Last week I received an interesting call from a recruiter seeking to fill a Midwest hospital position in Clinical Informatics. Though personally uninterested in relocating, I spent some time discussing the position just to see what hospitals are looking for in candidates. Little surprised me in regard to experience or technical knowledge, still there was one surprise, the hospital insisted that the candidate had a graduate degree.
As it turned out, this recruiter had been struggling with this facility and others in their desire for graduate degrees as a necessary condition for various position. The challenge with this approach is that there is no evidence that a graduate degree, though certainly wonderful to have, is a necessary condition for success. That is, there are no outcomes studies connecting graduate education to improved performance and outcomes, so why the requirement? By this criteria alone, people like Steve Jobs, Bill Gates, Jane Goodall all of whom have successful, highly innovative careers and none with even an undergraduate degree, would have no place in healthcare. Today we have Richard Davis, the highly successful President and CEO of US Bank with a BA in Economics, and Clay Shirky, Professor of New Media at Hunter College and now at New York University with his BA in Fine Arts; just how is that possible?
It’s difficult to imagine a robust industry of innovation if hospitals insist on outsourcing their hiring decisions to university admissions departments. Stunning as it is, an industry priding itself upon the rigor of science place upon itself entirely untested requirements in filling important position. Forward thinking hospitals desiring to be innovative, quickly need to be thinking differently about the getting the talent they need for success.
Being exceptionally fond of statistics, and even more so, aware of their limitations, I’m often delighted with when those limitations are discovered.
In this article by the Journal of the American Medical Association on Risk Prediction Models for Hospital Readmission the authors looked at a large group of studies and tested for their predictive statistical significance with interesting results.
This remains yet another indication of our limitations in treating “populations” rather than patients. Despite how exquisitely educated we may be or think we are, the incredible complexity of human biology and spirit requires that humility be practiced, as well as science.
In a startling find, a study from the RAND corporation found that higher deductables result in lower consumption of healthcare services.
“Studying more than 800,000 families from across the United States, researchers found that when people shifted into health insurance plans with deductibles of at least $1,000 per person, their health spending dropped an average of 14 percent when compared to families in health plans with lower deductibles“
It is believed that this discovery is found to be consistent with other items in the economy such as houses and cars. Sources say that it appears that there are fewer people looking for very expensive houses over $10 million than those looking for houses under $200 thousand. Similarly, fewer cars over $200,000 are purchased relative to those costing $10,000.
What are we to make of this incredible observation?
I’ve come across comments on various nursing websites highlighting difficulties for new grads finding jobs and thought some economic perspective might be helpful.
First, the demand for RN’s will continue to grow at an average 2.2% per year, with supply of RN’s short of demand through 2018. Given that the mean age of all nurses is in the low 50′s, while baby-boomers are just now hitting the retirement age at the rate of 10,000 people per day, the gap between RN’s willing to work and the demand for their services will continue to diverge, i.e. stay healthy, you may be on your own. For certain, how RN’s are treated today can dictate how profitable institutions will be five years from now.
What you may not know is that nursing is part of what Jacob Mincer, Labor Economist of the 1950′s identified as part of the “secondary labor force”. This labor force, according to Mincer, tends to provide secondary income to the household where there is another income producer providing the largest income. Nursing, being part of the secondary labor force, tends to run countercyclical to the general economy. When things are good, the secondary labor force is relatively quiet, nurses work less hours or perhaps not at all, while asserting muted demands for attracting their highest marginal wage. When the economy slows down resulting in lay-off’s of primary income producers, the secondary labor market becomes more robust. People return to the labor force, work longer hours, and begin seeking higher wages.
This latter response to a downturn in the economy can produce an illusion that shortages have gone away, when it certainly has not, that is, it’s a head fake. A second wave problem happens when employers of nursing services fail to recognize the fragility of their current situation. This secondary labor force can quickly return to lower participation rates as soon as household income needs are met, and do so much faster than any hospital can possibly hope to manage. The second wave effect includes students who also misread the market and choosing not to pursue nursing fearing an absence of work when they are finished. Times like these present a tremendous opportunity for hospitals and healthcare organizations, or can set them up for future disasters if they handle these times poorly.
This is a time for healthcare organizations to be as accommodating and supportive as they can be in attracting new and experienced talent. Hospitals can gain a ton of good will, as well as an exceptionally deep and loyal bench of RN talent for the future, if they take advantage of these times and build solid relationships with returning RN’s as well as warmly embracing new grads. Failure to engage nurses now will result in profound shortages and an explosion of expense in the future, and there is absolutely nothing a hospital will be able to do to reverse the damage.
Questions?
Tom
If I steal from you it’s theft, but what if I purchase lots of stuff on your credit card for which I expect you pay, is that any different? Oh I know, it’s for a good cause, still if I do not have your permission is it still OK?
What if you give me money that you can deduct from your income tax, and later I arrange for you to receive money and it happens to be very much the same amount, does that sound right?
This spending bill stinks.
|
|
