Current and Future Healthcare Workforce Trends – HRO Forum

I think that's one of the most the biggest ironies about going to a workforce conference is that your arrival time impacted by probably the most dated workforce solution known to man they had to cut 1% out of 136 billion dollar budget so they decided that air traffic controllers could take some time off so nothing that nothing fixes a good economy like not letting people fly across the country to go do business but hopefully today you'll get a little bit more information about maybe a little few more creative solutions than furloughs to kind of typical workforce challenges this morning I'm just going to kick us off and then we've got two panels coming up to talk both about RPO and how they implemented that within their healthcare systems and then the second is on MSP as well the benefits of the MSP programs how to manage your continued workforce differently than you do today and how to go about implementing those practices in your own organizations the session overview is really just we don't want to talk just a little bit about you know the economy is improving just a little and the Accountable Care Act is kicking in oh and and how is that going to impact right how we pay people how we organize how we hire how we manage our workforces and then help your own organizations thrive in kind of that challenging environment with all of the change that we expect we do hope that you'll take away right on a better understanding the key economic drivers impacting the industry best practices from MSP and RPO practitioners and then how to get value from you know your permanent and contingent labor it's moving from becoming in a necessary evil as it's been labeled years and years to becoming actually a more strategic part of overall healthcare system workforce management so with that I'll jump right into just kind of some trends that we're seeing from a immense perspective and in we're in workforce trends among healthcare I'm going to talk first about just those economic trends that are impacting health care I'm gonna start really high right in healthcare we tend to think about health care all the time and maybe don't fully share with each other some of the impacts that things like you know the growth economy economic growth rates and GDP have on the industry so I mean start really high and I'm gonna drill in just a little bit tighter and talk to some specific health care workforce trends and then I'm gonna go medium you may some may say a little bit low on this one and go into our assessment of the impact of the Accountable Care Act on the healthcare workforce makeup so definitely the first time we've actually haven't published this information yet when we'd have an estimate of job creation associated with the implementation of PIPA or Accountable Care Act or Obamacare all it has all kinds of great new names on exact employment numbers and things that your organization can do to be ready for those changes so first up and are those macroeconomic factors I was talking about the GDP improved by 2.5 percent in q1 this is a pretty decent jump in GDP we had kind of a disappointing result in q4 it's the initial number was kind of a negative number it ended up being a point for improvement in q4 and and jumped up to two and a half in q1 some reason why this is important to those of us in workforce solutions in health care is it in a the trend has been that the utilization and hiring you know in health care models GDP very closely so there's a certain amount of health care that's just tied to people's disposable income how well they feel about their portfolios and things like that so there's you know some percentage of treatments can be put off we all think of it as emergency medicine it's really not you know most most things are you know that you can put off you know you don't have to go to the doctor if you think you've got the flu but if you've got a great health coverage you go you know so things like that change is that GDP improves so does healthcare employment overall unemployment rate went to seven point six percent you know the Obama administration would be very happy to tell you that's the lowest rate since like two late 2008 they're all very excited about that number of course it's still the highest of you know the rates have been you know over the 50 years 52 years of my lifetime and it's only been at 7.8 some about eight or nine quarters in my entire lifetime so give you a little bit of perspective there college-educated unemployment very different three point seven percent and that's where most of us live work and breathe looking for those professionals managed healthcare to to impacts of healthcare on the situations it relates to healthcare employment one is that you know while healthcare employment stays very high I think the nurse unemployment rates like 1.1 1.2 percent position unemployment rates are 0.6 that's and I can't even fit where those people came from how you could not work if you had a license is it would is shocking but and then on some bi pts is really kind of in the 0.8 percent range so most allied professions are very high if you're in healthcare IT right now you're probably and you know less than 1% unemployment so it's kind of the world we live in most of the time is really kind of a very low unemployment rate so that doesn't really that you know the trend in unemployment doesn't really impact us much from a day-to-day basis but one thing that does happen when unemployment goes up the spouses of health care professionals careers get impacted right there 401k programs get dinged right so those two factors cause a couple of things to happen first people who are working part-time in our health care system we actually upgrade and become full-time employees right which creates a lot of opportunity for hospitals they feel fully staffed for the first time in a long time or skilled nursing facilities you know all your staff working full-time makes it easier to fill out the schedule and manage the workforce and a and contingent labor utilization goes way down as a matter of fact utilization of services like travel nursing went down 57% at the bottom of the recession per diem staffing was down 37% physician staffing actually stayed pretty consistent so when unemployment changes it doesn't impact the people that work that we work with and for as much as it impacts those that they live with right that second income in that household so as a result now we have stuff to start watching what happens with unemployment rates because that spouse is going to go back to work right the housing value is going to come up people are going to become more relocatable right all of those things their 401k is gonna get big again they're gonna feel like maybe I can retire right so those are put off retirements are starting to do that I'll show you some data on that in a minute and then housing prices improving by having housing prices depressed basically shut down all you know kind of physician relocation in the US nobody's gonna write a four hundred thousand dollar cheque to start a new job if they're underwater on the house so you know that that impacted quite a bit our physician businesses it really you know severely limited doctors choices in terms of employment as well even their nurses there were many who were in houses that were underwater and so that constrained things as well and then the consumer spending is increasing which is a good thing as well that they just came out with the numbers I think that preliminary is about a two point I'm sorry half a point increase but they had expected it to be flat to down so consumer spending you know impacts you know many things of course health care is is a component of consumer spending but it does show that people are getting more and more confident in the economy even though this is kind of a slow very you know kind of measured return and maybe we have a new normal these are kind of the new growth rates we don't ever gonna we're never gonna see big jumps I could live without big jumps in the you know in the marketplace and make my job a lot easier but maybe of slower measured jumps which are easier to deal with is a way and we're gonna look at you know coming out of this so so kind of the macro factors if you're drilling just a little bit more then kind of what's happening you know most employment in health care is still in acute care hospitals although that it makes up some seventy percent of total health care employment so there is a tremendous growth outside of acute care hospitals and you see kind of the the admission rates at hospital change this is a study that amn does we we take all of the publicly traded hospitals and they report their admissions and we roll them all together so we have about ten or fifteen hospitals in here such as HCA all of the big guy so you would be familiar with and we we basically run in index to see kind of what's happening there in terms of admissions you can see it's just not a lot of you know admission activity into acute care hospitals where all the growth is coming right is in all of the secondary care facilities doctors offices and things like that so a complain my growth over the last I think it might have this on a slide coming up on wait a second for your life employment growth over the last years about six hundred ninety thousand jobs but only about fifteen percent of those were actually created in acute care system so this really big employer that hasn't started moving yet right you know and I think you know maybe right at kind of an inflection point to start to see some movement in trends with it that big in the sector you know starting to hire again I don't know if it's gonna come from admissions as much as it's gonna come from changes in reimbursement administrative processes right wanting to manage patient care you know on a longer lifecycle right not just push them out of the hospital worry about them later there's gonna so I think that's gonna cause that growth of employment but for right now right it's not it doesn't look like admissions or people coming into hospital systems we're gonna drive a lot of employment near-term the openings that the BLS reports in the healthcare system today and the BLS is a great source of data for those of you that haven't tapped into it there's something called jolts Jo LTS it's a database you can go in there you can pull down specifics and by industry and the type of employment and things like this is where you can come up with numbers like what percentage of healthcare employees are part-time vs. full-time you can pull data like that out there by the way that it used to be about 3% to 5% now it's running about 1% of healthcare employees are part-time so that's that pent-up demand they went took you know went back to full time we are starting to see some sly swings upward but the openings data is I think very interesting we're back up over sick you know kind of six hundred thousand jobs posted things were great for us for the you know healthcare industry whenever the number of openings were lower that was because of the work force wasn't retiring to work there part-timers we're shifting full-time as I've been talking about you can see that you know no.8 oh nine and ten and then things began to grow again and so you're seeing about a 19 percent increase right now in our end jobs posted according to wanted analytics on a year-over-year basis you know certainly you know signs that that there's quite a robust need for additional health care professionals the bad news on this is that there aren't that many actually getting hired so their jobs are posted but they aren't the professionals don't exist or they're not flexible members I said they can't relocate they're hunkering down just a little bit so they're not changing jobs at the frequently frequency they used to this is what's happening with quits which don't get too excited about that last bar I often worry a little bit about the preliminary numbers that come out from BLS but you can see that there's an overall increasing trend in the number of people who are quitting and quits are made up of people who change roles you know and for many reasons right some of these are retirements some of them are just job changes and move at the hospital across the street some are you know have gone to part-time or they've gone into the in-house pools that usually changes their employer when they do that so yeah those things happen and then in some case you're starting to see some spousal relocation to go where the jobs are in many cases and so that that's causing quits to rise so kind of this you know number of new jobs increasing the number of quits on the way up you could get to kind of get a sense of you know where we're heading you know from an employment standpoint in health care the next one is and I call it the Ralph's index cuz and I thought of this idea was this was just talk to us about how well how much friction there is in the marketplace right so the red line represents the number of job openings that exists today and so just said it's up over 600,000 and then the blue line represents the number of hires that are actually made so there you can what you see is that while the number of hires are starting to creep up it's not keeping up with the trend of the red line right so the the difference between the red and blue line shows just how much in the elasticity there is right and where the shortages and supply issues begin to kick in where people are not changing jobs in the healthcare industry so this of course is going to create a couple of things we're all gonna have to have to deal with of course employment salaries and things like that you know will begin to trend upward it's usually emboldens labor organizations and just into believing that the market is back in healthy and that it's time to ask for increases and and other new benefits and things like that it also you know I don't you know your competitor down the street we'll probably start putting in place signing bonuses again I I ran a search on signing bonuses on one at analytics it's really kind of tapped into career builder and all of the major websites out there there was about 5% of employers in healthcare sector we're offering some sort of signing bonus or bonuses to our stay bonuses so really starting to see some increased trends on those things these are things that I had frankly just kind of gone away many of them some of you if you've joined the healthcare industry in the last three years don't even know what they are there was a fierce battle right in like 2006 2007 $10,000 you'd switch the hospital a nurse from one hospital to another the next year they'd switch back for another $10,000 nurses were flip and flop in for $10,000 you know from hospital hospital so there's some there's some interesting things start to develop when people won't move right for all the reasons I stated right they're kind of nervous about the economy two jobs being created and so that creates I think some some interesting dynamics I think for all of us and something we need to think about in terms of how we how we manage our workforce going forward so the last slide is just to see what at 690-thousand jobs looks like pretty exciting is the largest driver of job growth in the u.s. in 2012 was to healthcare industry again you know the vast majority of these were outside of acute care so again if the acute care system kicks in we can you know certainly you contribute quite a bit to that to the economy going forward alright so and then one more slide just on that this is called the temporary help penetration rate this calculates what percentage of the workforce out there is is contingent in nature and when you can see when you kind of look at 2008 about 1.8 percent of the workforce was you know contingent temporary in nature right it dipped down to about 1.3 percent through the recession that you know kind of it's at the trough but it's actually back up to higher penetration levels and it had been previously so during great economic times it's actually starting to even exceed that there's a couple of a couple of thoughts behind that one is that everybody remembers what a recession looks like everybody knows what laying off feels like they want to avoid that as much as possible so they've begun using more temporary help then there's a scale which is likely and very possible and you know within you know different settings but even more likely is that you know they're the workforce doesn't exist today right they're holding back on hiring they're slow and it can't find the right individuals and so the utilization has gone up so people are actually coming out of those quits that are coming out of healthcare are moving into more contingent more flexible work roles so then certainly again something where you know a you know a good thing for me because that's what drives our industry is you know temporary help penetration rate I think a smart thing for hospitals who are worried about the fluctuations in their business right the peaks and valleys of you know different seasons and the flu season comes around the census changes on a regular basis so this will let this you know you more contingent workforce will allow the health care system fluctuate you know more readily during the next downturn which we all hope is at least ten years away but because in its and look at recent trends I don't know about you guys I don't want to go back to another one in the next few years one more piece of data for is just a growth of the temporary help industry which I guess puts the emphasis on the point I just made and it's currently about a nine point projected to be a nine point eight billion dollar industry this year up from a nine point two last year and kind of at the bottom at seven point six million so we followed the recession very very nicely and fell very fast and grew very slow just like the economy so you can use this as a predictor I guess of kind of future events if you see our revenues go down maybe it's time to sell your stocks short and get out of the market the the break up of it is actually is a lot different though than it used to be if you look at 2012 back in 2006 about two billion in the industry was travel nursing now it's down to about 1.3 billion so that that part of the business has not taken off near as much as the allied segments in the physician segments have primary drivers of that just the physician shortage the need for temporary physicians physicians are you know drivers of revenues so you know the there's just really not that much of a pullback whenever the economic conditions aren't good in the physician business and then allied space is just a you know a plethora of new positions coming into the marketplace a lot of healthcare IT and Healthcare Informatics positions so don't let any nurse or practitioner you have leave your organization because they're burned out on it on the industry push them into informatics and healthcare IT if he can cuz they could use a lot more clinical professionals in that in that segment who really understand how how things work in a hospital environment or in a skilled nursing or other in a clinical settings alright the last piece is just a little bit of a look forward on on kind of what's projected this is the US Bureau of Labor Statistics projections and so there's all this talk have you seen all these ads about math and science we need the kids in math and science and I kind of get a kick out of it cuz that's the third most needed skill right now and I think the healthcare industry needs to get our act together a little bit because the two top needed skills right our healthcare support personnel and then healthcare clinical practitioners and professionals themselves so you know that certainly a tremendous you know employment growth a key driver of the u.s. economy for years to come and really from the school you know as many of you know the schools are not producing them at the right rates the hospitals aren't precepting and you know a fast enough clip there's not enough slots for doctors to get into residences and and so the entire system has got this you know kind of bottleneck or constraint and I take a look at this is the need for them I don't anticipate right that there's gonna be some magic bullet out there for this so that what this means for all of us is that healthcare is going to change in some way so I don't know exactly you know I can picked a few of the transi and a certainly telemedicine seems to be something that everyone is taking a look at you know looking at ways to use technology to make you know everyone in the healthcare systems more efficient from you know when to check in to the point of bill but who knows what other changes might come from that and I'm I'm predicting of course you know different types of work arrangements for people more flexible arrangements the things that people's lifestyles allow them to work from home telemedicine will do that allow people my sister is a pharmacist by the way she works from home she worked at it as a pharmacist in a major chain and I'll just go ahead and mention him because since they're here CVS pharmacy and she had an opportunity to move into a mill order pharmacy business about six or seven years ago at CVS she filled up close to about 150 to 200 prescriptions a day which we at the time was quite a pretty high volume you know versus her peers in an at home environment well first then she went to a call center kind of environment her per per day production ran up to someone that's 500 to 600 prescriptions per day filled and so you know utilizing a lot of automation she never touched a pill again she never poured you know juice from one bottle to another or did any of that sort of stuff to where she's at today where she's at a work from home environment with new technology and she's filling over a thousand prescriptions per day she only does escalations and does a thousand prescriptions per day so these are these are complex right where people have drunk interaction type type needs and things like that so that's the type of evolution right if you could see that in other healthcare professions like they've seen a pharmacy would allow that you know keep up with the demand for our services for healthcare services at the same time without the supply you know being available because and nobody really expects for anyone to get out there and all of a sudden just start mass producing doctors or RNs or physical therapist everybody remembers all of the news and all of the stories about I when health care reform got introduced but it was March of 2010 so we've had plenty of time I don't know what happened all the planning time I was gonna be ready and get ahead of this but certainly I think we all kind of started to wonder right when it went to the Supreme Court are they gonna prove it what's gonna happen so we all didn't move as fast as we probably showed it but the headlines were huge write all about it but most of those headlines are who's gonna get it and who's gonna pay for it right and it was very little right about who's in charge of delivering it clicker problem sir it's a big black hole right I don't I can't I've googled this for you know decades right trying to figure out what's you know what's the impact of health care reform on jobs right where's gonna provide the treatment for all of these all of these you know 30 million or whatever the number is you know patients that are coming out there and unfortunately there's been very very few people who are willing to stick their necks out even in an even guess that kind of the impact so that's the set up I'm gonna guess today how many jobs are gonna be and where they're gonna be so you did your one takeaway today will be that you'll at least go back with at least a guess of what's gonna where it's gonna go the first he's kind of understanding is there's 50 million people are uninsured this is the difference between the numbers you know how many people aren't insured but how many people are gonna get service only about 30 million actually are going to receive incremental coverage if you've been in the u.s. of a short period of time your foreign citizen things like that that they're there this act does not cover you so well you have 50 20 million people who basically aren't helped yet by by the program if you take a look at that profile the uninsured which is a total population right and find that that in that the age categories from eighteen to thirty five to forty four make up 57% of the uninsured population where they're only only thirty percent of the total population so the reason for that is pretty good of you know certainly you know Medicare and Medicaid you know hit both ends of the spectrum and help out and particularly the elderly are covered but it's really kind of in that in the middle category in the middle middle ages for people where they're not as well covered so the good news about that is because they're younger they don't need as much health care so on average right a kind of a young adult uses a much smaller percentage of the of health care then and an older a dode a older adult so for instance a forty year old spends about twenty-six hundred a year the 65 year old spends about four to five times that but there is a difference between coverage and care right so we're talking about how what does how many people are covered but how much care does that generate so you have to kind of ratchet down right so 30 million people flushing into a system that has you know close to 300 million people already in it you could say okay that's going to increase health care coverage by 10 percent it actually doesn't increase health care coverage by 10 percent because of what I just said right there younger right and not all of them are gonna have you know access to coverage and then last they're already covered by uncompensated care this is the silver lining for the health care industry is that they're required to give a certain amount of uncompensated care and many of the people who received coverage are in that uncompensated care bucket so this has enhanced the financial stability of health care systems across the country if you notice all of the investors willing to put money in them now because they're not as nervous I let the uncompensated care portion if the hospital is able to maintain their charity you know charitable initiatives and their endowment you know earnings and things like that then this actually could be a situation that improves the hospital profitability from a perspective of paid versus unpaid right of course there's an offset of that is going to be what do you get paid for it right and how much how much will your cost be driven down so based on all of those factors rolling all those things together moat any expert who's willing to bet to place a bet on this is really kind of the total is really three to five percent increase in provided healthcare right so it doesn't sound like a big amount 3% sounds like about in a normal economic year-over-year growth but when you kind of apply that to the math of large numbers it's a hundred and eight billion dollars right so as a country it would be somewhere around the hundredth largest country in the world in terms of the economic impact of just the increase to our health care system so it's you know quite a significant event so if you take a look at right now there's about eight million professionals and clinician aren't just clinicians in health care so this is just a professionals not the support personnel so allied professionals make up about 2.7 million of that registered nurses are 2.6 million LPNs lVN's are just under a million and physicians insurgents are about 700,000 of the total so applying that to the three to five percent this is your first stab at how many jobs will be created by the Accountable Care Act so our by our estimates right you'll see somewhere between two hundred two thousand and three hundred and thirty-seven thousand new professionals needed to keep up with the treatment of 30 million increment patients of the 108 billion we're gonna spend on this incremental health care only a 13 to 21 billion of it actually will go into wages and into employment cost so I would have thought 50 to 60 percent on where your head is it just seemed to me like you know we don't need more buildings we need more doctors and more nurses but this according to the way they rolled out the plan they're thinking 15 to 20 percent of it would actually go into employment so that doesn't really kind of change things right supply provisions are an inadequate access to medical Medicare Medicaid for you know patients is is is still limited primary care specialty you know differences exist right so the type of doctor you want to see versus the type of doctor available is available don't match in in many cases and so providers you know are taking a look at all of this and making decisions so you know some physicians have you know are signing up right now of course selling their practice to healthcare systems and putting themself in a position to retire if they can't if they if they want to at that if the reimbursement changes hit them there you know others are just rethinking their delivery models like I said telehealth seems to be one of the ones it's popular they're looking for different ways right to earn a living with the with the skills that they have so the government actually did have a just a tiny bit of the funding for the issue of employment in their bill you know at whopping 1.5 billion in scholarships which is really kind of a drop in the bucket the build the entire Pell Grant program is close to two hundred billion dollars so you put just a little sprinkle in in the Pell Grant program they also have some tax incentives short-term for primary care physicians our physicians who move into primary care practice for the next few years expanded residency programs right they tried to increase the pay payments that were available under you know Medicare and medical programs and to the Medicare I'm sorry under Medicaid programs under the met into the Medicare reimbursement race now about 16 or so states it didn't agree to do that so that's holding back that that part of the funding and then there was some national and state-level workforce planning organizations is my favorite there's a total budget of 1 million dollars for these in the bill none of them have actually formed they haven't actually put any members on them there they're basically probably just like the rest of us the program's go live very soon the insurers the exchanges start in November of this year the new coverage starts on the 14th and already there's you know the elements there was you know probably I think ten elements of health care reform that have already kicked in but the the organizations that we're supposed to support what are we gonna do about the challenge of shortages and supply haven't even even formed yet and they were funded at the whopping level of 1 million dollars for an entire country so what positions are gonna grow just just a some insight if you have some kids going to school and you want to tell them what careers to go after this is where to send them right now primary care physicians there's there's not enough of them the more that we'll live in a rural market the better nurse practitioners I think everyone's modifying their model to use nurse practitioners and physician assistants both to triage patients and to keep doctors from touching them reimbursement rate is virtually the same no matter who treats that patience so I think we will see some changes to what treatments the nurse practitioners and physician assistants and even our ins will be allowed to give under the new rules as this as a process unfolds but certainly and we'll see a huge demand for nurse practitioners and physician assistants it's already kicking in right and you know not just the doc in the boxes but just about every medical practice that I've been in in the last year plans to use more to help them manage more patients per doctor surgeons and surgery technicians will increase and that those middle ages that's where you need a lot of you have a lot of bone breaks right a lot of young males are gonna give be insured that weren't insured so surgery and surgery and technicians are going up diagnostic work will go up as well including lab and then medical assistants and then hospitalists and nocturne us who actually help make the system more efficient as well and we're introduced really into acute care about six or seven years ago if you want to know where to set your practice up well you've graduated your kid from college and they've got their degree as a physician in primary care the best places to be in Texas California right and you know there's some big growth in some smaller states but really kind of the the biggest need is gonna be Texas Florida and California from an overall standpoint the types of settings that are gonna be weather we're gonna need these professionals are gonna be in community health clinics doctors offices urgent care centers we emergency departments which is probably the only place in acute care will really need them outpatient surgery centers and diagnostic labs so what do you do with all this information first of your health care system get you know expanded clinics if you aren't already doing that if you have an acquired physician practice as I'm certain I'm certain everyone is it seems to be what everybody's doing to be to create their own accountable care organizations focus your recruitment on kind of less impacted States right so there's some states that aren't going to see that much of an increase in treatment you take the chart I gave you flip it around those are states that probably have enough supply to meet demand because they have more coverage citizens those are the people who we need to redistribute and then offer kind of loan forgiveness scholarships particularly to our ends and in Peaks and in those programs and then for healthcare professionals look for ways to make you know into primary care delivery and and to make it more efficient those companies that are doing that are springing up every day and very very successful shifting to primary care specialists learning Spanish believe it or not sooner when I said California Texas Florida you know a lot of the individuals who would receive coverage or Hispanic speaking I think it's some more than able to 45 to 50 percent or Hispanic speaking so that we're uncovered and will become covered and then considering relocation to the states with the greatest you know currently uninsured either way talk your kids into going to back to medical school so just wrapping it up and kind of take a look at what all this what all this do it does for all healthcare organizations right I talked about what health care reform would do I've talked about I think everybody's really fairly aware the aging demographics right there's a demand for health services as people get older we talked about the utilization be much higher there but the number of people who are retiring you know is starting to outpace the number of new clinicians so this can ends up with kind of an interesting market driver today and you know one of which will hopefully you know spur change in our industries Elliott said was kind of the the slowest adopter of outsourcing services is health care with all outsourcing services but I think that that these types of things will drive a need for change in a way recruitment gets delivered the way contingent labor gets used in healthcare in the future

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  1. The London gold exchange gofo (go forward) rate is miniscule. When London fails to pay debt in gold to China that is the end game. The dollar will lose about 70% of it value literally over night. They can paper over a default in the paper markets but they cannot in the physical market. Either the gold bars are there or they are not. I don't know how it will affect the medical profession but I do know how it affected the doctors and lawyers in 1929 during the great depression. Doctors and lawyers (minus bankruptcy attorneys) were broke many were homeless. People could not afford a doctor or attorney they were barely able to feed themselves and many did not. When Russia collapsed recently millions of people died. We will see how it goes in the future. Hopefully this will not be the case. 

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