Looking Into the Career Crystal Ball

(Note: This is part 2 of 3 of ADVANCE's series on the future of health care career opportunities. Please see the archives for part 1.)

After understanding how jobs will shift in upcoming years-as we face an aging population, training challenges, a shrinking workforce and evolving career choices-it's important to look at the efforts underway to manage the situation. In this segment, our experts discuss specific areas where shortages will be felt, as well as new directions in recruitment to overcome these obstacles. We'll also review some current events and the impact they may have on the long-term outlook. Shortages Increased need, expanded health care arenas, decreased program enrollment and a retiring workforce have all come together to cause a crisis in nursing. They aren't the only ones facing a shortage though-laboratory and imaging professionals, therapists, therapy assistants, and medical information professionals are all hearing similar tales of staffing woes. Pam Cipriano, PhD, RN, FAAN, chief clinical officer for the University of Virginia Health System, says the greatest shortages and continuing need will be in "highly technically challenged areas such as high-demand high-end radiology technologist jobs and some nursing positions." She sees a need for people with the skills to manage both high-tech and high touch. A pending issue is nurse-to-patient ratios, which a lot of states are putting into place, says Carlos Hagler, director of operations for CompHealth, a health care staffing firm. That's going to be a big issue for a lot of hospitals, how they manage that process-especially in a shortage. People who can blend skills are going to be increasingly in demand as health care develops, says Larry Altman, vice president of Corporate Marketing Communications & Product Development for Horizon Blue Cross Blue Shield of New Jersey. "We're in a situation with incredible growth in costs, and incredible advances that we all want to make available to as many people as possible. It comes down to how to do that as efficiently as possible," he explains. To answer these questions "combining clinical background and understanding with management thinking will be a requirement." Professions dealing with people with chronic illnesses will be in greater demand in upcoming years, says Alan Jette, PhD, dean of Boston University's Sargent School of Health and Rehabilitation Sciences. The issue won't be cut and dry, though. "There will be increased need for services, but whether that translates into demand for services will depend primarily on reimbursement issues." In specialized areas like medical laboratories, imaging and pharmacy, "it's more challenging," Dr. Cipriano states. "There aren't as many programs that prepare those individuals and, because they're highly specialized, we don't do a whole lot of cross-training. As technology changes, it requires that people move within their specialty areas or go back and get additional education." These technical fields aren't getting the visibility and attention they deserve to produce more professionals, notes Martin Ford, dean of Cooperative Education and Career Services at Drexel University in Philadelphia. Sue Valerio Sladen, director of Cooperative Education and Career Services at Drexel University in Philadelphia, explains that some of the other areas of growth "are mostly in areas where the most significant educational piece requires at least an associate's degree (for example, PTAs, OTAs); types of positions where the providers are really performing the service of higher paid PTs or OTs." She cites "the direct relationship to cost issues associated with health care and the challenges in HMOs and managed care as well." Dr. Jette points to changes that took effect in the late 90s with the Balanced Budget Act (BBA), which artificially capped reimbursement rates, as causing a severe drop-off in people entering physical and occupational therapy. An increased focus on alternative or holistic care will also cause a need for providers to add new skills to their tool kit. Altman identifies the general trend of looking at the person as a whole and the effect that has on treatment options. There is a "growing demand for people that can blend complementary care with traditional care or knowledge of both those areas. I think we'll likely see the boundary between those blurring," Altman affirms. "While certain facilities have done a great job retaining workers and may not be as desperate as other facilities, overall the shortage is everywhere," Hagler adds. "It's not all about compensation-other things about working are important to people too. A big thing hospitals need to work on is retaining, training, and growing the people they have." Recruitment Efforts Knowing where the need will be is only part of the plan for dealing with shortages, however. New, creative and aggressive campaigns to bring more people into health fields are an important part of the solution. Programs such as Drexel University's Accelerated Career Entry BSN (ACE) help people who already have a bachelor's degree to receive their bachelor's degree in nursing in one year. The majority of students if not all of them are adult learners who had previous careers. While attracting adult learners into health care programs is important, people undecided about a career path are an untapped resource as well. Educating pre-college age students on the importance of health care is key to reversing the trend of declining enrollment, Sladen explains. There's resistance to enter these professions because of stigmas that are attached, she says. "I think we have an obligation to start educating people a lot younger about health care and the benefits of those types of professions." Hagler points out that "years ago if you were a female and you wanted to be a professional you were a nurse or a teacher. Today, that's not the case." He believes new recruitment efforts need to start at the high school level, doing presentations about career choices and working in health care. Along with reaching out to those looking to start or change careers, recruitment efforts also need to reflect the diversity of the general population. Reaching into different communities and being open to people of different backgrounds who are interested in the field is important, Altman states. It's also important to "look at a broader set of people, including better representation and better opportunities for underserved groups that may have not traditionally entered certain parts of the field." For lesser-known health care fields, Dr. Jette says, "It is a challenge because the more traditional fields such as medicine and nursing have more visibility." The need to attract minorities to these fields is very great, he says. Increased exposure to opportunities in health fields should have a positive effect, creating a more diverse and plentiful potential workforce. Dr. Cipriano takes an optimistic view on recruitment efforts. "With all of the advertising campaigns and the workforce strategies to look at bringing not only women but certainly men into nursing, my sense is that we will be more successful continuing to recruit into nursing." Effect of Recent Events Along with long-term recruitment strategies, current events could have an impact on the future of health care professions. Recent economic downturns and the events of September 11 and may not bring floods of new recruits to the field, but they've helped shine the spotlight on helping and caring professions and boosted the role of providers in the public eye. "Every time the economy takes a downturn and the health care industry tends to be a very robust employment area, that helps bring individuals into nursing education programs," Dr. Cipriano says. The scarcity of jobs in other areas of the economy - like the technology sector - may help some people make the connection between the skills they possess and the openings health care. For example, people who have computer skills may find - with additional training or education - roles within the technical side of health information management. The effects of the events of September 11 on the perception of health care professions cannot yet be calculated. According to Dr. Cipriano, these events, in and of themselves, may not have a lasting impact: "[After September 11,] there might be a better appreciation for individuals in any sort of public service role, but I would be surprised if it really has a significant effect [on enrollment]." But, in conjunction with economic factors, and a growing media focus on health care shortages, the increased awareness may yield positive recruitment results. It's not simply a question of numbers - even in times of shortage, quality has to be stressed over quantity. As well, recruitment efforts will need to focus on opening avenues that encourage sound career choices. People contemplating entering the field "really need to get some strong advice if it's the right field for them," Ford advises. "If they get started down that path and it's not the one, then it can be not only discouraging but also counterproductive to what they're searching to do. For people considering going into a health care profession, really sit down and talk with somebody who's doing it. If it's the wrong profession, it doesn't matter what it is, it's still going to be the wrong profession. Awareness of impending challenges, developing recruitment and retention plans and being ready for the dynamic changes awaiting health care are the keys to successfully navigating the path to career and staffing success. In the final part of our series, ADVANCE explores the impact the largest entities paying for health care-government and managed care organizations-may have on health care career outlooks. Creating a balance between cost and care, these units may have the largest impact on the field. Nicole Benkert is on staff at ADVANCE.