As employers, hospitals weathered the recession better than most other industries. But now, shifting winds in healthcare delivery are creating a little storm of their own.
Hospital job growth had some of its worst months in nearly a decade this year, according to Bureau of Labor Statistics data.
That’s likely the reflection of a cloud of uncertainty looming over hospitals. They’re anticipating more patients to come into the care system as a result of healthcare reform and an aging population, but aren’t quite sure how many to expect. At the same time, some are seeing fewer patients as more basic care is being moved to outpatient facilities. Hospitals are seeing sicker patients but being reimbursed less for it.
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“Federal government plays such an important role in influencing spend, so when Medicare increases or decreases reimbursement, things can change almost overnight,” said Steve McMahan, president of Randstad Healthcare, a full-service healthcare staffing company.
That seems to be what’s happened this year, as Vanderbilt University Medical Center, Cleveland Clinic and numerous other hospitals announced layoffs and budget cutting. Yet healthcare is expected to add the most new jobs of any industry from 2012 to 2020, BLS projects.
Where are those jobs going? Karlene Kerfoot, vice president of nursing at API Healthcare, said that in the shift toward pay-for-performance and ACOs, they’re going to different venues like home care agencies, outpatient surgery centers and urgent care clinics. That changes the job requirements for, say, a nurse looking for a job in a hospital. “On the inpatient side, the acuity of patients has gone up, because most of the patients with low-acuity are not in the hospital anymore,” she said. “So acuity of the nurses (in hospitals) has gone up.”
There’s a slightly different skill set for the growing number of care providers working in ambulatory care facilities, where patients are seen episodically. Kerfoot said that some organizations are now even training people to be able to float between in-patient and ambulatory care so that they can be more flexible.
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API Healthcare provides tools and services for hospital staffing to help them, for example, make sure a nurse is handling the patient he or she can work with best. “When we match the patient needs to the competencies of the nurse, we can have much better outcomes,” Kerfoot said, emphasizing that technology is helping hospitals optimize the use of their staffs.
Another trend in employment, specifically among nurses, is an uptick in demand for critical care, according to Kerfoot. Some 32 million people are expected to gain insurance under the Affordable Care Act, and many of them will have been without healthcare previously.
They won’t be simple cases, Kerfoot said. And many of them will also face socioeconomic challenges that are boosting demand for non-clinical healthcare jobs in community health, patient navigation and health IT.
There’s also a lot of opportunity outside of the traditional healthcare provider organization. “Insurance companies are hiring nurses to be able to handle patients that they have to move into the ambulatory areas,” Kerfoot said. “And of course in academia there’s a huge shortage of people who can teach.”
According to McMahan, the outlook for healthcare employment overall still looks strong. Randstad’s third quarter healthcare employee confidence index found that confidence levels of healthcare workers were at their highest since Randstad began tracking the metric at the beginning of 2012.
“We’re seeing two big data points collide: Healthcare costs as a percentage of GDP really can’t go any higher, yet the demand is coming from people late in life,” he said. “This is a time when you’re going to see a lot more innovation in delivery of healthcare solutions.”