Health Care Recruitment and Retention

¶ … massive shortage of radiologic technologists of the 1990s has abated, there is still some shortage of workers in the field. Most such workers ply their trade in large hospitals, which average 21 imaging workers. Rural facilities have a harder time recruiting workers, so hospitals in the most desirable locations might not even experience a shortage at this point. Key to recruiting for rural hospitals is thus to outcompete the urban facilities, but they must also look to their own areas for talented people who can be guided into the profession.

Recruitment and retention are ultimately linked. Factors like training programs for career development solve problems both for facilities and workers. Workers like the control that such programs give them over career development -- this is a selling point both during the recruiting process and thereafter as well. For the hospital, such training results in workers who cost more, but who can do more, and this capacity utilization often has positive financial benefits.

The research that has been done on recruitment and retention of radiologic technologists is surveyed and cited to support these core arguments. Statement of the Issues Nationwide, there is a shortage of radiologic imaging technologists. While the shortage has improved somewhat in recent years, this remains a position that is in demand, and in some areas of the country the shortage still applies. Medical imaging is an important function, one that every decent-sized facility has a use for.

The Bureau of Labor Statistics estimates that there are around 230,000 jobs in the field nationwide. Demand for medical imaging technologists is growing at 9%, faster than the for the average position. Most work in hospitals. The education requirements are for an associate's degree or other training program where one learns how to perform this specific job. A bachelor's degree is not necessary but can often be a help. The median salary for this position is around $58,000 per year (BLS, 2016). For many years, there was an acute shortage of these professionals.

With more people entering training, the shortage is not as severe as it once was, but there is still high and growing demand. This creates recruitment issues for many companies (Bednar, 2008). Most facilities need multiple FTEs worth of technologists, the average for urban facilities being 21, with different specialties such as radiography, mammography, nuclear medicine technologists and other specialties as well (ASRT, 2008). Thus, being able to recruit an adequate number of these different specialists, and retain them, is important for the proper functioning of a modern hospital.

There are also differences between urban and rural recruitment and retention. The needs for rural areas are different, in particular because facilities are often smaller. Rural facilities find that it is important to recruit technologists who want to work in that environment -- retention is less a matter of competing against other facilities in the area as it is about hiring people who are going to be comfortable working in a rural environment long-term (Slagle, 2010).

It is important for facilities seeking to improve their recruitment and retention strategies to understand the differences between urban, suburban, and rural recruitment and retention strategies, in order that they have the most effectiveness. Human Resource Policies There are several aspects to the recruitment and retention of radiologic technologists. Issues such as pay, benefits, working conditions and responsibilities are all key elements of a strategy. Furthermore, hospitals need to identify the best sources from which radiologic technologists can be recruited. The first step for most organizations is to identify needs.

This is typically outlined in terms of FTEs required for each given position within the field (ASRT, 2008). In the best case scenario, there will be few immediate needs to be addressed through recruiting. Successful retention strategies can result in reduced need for recruitment. Candidates come either directly from school, or for more experienced candidates from other medical facilities. In the latter case, there are many reasons why somebody would change employer, but working conditions and pay are often key factors (Sundheim, 2013).

A facility with an insufficient number of professionals in a category might have trouble retaining the remaining ones, if they feel that they are overworked, for example. One HR policy is setting the signing bonus. Competition for radiologic technologists means that a signing bonus is often offered, sometimes simply enough to cover some of the expenses involved with starting a new job, such as relocating. Around 10% of facilities pay such a bonus, and the amount is usually around $3,000. Signing bonuses are higher for the more specialized positions.

Retention is a different issue altogether. Pay is important, but there are other issues such as benefits, autonomy, seniority/growth and working environment that matter. When one works in a field for which there is high demand, this creates an opportunity to have more control over one's working conditions and pay. The radiologic imaging technologist therefore has some degree of bargaining power over these issues.

For a hospital or medical facility, it is important to understand the bargaining position and ensure that the needs of the specialists are met, as a key component of the recruiting strategy. This can mean things as simple as ensuring that they are only doing the work for which they are trained (not being asked to perform other tasks that they are not comfortable with), to having the best equipment, to offering highly competitive wages and benefits packages.

Literature Review The ASRT's (2008) radiology staffing survey reveals that there is an ongoing need at many facilities for one form of radiology professional or another. Facilities that experience multiple consecutive years without recruiting or retention issues are the exception. For most facilities, multiple practitioners are required. That said, the vacancy rate was 1.5% in 2008, which was an improvement from levels just a few years prior, statistical evidence that the former shortage of professionals in the field is abating.

The BLS figures still show that demand for radiologic technologists is growing at a rate faster than for most positions in the economy. This likely relates to the increase in demand for health care in general, which reflects an aging population, given that older people tend to consumer more health care than younger people do. Further, the Affordable Care Act's promise to expand health care coverage should further increase the demand for radiologic technologists in the coming years, in combination with the further aging of the population.

All told, this should create an ongoing challenge for human resources professionals tasked with recruiting and retaining radiologic technologists. While there has been an increase in the amount of training opportunities, younger inexperienced technologists are not in as high demand as more experienced ones. For hospital that have multiple FTEs available, the ideal balance might be to have a senior person on staff, and a cheaper, less experienced one as well in the same role, to provide a balanced between experience and pay.

Slagle (2010) conducted a study of rural and urban demand in Tennessee. In this study, it was found that there are differences in the recruiting strategies between facilities in rural and urban areas. The author found that it was much more difficult to recruit professionals to a rural area. Human resources practitioners noted specifically that rural locations were a hindrance to recruitment. Most open positions at rural facilities are filled by local residents, which can pose challenges when seeking to fill specialized knowledge positions.

While rural facilities often set up relocation programs, these were deemed to be ineffective by human resources personnel. Urban human resources practitioners, conversely, found that relocation programs were effective recruiting tools for their locations. It was also found that suburban locations have recruitment challenges relative to urban ones, such that the further from urban cores one gets, the harder it is to recruit people. There are several factors that influence retention of radiologic technologists. One is professional development opportunities.

The Slagle study found that a majority of professionals in the field take advantage of the professional development opportunities that exist. Thus, this becomes an important retention tool. At rural facilities, the technologist might perform multiple roles, allowing for better learning, but at urban facilities the larger size of the facility can help it to spread the cost of professional development programs over a larger number of employees. Coombs, Wilkinson & Preston (2007) conducted a study of recruitment and retention at the NHS, or National Health Service, the government-run health organization.

This is an interesting comparative to American issues, because there is a virtual monopoly, and recruitment issues mainly reflect on the overall attractiveness of health care, rather than competitive dynamics between firms. The authors found that the overall attractiveness of the profession relied on human resources professionals to anticipate demand, and set pay and working condition standards that were adequate to entice people into health care professions. This particular study, however, featured rather scant discussion of radiologic technologists specifically. Bednar (2008) outlined the state of the profession in 2008.

At that time, the shortages that plagued the profession in prior years had abated, in part because the capacity of training programs had increased. This article highlighted some of how recruiting works as well. For example, companies utilize things like job shadowing at clinical sites to help evaluate candidates. This shows that health care facilities are taking more direct responsibility, finding quality people and doing a lot of the training themselves. Quality candidates are usually receiving some sort of education in the field.

Vacancy rates were as high as 18% before the industry took measures to alleviate the shortages. Even today, however, there may be some regional shortages. The Slagle paper (2010) indicates that rural areas are probably more likely to face shortage situations than urban areas. BLS (2016) data outlines the current state of the industry, including much lower vacancy rates, a strong growth rate, the education required for the position, and the approximate pay scale. One issue in retention is identified by Luckett (2000).

In this article, Luckett outlines that recruitment is an important aspect of retention. The argument is that even under conditions of shortage, human resources managers need to be patient when seeking talent. If poor attitudes or poor performers are brought into the organization, this will have negative consequences on the rest of the workforce, especially if management fails to identify the problem and react accordingly. Then, the problem compounds because the work environment has taken a negative turn, so that problem in recruitment becomes a problem in retention as well.

Other strategies have been identified. A study submitted to the Ontario Ministry of Health in Canada (2013) highlighted recruitment issues such as lack of pensions created mobility issues, and a gap between market rates of pay and those offered by the Ministry. This is obviously a slightly different situation than would exist in a freer market system domestically, but it highlights two key issues -- labor mobility and wage gaps. The market for radiologic technologists is national, if not international in nature.

Workers in the field still have substantial bargaining power, and can choose where they wish to live. This is one of the issues facing facilities in rural areas. Areas with lower living costs, better weather and more desirable cultures are ultimately going to be more attractive than areas without these things. This creates a challenge for facilities to think more in terms of total lifestyle when recruiting.

Simply offering what is viewed as a market-competitive wage is a starting point, but employees look at a whole range of issues, especially if the employee perceives that he/she has mobility. So eliminating any wage gaps is a good start, and those facilities in less desirable areas need to be at the high end of wages, relative to living costs, in order to attract people. That study also focuses on the competitive marketplace.

People must actively choose to enter the radiologic technologist field, because of the need for specialized training. In order to convince them to do this, human resources personnel need to convince good people that there are opportunities in the field, that the decision to enter the profession will be rewarding. More people entered the field in response to the chronic shortages of the 1990s, in part because they knew that they would have substantially bargaining power.

In other words, human resources personnel have to understand that while they are competing with other facilities for the same qualified people, they are also contributing to the overall attractiveness of the profession, against other professions that similarly quality people would be considering. Examination of the Issues The basic reality of recruitment and retention is that it remains a seller's market, and in such a market firms have to compete for scarce workers.

There is only a relatively minor surplus of radiological technologists, however, so the competition is not as aggressive as perhaps it once was. However, the evidence shows that firms still need to compete, but that they do so on things such as quality of life. Urban hospitals have the easiest time in attracting talent. Though the cost of living is often higher in urban areas, the quality of life often can be as well. The facilities are bigger in urban areas, too, and that offers particular advantages.

Rural hospitals and smaller medical facilities have a much more difficult time in attracting talent in this field. They offer fewer opportunities for either training or advancement, and there is a perception (rightly or wrongly) that the quality of life in rural areas is going to be lower than in urban areas. Even suburban areas have noted greater challenges in the recruitment phase than urban areas. For human resource departments, there are some significant implications to this. First, many employers do not need to offer incentives to attract talent.

Only around 10% of employers offer hiring bonuses, and for the most part these are only a few thousand dollars, often less than the costs associated with relocation. Even with that, urban employers find this to be more effective than rural ones. On the surface, rural employers should find relocation programs to be more effective, in terms of the difference between having a program and not having. This was not specifically subject to empirical study, but the perception among rural HR personnel was that such programs were not particularly effective.

Ultimately, rural medical facilities tend to draw from their own areas. Thus, training is something that some hospitals have had to add to their recruitment arsenal. Finding employees or candidates from the area who have studied/are studying medical related issues, and who are interested in specific studies to build up to a career in radiological technology, and then facilitating that training, is an approach that many rural facilities have had to add to their recruitment arsenal.

The different studies have noted that wages are only an issue where there is a wage gap. Information on the national wage for this position is publicly available from the Bureau of Labor Statistics, and human resource departments need to recognize that in a sellers' market labor has mobility. Thus, labor is often looking beyond an immediate region for work, and may be willing to move to another area for a significantly higher wage.

Employers that offer wages and benefits that are below the norm can be expected to have difficulty in recruitment. If that is the case in Ontario, where competition comes in the form of people choosing to work in a different province or leaving the country, then this is definitely going to be an issue anywhere in the United States, where there are far fewer barriers to finding an employer willing to offer more.

The wages for this field have increased steadily over the years, a result of the surfeit of workers, and so offering a competitive wage and continuing to do so would be considered to be an essential component of both recruitment and retention., Retention and recruitment are often juxtaposed, when really they should be linked. Finding great people means fewer issues with retention. Better people can be developed better within a system, and being surrounded by capable talent creates the sort of positive work environment that reduces turnover.

While the best workers will need to be paid more in order to ensure retention, the reality is that they are worth more than weaker workers, more than the wage gap between the two. Hiring the best people, people with positive attitudes and a high level of competency, creates the sort of environment that lowers turnover. Nevertheless, it is important that a company has a specific retention strategy, rather than accepting turnover as a fact of life.

Studies have indicated that training programs and opportunities for advancement are important elements of retention, in addition to managing the wage gap. Within this field, the more opportunities for a person to take charge of their own career development, and the lower the likelihood that a person gets stuck, the lower the rate of turnover will be. Larger facilities attract talent by promising them training programs and multiple career pathways, as those are elements in both recruitment and retention.

Training is therefore an important component, and the human resources department needs to have programs in place to allow employees to either gain this training in house, or to compensate employees should they decide to undertake training off-site. There is benefit to offering training programs, too. First, workers can add new skills and get paid more for these skills, but the added cost of these skills is incremental, and lower than if the organization needed to hire an additional person.

Thus, training is beneficial to both the organization and to the workers. Furthermore, training people to handle additional duties allows for employees to have their work time optimized, so that there is minimal downtime, and people can shift from one machine to the next, allowing for more efficient capacity utilization. While each machine is different, there are some fundamental principles that can be broadly applied within the field, and having one person learn these principles plus different machines is more efficient than teaching everything to a large number of people.

The other thing that training does is that it reduces the need for recruitment. Internal recruitment in form of training existing staff allows hospitals in particular the ability to keep good people by offering them more money and responsibility, but also to save money on the hiring process. The organization gets somebody with which it is familiar, and on top of that it gets somebody with a demonstrated level of competency. The recruitment process can be easier, and the workers benefit is well because with additional skills comes additional pay.

The worker therefore has greater control over his/her career at that point as well -- some workers might prefer to specialize while others might welcome the opportunity for additional training. Recommendations The first recommendation is to take care of the basics. Salary and benefits should be viewed as competitive on the national level, not regional, because many workers in the field view their opportunities.