Rx for Staff Emergency in Hospitals : Measures Include Foreign Help, Recruitment Bonuses

The medical technologists at St. Joseph Medical Center in Burbank say they work faster than they ever have, but in the face of staff shortages that promise to grow worse, it never seems fast enough.

The phones in the laboratory ring incessantly with doctors and nurses asking for test results. “It’s not that we’re not trying to get them out,” said laboratory manager Beverly Bryant. “But there is a large volume, and the machines only work at one speed.”

Similar frustrations are recounted in many departments of hospitals nationwide as a growing number of jobs acquire the “hard-to-fill” label that long has been associated with the field of nursing.

There is an urgent need for X-ray and ultrasound technicians, for physical and occupational therapists and for a host of workers in related fields, according to hospital administrators and other health-care officials.

Seeking Efficiency

These shortages, coupled with a troubled emergency-care system, have wreaked havoc at some Los Angeles hospitals. “Units cannot operate fully, or at all, because the staff is unavailable,” said Arthur Sponseller, vice president for human resources at the Hospital Council of Southern California.

With few exceptions, health-care administrators countywide are examining how they can make more efficient use of their staffs, and they are relying on an advancing technology for more innovative ways to deliver care, the Hospital Council said. In addition, some hospitals offer cash bonuses to employees who refer qualified candidates for hard-to-fill jobs, advertise more extensively and practice new recruiting techniques--even to the point of talking to elementary school students.

“We can’t just recruit people and do nothing else,” Sponseller said. “We must recruit them and change the way we use them.”

Hospital administrators agree.

“You don’t need an RN to empty a bedpan,” said Judy Hansen, director of recruitment services for Kaiser Permanente’s Southern California region--a department created 18 months ago in response to a growing manpower problem.

Health care is the third-fastest-growing employment sector in Los Angeles County, behind retail trade and business services, according to Jack Kyser, chief economist for the Los Angeles Area Chamber of Commerce.

Uneven Growth

In 1988, 250,900 people worked in health-related occupations countywide, compared to 107,500 in 1972, Kyser said. But the growth is spread unevenly across careers.

“We seem to have too many doctors and dentists, but not enough of the support type,” Kyser said.

One reason is that increasing numbers of women, once restricted to the nursing and technical ranks, are taking advantage of new opportunities. Opting for higher salaries and more prestige, these women are becoming doctors and dentists, lawyers and corporate executives.

“I think status is a very important factor,” said Norm Goldman, medical group administrator for Kaiser Permanente Medical Center in Panorama City. “Perhaps even more important than money, though we try to communicate with money.”

Kaiser’s Panorama City complex has four physical therapy positions open out of 13. The most recent opening has remained unfilled for 10 months, the oldest opening for more than three years.

A job for an ultrasound technician has been open for 11 months. Three of 22 jobs for respiratory therapy technicians have been vacant five months.

“That doesn’t seem long anymore,” said Goldman, who used to fill such positions in less than 30 days.

Other hospitals are in a similar predicament.

In 1987, the most recent year for which statistics are available, the vacancy rate for physical therapists was 13.1% compared to 11.8% in 1986, according to the California Assn. of Hospitals and Health Services.

“When you couple it with the turnover rate, it gets scary,” said Carolyn Beghin, the association’s director of human resources.

That rate topped 27% for physical therapists in 1987--compared to 20.3% the previous year--which means that 27 out of every 100 therapists in Southern California left their jobs that year.

Officials say the problem is getting worse. Statewide, the vacancy rate for various technical fields requiring advanced training--laboratory, radiation and ultrasound among them--jumped nearly 8% in 1988 compared to 4.5% the year before, according to Beghin.

That’s good news for students interested in health-care professions. Keith Hopkins, director of the physical therapist assistants program at Pierce College in Woodland Hills, said he receives between 25 and 30 letters a week from employers interested in his graduates. The amount of training needed for the hard-to-fill slots ranges from two years for a physical therapy assistant to a bachelor’s degree plus one year of additional hospital training for medical technologists who analyze body fluids for signs of disease.

Job Prospects Good

“The job market is excellent,” Hopkins said.

A physical therapist assistant who completes the two-year training program at Pierce can earn up to $30,000 a year right out of school.

Hospitals are experimenting with solutions to the shortage, including telling elementary school children about the virtues of health-care professions and paying employees for referring qualified candidates.

A $1,000 bonus awaits Kaiser workers who find suitable applicants for hard-to-fill positions. The company also offers scholarships to students interested in pursuing health-care careers, reimburses tuition of employees who want to train for other jobs in the industry, and gave employees in some technical positions double-digit raises last year.

Other areas of the country, particularly hard hit by shortages, have offered still greater incentives. When Callaway Community Hospital in Fulton, Mo., found itself with 12 vacant nursing positions, it agreed to provide maid service at the homes of full-time nurses, according to a newsletter prepared by the Bureau of National Affairs, a private publishing company that reports on government issues.

Patients Lend Hand

To ease shortages, other hospitals have tried alternatives to traditional care. In one program that operates in two Bay Area hospitals, patients perform tasks generally assumed by nurses--monitoring their blood pressure, taking medication and changing surgical dressings, for example.

Glendale Memorial is considering alternative work shifts once reserved for nurses (four 10-hour days, for example) for some of its technical employees. It may also begin an employee recognition program to applaud exemplary work in hopes of preventing high turnover in hard-to-fill areas.

Hospitals throughout the county often turn to workers from other countries, but immigration authorities occasionally stand in their way.

Devi Naidoo, 32, a radiation technician from South Africa, was recruited to work at UCLA Medical Center in 1986. But her visa has expired, and the U. S. Immigration and Naturalization Service has denied her petition for permanent residence. Unless she wins a temporary reprieve, she will be forced to leave her job at the end of the month.

Medical centers also rely on an increasing number of registries that provide temporary help in areas such as nursing and physical therapy.

‘Kelly Girls’

“We’re the Kelly Girls of physical and occupational therapy,” said Stephen Lindsey, president of RPT PRN, a registry based in Garden Grove that serves the Southern California region.

Sponseller predicts that advanced technology, particularly robotics, will play an ever-greater role in hospital operations.

The University of Michigan Hospital in Ann Arbor has moved in that direction, using computer-directed carts to transport surgical supplies, linens, food and drugs throughout the building.

And at Long Beach Memorial, a robotic arm assists surgeons during brain biopsies.

The Southern California Hospital Council started a Health Careers Project in November that tries to persuade young people and adults to consider health-care careers. In addition to school visits, the program includes a media campaign with full-page advertisements in consumer magazines.

The project, which cost $367,000 to operate this year, is funded by 110 hospitals throughout Southern California.

Toll-Free Number

The council operates a toll-free number to distribute information about health-care occupations and financial aid opportunities. Career counseling can be done over the telephone.

New bonds are also being formed between hospitals and schools, with medical personnel talking to public school students in the hope that they will chose a career in health care.

“Up until now, most of the impetus came from colleges,” Goldman said. “Now the provider is taking the initiative to stimulate interest.”

In April, Kaiser in Panorama City sponsored a luncheon for 50 vocational counselors in the Los Angeles Unified School District. Its aim: “To rally them to join forces,” Goldman said.

The shortages, which are approaching crisis proportions in some rural areas across the country, have their roots in the changing nature of the health-care industry and the patients it serves. People live longer than in the past, and this aging population demands sophisticated medical services.

Costly Care

Because skyrocketing health-care costs have led to more outpatient care, patients in hospitals tend to be more seriously ill than in years past. Medical experts say patients frequently require more diagnostic tests and highly skilled services, increasing the demand for technical workers.

And as large numbers of older hospital workers retire, fiscal constraints have curtailed many training programs, producing fewer graduates to replace them.

“We are competing for this minuscule emerging work population,” Hansen said.

There is competition within the industry as well. Physicians band together, form medical groups and hire their own technicians instead of contracting with hospitals for services. Many physical therapists opt for private practice instead of signing on at a hospital.

Experts agree that resolving industrywide shortages will require an industrywide effort.

“The demand for health-care workers is at epidemic proportions,” Hansen said. “It is not an issue one organization can solve itself.”