The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.
If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.
This question this time: What positions have been challenging to fill and what creative techniques have you used to fill them?
Many positions are hard to fill. Some good people have moved into consulting. There is an absence of candidates with desirable skills and experience or expectations applying for some of our positions such as EHR analyst and project managers. At times we have hired strong end users and trained them as one source of talent.
Medical assistants, receptionists, nurses, all the forgotten heroes down in the trenches without whom a medical office cannot function. They are harder and harder to find as we expect them to: be nice to patients so we do not ruin our Press Ganey scores, learn and operate new billing and EMR systems on the fly, multitask, cross train, be loyal, be health IT and coding experts, show up for work and help see ever more patients, all for almost minimum wages of $9 to $10 an hour at times. All while an EMR vendor, IT consultant, medical device seller, and reseller makes triple the amount of money and not that anybody would miss them if they do not show up for work. ACO stands for " awesome consulting opportunities" and while I am happy that the healthcare reform provided ample employment opportunities to these armies of consultants, the real value in healthcare still gets delivered by those other people… They are grossly underpaid and under-appreciated.
Clinical Analysts for configuring Cerner and Data Analysts. We hired a coder from medical records with a background in computer science to fill the Cerner Analyst position. It’s working out very well, especially since we are reducing our coding staff because of simplification of our reimbursement rules under bundled payments. To fill the Data Analyst positions, I dipped into the finance industry and paired them with a healthcare domain mentor on the data analysis team.
We’ve had challenges filling most of our IT analyst positions. This includes those focused on application development, support, etc. and networking and infrastructure. We’ve started to do some recruiting at college career fairs and looked at a broader market to reach out to.
We have had some degree of difficulty finding programmers and developers that know Delphi and understand healthcare. We will hang on tight to the ones we have because of this. It seems that if someone knows Delphi, they have no idea what an EMR is our how an interface works.
The most challenging this month have been those that actually can understand an implementation plan – not necessarily even having done many as much as someone understanding workflow between the various clinician groups. Individuals are now seeming to get siloed into various career skills and this could get dangerous as we move forward into unchartered ground.
Where I sit on the tech side, programmer/developer positions. These are the people on your development and interface team that can actual program something from scratch. Not, oh I know Sharepoint, or I can "read" Visual Basic, C#. I mean, here is a business process that is junk, go develop a solution based on a platform and programming language. We never have enough of those people and they are so good, the ones you do have get sucked into building templates/screens for your CPOE or outpatient EMR. To fill those positions… man. That’s a tough one because in our organization HR will not work with us on these hard structured pay bands. They treat everyone like a nurse or a millworker. They also have an equation for how much a person should be paid and it’s based more on
age/seniority that experience. When I hired an oracle DBA out of another industry, he wasn’t making that much, but he was older. The equation said I should pay him over $20k more than what he wanted to jump into our org! That kind of stuff is frustrating. So, I would say have an HR department that will work with you on recruiting talent via well-structured pay packages. Also, remove any of those pesky gaps in insurance coverage for when a person starts. Our HR department would make everyone wait 90 days before their medical coverage started. That means all of your new hires have to purchase COBRA for 90 days and that’s almost $700 per month in some cases.
Anything Epic is a real challenge. We’ve taken the Epic approach to recruiting. Rather than trying to find people with Epic certification or using high-priced consultants, we started a "grow our own" program. We’ve contact local colleges and were able to get access to seniors in engineering, science, and math with GPA of 3.5 and above. They are bright, motivated, and cost about half of a seasoned Epic resource (including certification). They also receive a retention bonus if they stay for a specified time. This program helps with the "brain drain" of the local economy and adds more Epic resources into the national mix. We also don’t have to worry about running afoul with Epic’s non-compete with the existing talent pool. A second program is with a local consulting company that wanted to develop an Epic practice. In return for sponsoring some of their consultants, we received a 50 percent discount on the certified resource and a right to hire after six months. The consulting company paid for all certification training. Lastly, we recruited and hired a CMIO last year. Since everyone has their own definition of CMIO (including the candidates), it took about a year before we found the right fit. As a CIO, I think the best approach is to use the recruitment process as a succession planning process for your job.
None have been a challenge. We have actually reduced our staff by 15 percent since January for cost restructuring purposes.
Database administrators have been the hardest to fill as there are no training programs available locally and very few people have an interest in it. This isn’t very creative, but we found a vendor that specializes in remote database administration at a very reasonable price (a lot cheaper than having an employee). Their team is primarily offshore, but the management is stateside. We have a hard time with project management for the same reasons as above. Again, not a creative solution, but we are training all of our analysts in basic project management skills and working on standardizing project management for our organization.
Developers and HL-7 experts. Lots of folks with average skills, but few with an inquisitive mind and in-depth skills. Hard to find technical pros with a "healthcare mindset."
Finding the really good Epic consultants to work on projects is the biggest problem. There are so many substandard folks that the expectations have been lowered. We are finding that education is the best medicine to our customers to help them understand to wait for the right person or to set their expectations to a level that they will understand what they are getting. Furthermore the staffing companies who feel they can provide all the staff for the project are doing an injustice to their customers and further damaging the space at this difficult time.
We are a software sales organization. Our greatest challenge is finding good sales people dedicated to thoughtfully selling our solutions. We’ve found that hiring friends of current employees is the best way to find good, competent people.
I think having a good EMR analyst / trainer / optimizer is always a key position. We have had success by looking from within. The typical person will be a recent college grad who has worked at the front desk in one of our offices for at least 6-12 months. This gives them an understanding of healthcare, as well as the experience of our group culture, while also giving us an understanding of their skillset. They need to have the type of smarts that means they can figure things out when we don’t have the right answer, and they need to have they type of personality which can get along with busy doctors. They enjoy having the ability to extend their career skills and most stay several years.
Telecommunications manager who is more than a functionary; who understands the urgency for improving clinician-to-clinician communication. Asked our various telecomm vendors who were the best folks fitting that description in the region and hired one who was under-valued where they were then working.
EMR analyst jobs have been the hardest to fill. Our best success in filling these roles has been recruiting internally within our hospitals and medical group and investing in training and experiences to transform them into new IT roles.