Nursing Needs

Can local health care providers find a solution to worker shortages?

Back Longreads Jul 1, 2010 By Adam Weintraub

The Arthur A. Benjamin Health Professions High School in Sacramento opened in 2005 and has two graduating classes.

The Arthur A. Benjamin Health Professions High School in Sacramento opened in 2005 and has two graduating classes.

California will need close to a million new medical assistants, lab techs, respiratory therapists and other skilled health workers in the next 20 years in addition to new doctors and nurses, a recent study estimates. But the state doesn’t have enough educational capacity to train them all.

The situation is yet another echo of the baby boom as the postwar generation enters its retirement years, leaving the world of work and entering a phase of life requiring more medical services. A study for the California Wellness Foundation estimates that the state’s population aged 65 and older will grow by 4.5 million by 2030.

That means training replacements for the retiring health workers and adding workers to meet the increased demand. But training is expensive, teachers are scarce and existing programs can’t meet the need. Beacon Economics, which conducted the foundation’s study released in 2009, estimates that the state could fall short by as many as 375,000 workers in allied health fields such as imaging and physical therapy, forcing local employers to compete for trained workers elsewhere.

Educators and the health care industry recognized the problem years ago and have taken some steps to correct it. Efforts include:

• High schools built around a core curriculum that exposes young students to a wide variety of job opportunities in health care

• In-house training programs and educational partnerships backed by major hospital chains

• An ambitious redevelopment project in Stockton that aims to combine both of those approaches with access to nearby hospitals and medical offices, and might even land a new Veterans Affairs clinic and nursing center.

But the economic slump threw a wrench into many plans to address the worker shortage — in fact, two wrenches.

The downturn gutted the savings of health workers, forcing many of them to delay retirement and stay in the work force longer than planned. At the same time, hospitals and other health care providers cut staff and costs. Those factors made training replacement workers less urgent.

The slump also worsened the state’s chronic budget problems, prompting deep cuts at the community colleges and universities that train many health workers, particularly those who must be certified. With less cash and less immediate demand, educators are struggling to maintain existing programs, let alone expand them to meet future needs.

“Right now, a lot of nursing graduates are looking for work, but after the recovery, the projections are devastating,” says Linda Zorn, statewide director of the Health Care Initiative for the California Community Colleges chancellor’s office. “The biggest problem is money.” The initiative was set up to help meet demand for health workers and works with employers through regional centers around the state. The budget proposal released this spring would slice the number of centers roughly in half, and cuts in nurse training grants would reduce enrollment.

But in some ways, now is the worst time to scale back training efforts, educators and industry insiders say. Assuming the economic recovery firms up, health workers who delayed retirement may change their plans again. “Those people will retire en masse,” says Jim Comins, Zorn’s predecessor at the Health Care Initiative.

Inaction will only make the situation worse, says Susan Chapman, an associate professor with the School of Nursing at University of California San Francisco who has studied work force issues for years and serves on the faculty of the school’s Center for the Health Professions. Because of the low ratio of teachers to students, the difficulty of finding “clinical placements” so students can learn in real situations and the high cost of specialized equipment, health worker training is expensive, she says. When you factor in the budget mess and the economic downturn, “funding is dire for all of this.”

The sheer numbers of nurses needed to meet demand prompted a major training push starting in the late 1990s that has improved the situation in that field, and similar efforts were launched the past five years to address the looming worker shortages in the so-called allied health fields.

In the early part of the 2000s, nursing vacancies were chronic in health systems in the Capital Region, forcing hospitals and clinics to employ expensive contract workers. “We looked at it, and we had 1,000 (nursing) openings across the four health systems here, and a capacity to train 200 nurses,” says Anette Smith-Dohring, program manager for work force development at Sutter Health in Sacramento. “We were never going to catch up.”

So Sutter kicked in nearly $17 million to launch the Sutter Center for Health Professions, a partnership with Los Rios Community College District that created an accelerated nursing program in Sacramento. “We bring the business savvy, and they bring the organizational savvy,” says Monica Small, regional director of training and development for the center. The five faculty members and other speakers come from Sutter’s local care centers and remain Sutter employees, which avoids some of the state budget issues and ensures that they are clinically up to date.

The Sutter grant money covers tuition, and the Sacramento-based health company also provides space and clinical opportunities, a comprehensive approach that addresses the major stumbling blocks for many training programs. Since the first graduating class in 2005, at least 361 nurses have come through the Sutter program. Graduates aren’t required to work for Sutter, but the company likes its chances. “If we give them a good experience and good clinical placements, why wouldn’t they choose us?” Small says.

But while the numbers of nurses needed are huge, the looming shortage of allied health workers is proportionally even bigger in some fields. Sutter also is involved in partnerships to address some of those key needs.

A program at Cosumnes River College to train health information technologists — who handle medical information and apply coding so it can be used by the whole health system through electronic medical records — has been completed by at least 44 students since it was launched in 2004. A pharmacy tech program began last year at Cosumnes, and a sonography program is planned for spring 2011. Medical laboratory technician training will kickoff at Folsom Lake College in the fall, Small says.

“We’ve been very lucky in Sacramento because Los Rios has been so committed” to addressing the need for workers and the opportunity to prepare students for good jobs, Smith-Dohring says.

Oakland-based health care giant Kaiser Permanente has forged training partnerships with colleges and universities in the states where it operates, including California. It’s also taken a ‘grow your own’ approach to preparing for the future.

Kaiser more than a decade ago launched its School of Allied Health Sciences in Richmond to address worker shortages in radiology and imaging, says Bob Redlo, director of national work force planning and development for the company. From 2006 through 2008, more than 85 percent of the students taking courses in radiology, sonography, nuclear medicine and radiation therapy stuck with those programs, and more than 93 percent passed their certification exams on the first try. In nuclear medicine and radiation therapy, the pass rate was 100 percent.

Training efforts have been emphasized even more in the past five years or so as technology and electronic medical records have become a major factor in health care, Redlo says. Kaiser found that workers needed nominal additional training once they were hired because the industry and the jobs were changing. “The schools were still using fairly traditional training models,” he says, and school systems can be slow to change an established curriculum. “They were trained in their professions, but not really trained for their positions.”

Kaiser uses distance learning extensively, using an instructor far from the students to guide classroom instruction, then sending the students to company hospitals and clinics near their homes — including sites in and around Sacramento and Stockton — for hands-on training at the elbow of working medical staffers. Some 450 workers in the past year have completed some sort of Kaiser group training program, while 17,000 workers in recent years have received benefits toward training on their own, including tuition reimbursement, career counseling and paid time off from work for professional development. While many companies have reduced such benefits during the downturn, Redlo says, Kaiser has increased them, and it’s paying off. “Our retention rate has improved considerably over the past few years.”

The economic benefits of allied health jobs are a big part of the discussion; as Redlo puts it, “They pay well, and they’re not moving offshore.”

But a lot of potential workers don’t know about the wide range of jobs in the field other than doctors and nurses. Combining a sound education with exposure to the array of available health jobs is the driving force behind the Arthur A. Benjamin Health Professions High School in Sacramento and others like it in Antioch, Placerville and elsewhere around California. A fundamental precept at the Health Professions High School is, “You can get ready for a high-quality career and college at the same time,” says principal Matt Perry.

A small Sacramento City Unified high schools backed by a grant from The Bill & Melinda Gates Foundation, the health school opened in autumn 2005 and has had two graduating classes. It draws some 450 students from across the metro area, and 70 percent qualify for free or reduced-price lunches. All of its graduates so far have been enrolled to go to college, Perry says, and about half are entering health care majors. One, Rene Monzon, won a 2010 Gates Millennium Scholarship for full four-year tuition and wants to study neuroscience.

The curriculum is based around health themes, which incorporate math, science and all the other required subjects for college admission, and ties them to projects such as improving nutrition for a specific small group or understanding infectious disease or health insurance. Throughout the year, students get exposure to all aspects of health employment, with around 55 guest speakers a year and 50 to 60 field trips offered.

“We really want them to be trying on different hats,” Perry says. “When we take them to a cadaver lab, some of them may run, but some move in closer, and they might wind up working in pathology.”

Such schools can play a role in building the health work force, Chapman says. “Awareness and exposure are the keys, as well as making sure they have a sound basis in math and science.”

All those notions — exposure to health jobs from an early age, access to training and clinical settings, and partnerships between education and health care — go into the plans for University Park in Stockton. The redevelopment is emerging at the 102-acre former site of the state mental hospital; it was called an asylum when it opened in 1852 and had evolved into a developmental services center when the state shut it in 1996.

There’s always been an educational focus to the redevelopment plans; California State University Stanislaus moved its Stockton satellite campus to the site in 1998. But the economic downturn slowed progress toward the mixed-use redevelopment originally proposed for the site near downtown and the Port of Stockton. So The Grupe Co., which started managing the site in 2002 for a joint-powers agency combining the city of Stockton and CSU, shifted its focus to health care education.

“We think there’s an opportunity to create at this location a health care and wellness education center,” says Kevin Huber, president of Grupe. The pedestrian-friendly site is across Harding Way from St. Joseph’s Medical Center and fronts on California Street, a main drag for medical offices in Stockton. CSU Stanislaus already has health worker training programs. With high unemployment in the region, local schools are looking to tap training grants to meet the anticipated need, which would only grow with the planned construction of a hospital east of Stockton for state prison inmates.

In addition, local K-12 educators are eyeing a building on the site for a high school specializing in health careers, and Kaiser reportedly is interested in adding training at the CSU building. Kaiser and education officials wouldn’t discuss specifics. “The need in Stockton is to start teaching young people skills that will create a career ladder in the field of health care,” says Patrick Johnston, a former state senator who now serves on the joint powers board that oversees University Park. “The goal is by fall of 2011 there would be an open academy drawing students from throughout San Joaquin County.”

And Grupe is awaiting word from the U.S. Department of Veterans Affairs on whether the corner of the site once slated for apartments has been chosen as the new home of a medical center and nursing home for patients who served in the military. A decision was expected in June.

“Health occupations training and education has been a good prospect for a long time, even without the prison hospital and the VA center, but they certainly accelerated the discussion,” Johnston says.

There’s little precedent for the approach Grupe is using, but the company is sold on the idea and has spent millions on redeveloping the site with its full-grown trees and historic buildings. “When you’re trying something where there’s no model and there are so many different components, it’s very tricky to get it all to come together,” Huber says. A comprehensive center could expose students and trained workers to everything from pediatrics to gerontology, lab work to patient care, and physical therapy to computerized record keeping. “If you have that kind of exposure, it will open their eyes to opportunities they wouldn’t otherwise have seen, and you … ultimately can create more health workers.”

If the combined approach chips away at the need for workers in Stockton, Huber says, there’s no reason it couldn’t also work in Fresno, Sacramento, Riverside or other areas facing a health worker shortage.

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