On Thursday, June 22, HC3 hosted the latest installment of the Future of Work Series focused on hiring and sustainability and addressing sector-based challenges and opportunities. In this discussion, we’ll take an in-depth cross-sectoral look at the challenges and opportunities in fostering a stable workforce to meet organizational and industry demands.
Moderator:
Meghan Phillipp, Executive Director, HC3
Panelists:
Aleena Agrawal, VP of Talent Solutions, P33
Hana Alberti, Senior Director, Center for Dental Practice Policy, American Dental Association
Chris Coon, Director of Business Operations, Medix
Matt Hartman, Executive Director, Illinois Health Care Association
Susan Swart, Executive Director of ANA-Illinois and ISAPN (Illinois Society for Advanced Practice Nursing)
Watch the Webinar
Event Recap
Panelist Introductions
Meghan Phillipp (MP): The general consensus in regard to the workforce is burnout, shortages, and so forth. As each panelist introduces themselves, please share what you are seeing as the challenges and opportunities in your sector.
Chris Coon (CC): I have been in health care recruitment for 11 years. Medix is a workforce solutions company, our role is to be hiring consultants for our clients. We bridge the gap for allied customers with a focus on nursing My observations are nothing new: it’s hard to hire right now. There is not enough skilled talent in the labor market, not enough individuals in school for health care, and we are seeing baby boomers leaving the health care workforce and now needing services, which creates the perfect storm. Our job is to educate our clients on these factors and coach them on opening up the supply. We are thinking about how to create rewarding career opportunities so that individuals will go into these roles and have a rewarding experience.
Susan Swart (SS): Prior to the pandemic, nursing shortages were more regional, and Chicagoland didn’t feel it the way the rest of the state did. My focus right now is on registered nurses and the faculty needed to educate them. We don’t have the pipeline that we used to have. And our focus used to be on encouraging people who are already RNs (registered nurses) to continue their education and expand, but now it’s more focused on engaging CNAs (certified nursing assistants) to improve the pipeline. Another big challenge is that no one in the health care workforce has had their wages adjusted for cost-of-living. We are not doing a great job of making sure there is appropriate reimbursement for services, and currently salaries are not reflective of the reality we’re in.
Aleena Agrawal (AA): Our focus at P33 is how to boost the tech sector of Chicago to create economic development opportunities for our entire region. Remote work has created some opportunities because we can recruit technologists from across the country. A lot of the tech workers that have been laid off typically have been on the west coast, so there’s an opportunity to pull them into spaces they wouldn’t have looked at previously because of salary caps.
Hana Alberti (HA): When we think about dentistry, in Chicago specifically, we forget about the faculty at the university teaching the next generation of dentists. We have dentists that are fully in academics, research, and developing technology. The most recognizable dentists are those that are chair-side, embedded into our communities, and usually treat the whole family. There is usually high job satisfaction, and there has been an expansion in the scope of service to include medical health screenings such as for diabetes. Dentists have a lot of responsibility for operational and administrative decisions. With dentistry, it’s not insurance it’s a benefit that can leave patients with a lot of out-of-pocket expenses. Patients have an expectation of what they will pay, and dentists must balance that with still being able to pay staff and maintain their clinic. Dentists are facing increased costs for technologies and shortages for dental teams. The dentist pipeline is strong, but there is a struggle with front desk staff, practice managers, dental assistants, dental lab techs, and hygienists.
Matt Hartman (MH): During the pandemic, there were a lot of negative headlines for long-term care. There was a microscope put upon those who operated in that space, and burnout was very real. We already see high turnover in this sector. Over the course of the pandemic, we saw over 300,000 nurses leave the field nationwide, since then, hospitals and clinics have seen a bounce back in nursing numbers, but long-term care is still experiencing a high shortage of 200,000 nurses. To increase wages, which is one piece of the puzzle, we must rely on the government to understand the value of what nurses are doing because 70 percent of reimbursement is through Medicaid. Expansion and contraction of the scope of practice are other things to look at. Also, issues like transportation and childcare can be part of the solution.
Discussion
MP: What are some primary workforce challenges relating to staffing ratios, and how do they impact patient care outcomes?
SS: In acute care, the ratios are still like what we saw during the pandemic. We are still dealing with burnout from when we didn’t have enough individuals to provide care. We know that the fewer patients a nurse takes, then the better the outcomes. If you look at the research, we don’t know the number of RNs we have employed in Illinois – we don’t have accurate data. Until we have those numbers, we are challenged to accept the legislation to deal with the ratios.
Regarding long-term care – nurses provide care across the life span – we should be doing it more in long-term care and embrace that. How to build those systems is the question we need to talk about. Ratios are huge, and data shows that those numbers increase better outcomes.
MP: How does the physical and emotional strain of long-term care nursing affect the workforce? What support systems exist, and how does high turnover affect patient outcomes?
MH: What happens is we have a shortfall, and people leave the sector. The pipeline is narrowed to the point that 25 percent of nurses say they plan to retire in the next year, and we don’t have a viable plan to replace them. Regarding support systems, providers must look for every way possible to make things meaningful for nurses. When it becomes more paperwork than hands-on care, it loses meaning, leading to burnout. We look for ways to alleviate stress. Some providers offer in-house daycare. Another solution is creative scheduling. Some nurses want 4, 8, 12, or 16-hour shifts. Building scheduling around that makes it work better for them. Another piece is consistency in seeing outcomes – consistent assignments and staffing to see the patient's impact. Keeping up with salaries is important, but that’s not all there is to it. There is a need for a multi-faceted approach.
MP: What can you share about the challenges of administrative burden in the dental industry?
HA: The dental team is facing a lot of vacancies. According to the Bureau of Labor Statistics, will have a shortage of 56,000 assistants in the next ten years. The assistants are critical to the patient experience. A healthy team dynamic and environment can prevent burnout issues, often more than compensation increases. Dentists are losing 10 percent of their normal capacity to see patients.
MP: How are you working with employers to meet the needs of both the organization and the employees?
CC: To focus on the potential employee piece, it’s still a job seeker’s market right now. We are still coming out of the travel boom, and a slow shift is happening where talent is considering local opportunities more than travel. Pay is still number one, but we are seeing a shift to focusing more on stability and quality of life. After pay, benefits, patient ratios, and commute are increasingly important. You can find the perfect nurse and offer top dollar, but an offer in the small world comes along, and top dollar is no longer the main factor. We challenge clients to ask what is most important to clinicians in their next opportunity. Companies are investing more in benefits. Culture is a game changer; it’s a big selling point opportunity.
MP: How are you looking at workforce development from the talent pipeline? How does it translate into health, life science, and insurance opportunities?
AA: A lot of the culture piece that Chris talked about hinges on diversity and being able to see yourself at the company. We think about how to develop local talent, attract talent, and retain talent so that they see Chicago as a great place to start their career. Currently, all companies are tech companies. There are different pathways to these tech careers in health care. At P33, we try to think about how to make sure everyone has the right opportunity for them. We run a program called Strong Start, bringing employers into early classrooms. This builds brand recognition, starts an early pipeline, helps individuals begin to see how specific careers could interest them, and helps get to know the culture through the employees.
MP: What barriers exist to the development, training, and education of nursing in Illinois? What are the gaps?
SS: One of the unique opportunities health care employers have been when nursing students go through their programs, they do clinical rotations, but we are seeing fewer and fewer opportunities to do rotations, so that has become a challenge. One reason is that nurses are burned out, and you are asking a nurse to take on that student for the day. Regionally, there are issues with bringing students in because systems have decided not to do that. Having nursing students work with EHRs has been a challenge for bringing students in because it can affect reimbursement. With faculty, an issue is not just enticing people to go into academia but the salary difference between a clinician and a faculty person. We are looking at HRSA (Health Resources Services Administration) grants colleges can apply for to bridge the payment gap. We have to find innovation to entice people into health care and how to do things differently than before.
MP: What are we seeing for the pipeline in dentistry?
HA: Aleena said, “Patients want to see themselves in their providers,” and that diversity aspect is so special. I have had patients drive far to see me because I spoke Czech; they felt that connection. Career days do make a difference starting in elementary and high school. Many dentists say they knew very early on that they wanted to attend dental school. Regarding the pipeline question dentists, in the U.S. in 2022, there 200,000 dentists. That’s 60 per 100,000 people nationally and 68 in IL per 100,000. When we look at the IL workforce, there’s a sizeable generational shift of dentists. Most dentists are baby boomers nearing retirement, then a dip in mid-career providers, and because of the boomers approaching retirement, the school numbers have increased. There are three dental schools in IL, 260 seats for the first year, and about half are IL residents, so 130 dentists per year. The pipeline for dentists looks good, but there was a shortage of hygienists during the pandemic, and although it has rebounded some, it continues to be an issue.
MP: With training and advancement, how do people get promoted or add licensure? What challenges and opportunities are you seeing?
MH: There are opportunities to advance careers in long-term care. A career ladder is very important. CNAs are the backbone of long-term care; they do so much of the hands-on work. A typical CNA is a single mother, and it’s a lower-paying job. Opportunities such as being a shift leader allow CNAs to make a little more money and have increased responsibility. There are things out there we need to develop to make the career ladder more meaningful that will keep people in the field. One example, although there is some controversy, is Medication aids. Medication aids would operate under supervision to administer medications that require oversight. We can also think about how we offer educational opportunities for folks to take advantage of, such as in-facility training. Expanding the scope of practice is another way to improve the workforce ladder.
MP: Regarding recruiting from colleges, where do you cultivate a flow for partners you work with?
CC: We have direct partnerships with schools. One pathway is in imaging. We are working with schools to bring people as x-ray techs and then scale to a higher level like MRI tech. They learn the organization's culture, and the organization gets to know that individual and see if they would be a good fit. Tuition reimbursement is huge. We also have worked with a chief nursing officer in the behavioral health space and partnered with seven schools offering opportunities to come in as a CNA and get the education and scaling skills.
MP: How is P33 engaging leaders to think about the priority of health equity?
AA: P33 looks at the whole system. We think about various stakeholders and the incentives that drive them. We look at the education system to see what is happening at a university with faculty, career services, etc., to influence the changes we want to see.
Final comments
MH: Our challenges are so vast that no solution should be left off the table.
SS: We need to bring all stakeholders to the conversations.
CC: Focus on collaboration and seek partnerships outside the box.
HA: Look at what’s causing people to burn out and what prevents them from getting the help they need.
AA: Early exposure to careers is key to building a more robust talent pipeline.