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California Hospitals Expand With Eye To The Future

Paresh Dave |
January 9, 2012 | 3:41 p.m. PST


The construction of a new hospital in Burlingame, as seen in 2010.
The construction of a new hospital in Burlingame, as seen in 2010.
As the scaffolding goes up on the new medical tower at Tulare Regional Medical Center, the hospital knows it will be adding tens of new steady and well-paying jobs.

But Tulare and other hospitals face two challenges. Filling some positions takes as long as two years because job-seekers lack specific qualifications and experience. Second, federal healthcare reform and the recession have frozen budgets and shifted the patient population, creating uncertainty about exactly which jobs the hospitals will need.
Tulare Regional added a net of 10 positions at the beginning of 2011, including clinic aides, medical assistants and finance staff. The growth was small but welcome in a county with an unemployment rate of nearly 16 percent.

By the fall, the hospital began a hiring freeze. Mired in uncertainty and saddled with debt from the construction and fewer paying customers, it made sense to keep payroll costs down until its forecast improves from mostly sunny to sunny.

“If it doesn't get any better, we don't want to bring on people we have to go around layoff,” said John Barbadian, Tulare Regional’s vice president for human resources. “We've been getting very, very tough on where we're hiring.”

The cautious approach to creating jobs is the latest development for the healthcare sector, which continues to see steady job growth while other industries scale back.

“We’ve been fortunate, the health care industry as a whole, because we provide a service that doesn’t go away,” Barbadian said.

A few weeks after the hiring freeze went into effect, Tulare Regional's directors agreed to take out a $6 million loan to buy equipment for its new tower, including a $2.4 million robot to perform surgeries. While cash remained loan, the trustees reasoned that it was a safer bet to invest in tools than people.

But hospital officials continue to see the slow-down in hiring as only a temporary blip. California hospitals have created about 13,000 jobs over the past four years. The growth rate of about 3 percent is a stark contrast to an 8 percent decrease in total nonfarm jobs statewide during the same period.

At least 18 of those new jobs have come at Kaiser Permanente’s South Sacramento Medical Center. The partial opening of new medical tower brought the need for additional staff in engineering, environmental services and nutrition services. Other hospitals, from Redding to Davis to Riverside, are beefing up information technology and senior-care departments.

Hospitals have been able to expand despite the poor economy because they are the refuge of last resort for uninsured patients in need of care because hospitals can't legally turn anyone away. That's offset a decrease in the number of people undergoing voluntary surgeries such as joint replacements and gall bladder removals.

Hospitals know the future is somewhat bright because baby-boomer retirements will both open hundreds of thousands of positions and lead to more customers.

They are slowly tailoring their workforce to account for that aging population and the provisions of the 2010 healthcare reform law. They want workers who can help them take advantage of monetary incentives tied to the use of electronic record-keeping. All the while, their financial futures are staked to meeting the federal government’s mandate to provide better service at cheaper costs.

“There's a lot of questions about who can deliver the best care most efficiently,” said Timothy Bates, an expert on the healthcare workforce at the University of California, San Francisco. “Hospitals want to position themselves to be the answer to that.”

But the new dynamics in healthcare have also appeared in a troubling trend: a lack of very specific talent that’s in high demand.

“The issue we have that’s relevant is a workforce shortage, a need that this only going to grow
as the population ages,” said James Lott, executive vice president of the Hospital Association of
Southern California. “We are being challenged by a lack of qualified individuals.”

Eight of the 15 occupations projected to see the greatest rate of job growth through 2018 in Tulare County are in healthcare. Barbadian checked off three of the occupations -- home-care specialists, physical therapists and pharmacists -- as jobs that have been tough to fill.

He bemoaned the shortage of lab scientists as well. About 125 new lab scientists graduate each year in California, according to the California Hospital Association. That's low enough to pose a serious challenge.

“There are not enough of them coming out of schools,” Barbadian said. “Some hospitals could hire an entire college’s graduating class.”

The demand for similar positions will only grow across the state in the coming years. About $4.4 billion in hospital construction projects are underway in the state and another $12 billion in projects is likely on the horizon.

Paring costs while adding employees inevitably means something has to give.
The Central Valley’s Community Medical Centers system cut at net of 17 out of 6,000 positions this year. Most of them were administrative roles. When it finishes a new facility in Clovis in 2013, the hospital will need up to 400 new workers.

“The demands for hospital care are continuing to increase in the valley as the population grows and ages,” said Ginny Burdick, the centers’ chief human resource officer. “Community always has job openings for skilled clinicians, especially experienced nurses.”

She too brought up the talent shortage.

“Those skilled, licensed clinicians with several years experience continue to be difficult to find and hire – and attract to the Central Valley,” she said.

San Diego-based Scripps Health also cut positions during the past couple of years.

“In order for us to maintain stability in the upcoming healthcare storm, (we are) ensuring across our system that we’re really bringing a centralized focus and that we’re maximizing people’s time,” said Veronica Zaman, Scripps’ corporate vice president of human resources and learning, referring to healthcare reform as a storm.

Zaman said Scripps has prioritized avoiding layoffs because positions that require experience are hard to fill and bringing someone new into its system often costs more than switching someone's role.

“The more stable you can keep your patient-care environment,” Zaman said, “the better you can keep up your quality.”

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