January 23, 2012

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Low Supply, High Demand

Disinterest in Medical Profession Fuels Health Care Crisis

Spencer Sutherland

January 23, 2012

During the current health care reform debates, a myriad of options have been discussed to help Americans gain better health care access. Though details such as pre-existing condition waivers, coverage portability, and premium subsidies are certainly important, one crucial component is continuously overlooked—health care providers. According to the American Association of Medical Colleges, the United States is facing a serious shortage of health care professionals—from doctors to the support staff admitting patients or handling paperwork. The association reports that the country is already short 15,000 doctors and if all Americans were to have health coverage, that deficit could increase to 150,000 in 15 years. So how can the health care industry keep up with the growing demand? It would seem that the short answer is to simply train more doctors and hire more employees—though that would cost an estimated $2 billion each year. Unfortunately, the industry is finding that the problem goes deeper. With the high cost of medical school, the number of years it takes to graduate, and the long hours medical professions require, younger generations are choosing to look for careers elsewhere. The Price of a Good Salary Like many of his medical school colleagues, Robert Jones, an orthopedic surgery resident, has wanted to be a doctor for as long as he can remember. The son of an ophthalmologist, Jones grew up around medicine and as he got older he became intrigued by the science of the profession as well as the lifestyle it provided. Now, a decade into his training, he worries about money as much as he does his training. "When my dad was my age, he went to the best school in the country. It cost $8,000 a year and he paid for it with a government-subsidized loan," Jones says. "Thirty years later, $8,000 is still the maximum amount of a government loan, but my debt from schooling will be around $200,000." Because of the high cost of medical school and decreasing salaries of primary care physicians, students like Jones gravitate toward higher-paying specialty fields. "Recent trends in health care reimbursement have only increased the differences in earning potentials between medical specialties," Jones explains. "It's hard to not pay attention to that fact when looking at potential career paths." In addition to heavy debt, medical students have to decide if the long hours are worth the U.S. average annual base salary of $173,000 for primary care physicians. "Besides academic pressures, a significant stress comes from the time commitment," says Richard Irion, a radiology resident. "Four years of schooling beyond college, plus an additional four to six years of residency or fellowship training, is a long time. That feels even longer when you consider that during residency or fellowship it is not uncommon (and in many cases expected) to work 70-plus hours each week." More than Just Doctors Though many Generation X and Generation Y students are still willing to put in the time and effort to become a doctor, there is less interest in other health care professions. "People are always going to want to be doctors, and that may be true as well for nurses," says Kori Novak, a member of the White House Council on Aging. "But it’s the other types of health care work—the nursing assistants, the gerontologists, the nursing home staff—is where we see the largest disparity." Novak says there are two main reasons why young people avoid these health care careers. "A lot of this generation is too concerned about making money—and unless you’re a specialist physician, you’re not going to make a lot of money. And it’s a 'me' culture." She adds that a typical Gen Y individual is likely take the position of “I don’t care if you get old and go to a care center, because it’s not me. It’s not my family—too bad for you. Hopefully you have someone to take care of you when you’re old." This attitude can be very troubling for an aging baby boomer generation. "I fear that if we don’t start recruiting this generation into the field, it’s going to be a huge problem and one that no one is really talking about," Novak says. Not Lazy, Just Different In addition to being labeled as self-interested, Generation X (generally considered those born between 1961 and 1981) and Generation Y (1981-current) are sometimes considered lazy workers. "Sometimes employers think that the younger workforce is not as hard working or that they’re lazy," Novak says. "I wouldn’t use the word 'lazy,' I’d use the word 'different.'" She explains that because these generations grew up using technology, their workforce habits can be vastly different from those who hire them. "They might not feel they have to put in 18 hours a day, but when they work, they work very intensely," she adds. "They don’t see a problem with working from home. They might put in five to six hours in the office and go home and work for another four or five. It’s a different mindset." A number of benefits comes with that mindset. When Paul Jackson, chair of the Workforce Committee at the Utah Hospital Association, describes the state's younger heath care workers, he uses the words "bright and energetic." He says, "Though we hear to the contrary, they are hard workers and very committed. They approach their career and the industry with a passion." Novak adds, "You get their energy and their ideas. Health care is not known for innovation. It’s innovative in its technologies, but when you get down to the nuts and bolts of health care [administration], it hasn’t changed in years. We need to integrate some new ideas and some new perspectives. That’s what you’re going to get from a young person." Hanging on to Young Talent While the baby boomer generation reached management positions by slow and steady progress within one company, the younger generation is more likely to look for a raise or promotion by switching employers or industries. Though employers find this troubling, both Novak and Jackson agree that company loyalty is something that can be fostered. "Some ask 'why do they leave quickly? Why don’t they stay in their jobs for 20 to 30 years?' They change industries because those industries do not keep them challenged," says Jackson. "Whether it’s physician’s offices, clinics or hospitals, those in the industry need to let their employees know that if they want a health care career, they have hundreds of options." He also encourages employers to stress the industry's intrinsic value. "It’s bigger than just a job, it’s a purpose. As long as those working in health care in any capacity understand what they do makes a difference, they'll be committed." Novak says another key to a long-term working relationship is respect. "Employees leave when they aren’t satisfied or respected, when they don’t feel like their ideas mean anything to anyone." She notes that companies that are having the most success retaining young employees are those that welcome innovative new ideas. "When you start disrespecting new ideas, the industry stagnates and dies. I’m not saying that we need to employ every new idea a Gen Y-er proposes," Novak says. "But if we implement some of them, we make people feel like they are contributors to the industry and that’s when you see less job hopping." The Give and Take It works both ways, though, when it comes to young health care professionals obtaining a job and employers holding onto them. Just as employers need to have consideration for their employees, freshly graduated applicants should remember that they also have a lot to learn, says Novak. "There is still something to be said for having experience—and they don’t have it. They need to remember that," she says. She also stresses the importance of being teachable and checking your ego at the door. "I see too many college kids going into an interview like they know everything. If you think you know it all—and even if you do—you can prove that after you get the job." Novak also reminds young applicants to dress the part. "If you want the respect of a professional, you need to dress like a professional," she says. "Don’t think that just because Google will hire you wearing jeans that TOSH [The Orthopedic Specialty Hospital] will." Utah's Outlook Despite the recruiting woes in the rest of the country, Jackson says that the Utah health system is not suffering from a lack of interest in health care fields. "You read that nationally the baby boomers are going to have to worry about who is going to care for them because there are not going to be as many Gen X and Y workers. In Utah right now, that is not an issue," he says. Jackson attributes this to sponsorship and marketing efforts aimed at promoting various health-related career options to high school students. "As an industry, we host job fairs for thousands of high school students each year," he says. "We take lectures into the classroom and we take students into our facilities." Though interest remains high in Utah, there are still shortfalls in the system. "The professions in health care compete one with another for exposure," Jackson explains. "We hear a lot about being a nurse or a doctor but we don’t hear a lot about becoming a respiratory therapist or a medical technologist." There are also shortages in imaging, specialty nursing, respiratory therapy, pharmacy, and support services. The deficits come as a result of a lack of awareness and limited academic opportunities. The state, however, has an impressive track record for meeting growing medical demands. In the early 2000s, Utah faced a major nursing shortage. Through a concerted effort of industry, legislature and the academic community, the number of annual nursing graduates has risen from 600 to nearly 1,400, Jackson says. Novak says that less notable jobs will be filled when the industry succeeds in promoting the global possibilities and the personal value. "As a health care recruiter going to a university, the message needs to be ‘what’s your passion? We’ve got it,'" she says. "When you find your passion, it fuels your career."
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