professional practice, and work environment each was more important to retention than salary and staff development factors. Salary and bonuses may get the pharmacists in the door, Scheckelhoff says, but will it keep them there?
To increase the supply and demand issues, there is a push to provide more funding to pharmacy schools, particularly those that are in underserved areas, he says. More certified pharmacy techs also can help. "You have to make sure that pharmacists are doing what pharmacists should be doing, not what a tech can do."
The ASHP also is promoting the use of automation in pharmacies — whether unit-based dispensing cabinets or robotic systems. "Most or all of these can reduce the amount of time a pharmacist spends dispensing and checking prescriptions. The demand for routing functions goes down, and the pharmacist can spend more time helping to manage patient care."
Grow them from inside
One method for finding some of these hard-to-fill staffers is to look in your own organization and train them into the role. "What has worked best for our hospital is to train and promote from within," says David Newman, director of radiology for Methodist Medical Center of Oak Ridge, TN. "Technologists are, for the most, part loyal when they know that if they stay with you, they will get the chance to be promoted and trained, and to grow in their abilities."
Newman has worked in the same organization for 30 years, watching the department grow from a three-room X-ray department to a medical center with everything but PET (positron emission tomography) — "and we are working on that," he notes. "We have never hired a specialist, MR or CT tech from outside our hospital, and we have hired only one ultrasound tech — and that was 15 years ago — from outside."
Also going the grow-your-own route is Baylor University Medical Center in Dallas which two years ago faced a medical coder shortage: There were several vacancies and no people in the area to fill them. So the hospital created a six-month paid training program that has solved the shortage issue completely, says Dana Choate, RHIA, associate director for health information management at Baylor.
There are seven spots each semester, she says, the number chosen because that was how many vacancies there were for coders when the first class started. "We wanted to be out of hot water," she says. It also was the number that could be accommodated for the practical work experience part of the class, and it was the number for which Choate was able to justify the expense.
The first time the course was offered, there were 56 applicants. The second time 83 people applied. By the third course, the hospital had 174 applications. With needs met for the time being, Baylor didn’t offer the course for two sessions. It is just getting ready to offer its fourth course.
"Initially, it was for people who worked in the hospital already and were looking for an opportunity to grow professionally but couldn’t afford to quit work and go to school." Aimed at clerical-level employees, the pay was higher than minimum wage, but about on a par with an entry-level administrative job, says Choate. The students also receive benefits.
Things have changed, however. Now, applications come in from across the country. "There are highly skilled individuals — nurses, nursing assistants, transcriptionists — who wanted to stay in health care but were looking for a different track," Choate says.
The course includes classroom work on medical terminology, ICD-9 and CPT codes, as well as classes in anatomy, and pathophysiology. It also includes hands-on experience in a health information management department. "We think the work experience part of the class is critical to helping them understand what they will be doing in the real world," says Choate.
Those who make it to the course have to promise to work in the Baylor system for two years after graduation. The first graduates now have been at Baylor for more than two years and seem content to stay there, says Choate. "We even did some employee satisfaction testing with the students and asked if they would still be working here if they hadn’t had to sign the two-year agreement. The answer was an overwhelming yes."
Once they complete the course, the students are eligible to go for an entry-level coding credential through the American Health Information Management Association, says Jessica Rudd, RHIA, the coding instructor for the course. After they have two or three years of experience, they can sit for a certified coding specialist exam.
The cost wasn’t insubstantial, says Choate: some $300,000 for books, computers, salaries, and the cost of educational consultants to design the course.
Was it worth it? From an accounts/receivable perspective the ability to fill vacancies has allowed the hospital to drop some $2 million from outstanding A/R. In addition, there hasn’t been a real need to go looking outside the hospital for coders — something that would make many hospitals green with envy. "It was a risk," Choate says. "But it was definitely worth it."
Douglas Scheckelhoff, MS, Director, Division of Practice Leadership and Management, American Society of Hospital Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Telephone: (301) 657-3000, ext. 1350.
Dana Choate, RHIA, Associate Director for Health Information Management, and Jessica Rudd, RHIA, Coding Instructor, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246. Telephone: (214) 820-2135.
David Newman, Director of Radiology, Methodist Medical Center, 990 Oak Ridge Turnpike, Oak Ridge, TN 37831. Telephone: (865) 481-1000.