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Advisory Panel: Hard-to-Fill Positions

May 27, 2013 Advisory Panel 7 Comments

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.

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Currently there are "7 comments" on this Article:

  1. What have health organizations and HIT vendors learned from exit interviews? What factors create vacant positions? Are the perceptions of former employees affecting the ability to attract and retain employees?

    For those who seek IT employees who “get” health care, look for intellectual curiosity that extends beyond computer technologies. Have employees do periodic internal internships to gain and maintain an appreciation for health care operations. Send them to HIT industry meetings to gain peer knowledge. For more experienced employees, have them participate in standards organizations. When your employees participate in the industry, they add value to their employers and gain job satisfaction.

  2. Never ceases to amaze me how many times I am looked over as a viable candidate, simply because I “don’t have any EMR experience”. Apparently seven years’ experience in health IT analytics and a masters in health informatics is just not good enough? And managers wonder why they can’t find good people….

  3. Time for a short rant in response to nurses, amongst other “heroes down in the trenches” being hard to find. I’m calling BS having watched a close personal friend who had finished her MA in nursing look for a job for 9 months. It is certainly not a shortage of available positions that was her issue, but rather the seeming catch 22 of healthcare delivery work – you must have experience to get a job, no one wants to hire and train the next generation of nurses, pas, analysts etc. Even in recruiting, HC orgs are slow to “try new things” and thus end up missing out and patients end up suffering.

    I ran into a similar issue while looking for a role on healthcare delivery as my first job after completing an MBA (with a strong HC focus) from a top 10 school. Even my university’s own AMC didn’t have a path for bringing new management talent into the fold because no one seems to think that smart people without previous direct experience in a HC org could ever figure out our stupidly backwards and complicated HC system. Yet the desire to solve such problems is precisely why we go get our MBAs…so I ended up at one of the rapidly growing HIT vendors that actually has a vision and understands the value of outside viewpoints and experiences. How about some long term thinking about what is ultimately better for the patient…as well as your overworked and underpaid heroes….

    rant over. Happy Tuesday.

  4. Glen Marshall and Digital Bean Counter pretty much echo my sentiments…hiring managers in healthcare delivery organizations rarely have any imagination when it comes to recruiting (or aren’t allowed to have it). Their organizations and the patients they supposedly care about get the short end of the stick as a result.

  5. Regarding the consulting company discounting their rates in return for training sign-off by a healthcare system – is this practice approved by vendors (specifically Epic)? It appears this could be an interesting way for consulting firms to circumvent some of Epic’s choke hold on certification for third parties.

  6. I’d be interested to hear more about the group hiring new college grads to work the front desk for 6 to 12 months. I don’t know many college grads willing to work for the $11/hr paid by most players in our region.

  7. I am a Super User on my 2nd Go Live. I have both an IT and Healthcare background, but because I do not have a Bachelors degree HR doesn’t look twice at my resume. No matter how much programming I learn from CodeAcademy, it still won’t matter. I think many in HR lose out because they want employees with degrees with experience and at a lower rate than you can find in other fields. I myself would personally sign up in a heartbeat if someone offered epic certification sponsorship for say a 2-3 year contract at a specified lower rate than they would have to pay a consultant. Wishful thinking because the medical field is an “old boy” mindset that really never thinks outside the box to recruit people who would be willing to do something like that. So in the end, they will get a programmer who has no idea about medical workflows but who has a bachelors or masters degree then when they implement epic it won’t work smoothly and they will have to adapt their own workflows to match epic instead of the other way around. I see it every time and I have to, as end user support, try to bridge that gap between the technical jargon of an epic build team and the medical jargon of the end users. In the end, when there are no more technical issues with epic, then begins all the workflow issues that may or may not get resolved when the Go Live team moves on to the next place. Just an observation from someone who has seen this first hand.

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