Recruiting and Retaining Radiologic Technologists Effectively

Introduction and Overview

Although the massive shortage of radiologic technologists that characterized the 1990s has largely abated, some shortage of workers in the field persists. Most such workers practice in large hospitals, which average 21 imaging workers. Rural facilities have a harder time recruiting, so hospitals in the most desirable locations may not experience a shortage at all. The key to recruiting for rural hospitals is therefore to outcompete urban facilities—while also looking to their own communities for talented individuals who can be guided into the profession.

Recruitment and retention are ultimately linked. Factors such as training programs for career development address problems both for facilities and for workers. Workers value the control that such programs give them over their career development—a selling point both during the recruiting process and thereafter. For the hospital, training results in workers who cost more but who can do more; this capacity utilization often produces positive financial benefits. The research surveyed here supports 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 shortages still apply. Medical imaging is an important function that every decently 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 average for most positions. Most technologists work in hospitals. The education requirement is an associate's degree or other training program in which one learns to perform this specific job. A bachelor's degree is not necessary but can often be an advantage. 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 demand remains high and growing, creating recruitment challenges for many organizations (Bednar, 2008). Most facilities require multiple full-time-equivalent (FTE) technologists—the average for urban facilities is 21—covering different specialties such as radiography, mammography, and nuclear medicine (ASRT, 2008). The ability to recruit an adequate number of specialists across these disciplines, and to retain them, is therefore essential to the proper functioning of a modern hospital.

There are also meaningful differences between urban and rural recruitment and retention. Rural facilities are often smaller, and their needs are correspondingly different. Rural facilities find it important to recruit technologists who are genuinely willing to work in that environment; retention is less a matter of competing against nearby facilities than it is about hiring people who will be comfortable in a rural setting over the long term (Slagle, 2010). Facilities seeking to improve their recruitment and retention strategies must understand the distinctions among urban, suburban, and rural contexts in order to achieve maximum effectiveness.

Human Resource Policies

Several dimensions shape the recruitment and retention of radiologic technologists. Pay, benefits, working conditions, and job responsibilities are all key elements of any strategy. In addition, hospitals need to identify the best sources from which to recruit. The first step for most organizations is to identify needs, typically framed in terms of FTEs required for each position within the field (ASRT, 2008). In the best-case scenario, few immediate vacancies will need to be addressed through external recruiting, because successful retention strategies reduce the need for recruitment.

Candidates come either directly from school or, for more experienced professionals, from other medical facilities. In the latter case, working conditions and pay are often the primary reasons for changing employers (Sundheim, 2013). A facility that is understaffed may struggle to retain the workers it does have, who may feel overworked and at risk of burnout.

One specific HR policy concerns signing bonuses. Competition for radiologic technologists means that a signing bonus is often offered—sometimes simply to cover expenses associated with starting a new job, such as relocation costs. Approximately 10% of facilities pay such a bonus, typically around $3,000. Signing bonuses are higher for more specialized positions.

Retention presents a distinct set of challenges. Pay is important, but so are benefits, autonomy, opportunities for advancement, and the working environment. When one works in a field in high demand, this creates an opportunity for greater control over working conditions and compensation. The radiologic imaging technologist therefore holds some degree of bargaining power. For hospitals and medical facilities, it is important to understand this bargaining position and to ensure that specialists' needs are met as a core component of the recruitment strategy. This can mean ensuring that technologists perform only the work for which they are trained, providing the best available equipment, and offering highly competitive wages and benefits packages.

Literature Review

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

Bureau of Labor Statistics figures still show that demand for radiologic technologists is growing faster than for most positions in the economy. This likely reflects increased demand for health care in general, driven by an aging population, given that older individuals tend to consume more health care than younger ones. Furthermore, the Affordable Care Act's expansion of health care coverage is expected to increase demand for radiologic technologists in the coming years. All told, this creates an ongoing challenge for human resources professionals tasked with recruiting and retaining these specialists. While the number of training opportunities has increased, younger and less experienced technologists are not in as high demand as more seasoned ones. For hospitals with multiple FTE openings, an ideal balance might involve pairing a senior person on staff with a less experienced—and less costly—colleague in the same role, balancing experience against payroll cost.

Slagle (2010) conducted a study of rural and urban demand in Tennessee. The study found meaningful differences in recruiting strategies between facilities in rural and urban areas, with rural locations presenting a significantly greater challenge. Human resources practitioners specifically identified the rural setting as a hindrance to recruitment. Most open positions at rural facilities are filled by local residents, which can create difficulties when seeking to fill specialized roles. While rural facilities often establish relocation programs, human resources personnel generally deemed these ineffective. Urban HR practitioners, by contrast, found that relocation programs were effective recruiting tools. Suburban locations also face greater recruitment challenges than urban ones, suggesting that the further a facility is from an urban core, the harder it is to attract talent.

Several factors influence the retention of radiologic technologists. Professional development opportunities are particularly significant: the Slagle study found that a majority of professionals in the field take advantage of available development opportunities, making this an important retention tool. At rural facilities, technologists often perform multiple roles, which facilitates learning. At urban facilities, the larger employee base allows the cost of professional development programs to be spread across more workers.

Coombs, Wilkinson, and Preston (2007) studied recruitment and retention within the National Health Service (NHS), the government-run health organization in the United Kingdom. This offers an interesting comparison to American conditions, because the near-monopoly of the NHS means that recruitment dynamics mainly reflect the overall attractiveness of health care as a field, rather than competition between employers. The authors found that anticipating demand and setting adequate pay and working-condition standards were the primary tools available to HR professionals seeking to attract people into health care professions. The study's discussion of radiologic technologists specifically was, however, relatively limited.

Bednar (2008) outlined the state of the profession as of 2008. At that time, the shortages that had plagued the profession in prior years had eased, partly because the capacity of training programs had increased. The article also highlighted how recruiting works in practice: health care facilities use tools such as job shadowing at clinical sites to evaluate candidates, reflecting a trend toward facilities taking more direct responsibility for identifying quality people and providing much of the training themselves. Vacancy rates had once been as high as 18% before the industry took corrective measures. Even today, regional shortages may persist. Slagle's research (2010) indicates that rural areas are more likely to face such situations than urban ones. BLS (2016) data documents the current state of the industry, including much lower vacancy rates, a strong growth rate, educational requirements, and the approximate pay scale.

Luckett (2000) identifies an important link between recruitment and retention: even under conditions of shortage, human resources managers need to exercise patience when seeking talent. Hiring candidates with poor attitudes or poor performance will have negative consequences for the existing workforce, especially if management fails to identify the problem and respond appropriately. The issue compounds quickly, because a deteriorating work environment then becomes a retention problem as well.

A study submitted to the Ontario Ministry of Health in Canada (2013) highlighted additional recruitment issues, including the lack of pension arrangements, which created labor mobility problems, and a gap between market pay rates and those offered by the Ministry. While this situation differs from a free-market system, it highlights two broadly applicable issues: labor mobility and wage gaps. The market for radiologic technologists is national—if not international—in scope. Workers in the field retain substantial bargaining power and can choose where they wish to live and work. This is a particular challenge for rural facilities. Areas with lower living costs, better weather, and more appealing cultures will naturally be more attractive destinations. Facilities therefore need to think in terms of total lifestyle when recruiting. Simply offering a wage perceived as market-competitive is a starting point, but employees—especially those who recognize their own mobility—evaluate a wide range of factors. Eliminating wage gaps is essential, and facilities in less desirable areas should aim to be at the high end of wages relative to local living costs in order to attract talent.

That same study also focuses on the competitive dynamics of the marketplace. Because specialized training is required, people must actively choose to enter the radiologic technologist field. To encourage that choice, human resources personnel must persuade promising candidates that the profession offers genuine opportunities and that the decision to enter it will be rewarding. More people entered the field during the chronic shortages of the 1990s, in part because they recognized they would have substantial bargaining power. In other words, HR professionals must understand that while they compete with other facilities for the same qualified individuals, they also contribute to the overall attractiveness of the profession relative to other careers that equally qualified candidates might consider.

References

ASRT (2008). A nationwide survey of radiology department/facility managers and directors conducted by the American Society of Radiologic Technologists. ASRT. In possession of the author.

Bednar, J. (2008). They can see clearly now: Despite a less severe shortage, radiologic technologists are still in demand. Health Care News. Retrieved June 29, 2016 from http://healthcarenews.com/they-can-see-clearly-now-despite-a-less-severe-shortage-radiologic-technologists-are-still-in-demand/

BLS (2016). Radiologic and MRI technologists. Bureau of Labor Statistics. Retrieved June 29, 2016 from http://www.bls.gov/ooh/healthcare/radiologic-technologists.htm

Coombs, C., Wilkinson, A., & Preston, D. (2007). Improving the recruitment and return of nurses and allied health professionals: A quantitative study. Health Services Management Research, March 2007. In possession of the author.

Luckett, D. (2000). Recruitment and retention topics for a changing environment in medical imaging. Radiology Magazine, 22(Oct 2000), 32–37.

Slagle, D. (2010). Rural versus urban: Tennessee health administrators' strategies on recruitment and retention for allied health professionals. In possession of the author.

Sundheim, K. (2013). What really motivates employees? Forbes. Retrieved June 29, 2016 from http://www.forbes.com/sites/kensundheim/2013/11/26/what-really-motivates-employees/