Code blue | Two new surveys look at health care staffing in Maine, which could wind up in critical condition if measures aren't taken soon

At St. Andrew's Hospital and Healthcare Center in Boothbay Harbor, human resources staff have been recruiting for physical therapists for roughly a year now, with nary a bite. Are they being too picky? Is the hospital an inhospitable workplace? Are they failing to place ads or make use of recruitment options?

None of the above, insists Peggy Pinkham, the hospital's president. Quite simply, she says, no one is applying. The lack of applicants could result from the fact that salaries in Maine don't keep up with the cost of living here, she says. It could be the lack of funding and educational opportunities for Mainers who might want to be physical therapists. It might simply be that, everywhere in the state, there is a huge demand for a limited pool of professionals.

"On the other hand, we recently hired a full-time speech therapist, and we were delighted that it was someone who lived in the community and graduated from an area high school," she says. "Local health care has to promote local opportunities within the school system. We all need to do better job of that, and elementary school isn't too early to talk to kids about health care careers."

The problem, and Pinkham's "reach the kids" approach ˆ— which is one of many solutions she advocates ˆ— is a familiar refrain for Marcella Sowerby, president of Medical Source, a Portland-based health care recruiting firm. "Every area is a huge challenge," Sowerby says. "You have peaks and valleys all the time in certain health professions, and we're in a valley with everything right now."

But the problem is much deeper than mere shortages. Complicating ˆ— and worsening ˆ— the picture is the biological inevitability of aging. Simply put, there are fewer people to pick up the health care professions as young adults leave the state in growing numbers. Existing health care workers are retiring in increasing numbers. On top of all that, the overall population is aging, putting more demand on a smaller and more harried health care system.

Two studies due to be released in the next few weeks attempt to address these issues, albeit with very different approaches. One, by the Maine Area Health Education Center Network ˆ— a University of New England-based program that supports health profession training ˆ— takes what researcher Meredith Tipton calls a "50,000-foot view" of the state's health care workforce situation and makes a series of recommendations for state government, individual communities and health care providers and educators to deal with the issue.

The other, by the Health Care Action Team ˆ— a group of Androscoggin County health care and education organizations ranging from Central Maine Community College to the Sisters of Charity Health System ˆ— shows the view from 1,000 feet up, focusing on the educational background and aspirations of employees at Androscoggin County's three biggest health care employers. The tighter focus of the second study is due to HCAT's mission to alleviate health care workforce shortages in the Lewiston-Auburn area ˆ— which is designated as a primary medical care shortage area by the U.S. Department of Health and Human Services ˆ— but the team believes that its findings could help illuminate challenges and solutions elsewhere in the state.

These studies are significant, according to Wendy Wolf, executive director of the Maine Health Access Foundation, which funded them, because health care is the "one growth sector for workforce in the next 20 years."

And what both studies show is that health care workforce shortages may have a lot more to do with a dearth of faculty, educational programs and outreach efforts than with a lack of willingness or ability on the part of Maine residents to enter the health professions.

Think outside the silo
Awareness of the industry's workforce shortages isn't new. But coordinated, system-wide action to address the problem is, says Tipton, who is associate dean for community programs at the University of New England College of Osteopathic Medicine in Biddeford and director of the AHEC Network. "It's a problem that affects the whole state and the whole health care system, but people have in the past addressed the problem from within their own individual silos," she notes. "So, people say, 'we need nurses,' and people focus on that, and other areas get left behind."

That's why Tipton's team ˆ— made up of physicians, public health experts and others ˆ— focused on coming up with broad recommendations that would apply to the various specialties that make up the health care workforce. The group issued seven major recommendations: centralize access to health care professions information, get young people interested in health care careers earlier, recruit more nontraditional workers, increase minority representation, challenge federal and private funding sources to broaden access to health care education, look beyond short-term needs and increase funding for recruitment and retention.

In the midst of those recommendations, though, Tipton was concerned with some very specific problems, one of which is the shortage of direct care workers, including home health aides, mental health technicians, in-home companions and respite workers.

"In terms of broadening access to educational opportunities, one of the major things is that the people who aren't getting as much help are those who want to go into the less-high-paying jobs," she says. "If someone wants to be a direct care worker, there is no funding for them to attend school. Yet those are the jobs we may need the most. As we age, we often need help with day-to-day living and maintenance issues more than we need major medical interventions."

In the other study, led by Steve McFarland, director of the Pathways to Higher Education program at the University of Southern Maine, the primary goal was to look at where the health care workforce currently is educationally, where they want to be and what's keeping them from getting there. Surveyed for the report were roughly 1,300 employees of the Sisters of Charity Health System, Androscoggin Home Care and Hospice, and Central Maine Medical Center.

McFarland says that the news was very promising on some levels. "We found that this health care workforce is already pretty well educated, with 52% of the employees holding at least two-year degrees," he says. "The average for the country is around 21% and 30% for the state."

In addition, more than 90% of survey respondents indicated a desire to remain at their current employer after obtaining more education, with 38% interested in remaining in their current position, 27% interested in earning a promotion and 24% desiring lateral movement within the institution.

Still, the Androscoggin study found some of the same problems for which Tipton and her team outlined statewide solutions. "The largest barriers to pursuing higher education are cost, inflexible work schedules, lack of time, child care issues and not knowing where to begin," McFarland says. "Nearly 40% of respondents indicated they faced three or four of those barriers, which means that any solutions will need to address the multiple concerns of busy, working adults."

Thinking long term
Policymakers traditionally have focused on nursing shortages, and Mary Mayhew, vice president for governmental affairs and communications for the Maine Hospital Association in Augusta, says that nursing is indeed one of the most critical shortage areas.

"But that's in part because we rely so heavily on the nursing staff to do so much of the work, particularly in hospitals," she says. "There are many reasons why we cannot get more people to enter into the nursing profession, and one of those reasons is that there are so many more options available to women now than in the past. So, one of the things we have to do with a profession like nursing, or any other health care profession that is heavily female, is to make them attractive for anyone interested in health care, including men."

Mayhew says that compiling data is key to finding solutions. "We need to think about not just what the situation is now but what it will be five or 10 years from now, so we can make adjustments to the educational system along with the workforce," she points out. "For example, we need better insights about when people expect to retire, for example."

The MeHAF-supported studies are expected to be a good start to this process, as both take a long-term view of the industry's workforce challenges and solutions.

In addition, the Maine Hospital Association pushed hard to successfully pass "An Act to Ensure an Adequate Supply of a Skilled Health Care Workforce" during the last legislative session. That act requires that certain health care workers be surveyed to collect data on health care occupations; that the Department of Labor compile and post online a report on health care occupations; that the state add representatives to the Health Workforce Forum previously established by the Legislature and direct them to review and make recommendations based on the reported information; and that the Department of Health and Human Services post the forum's recommendations on its website.

"In the midst of a state budget crisis, we had concerns about whether it would pass," Mayhew says. "We worked hard with state agencies and others to be creative in terms of finding things like federal funding sources to minimize the state impact."

Maine's community colleges are also pitching in with such efforts, joining forces with the Maine Hospital Association and other organizations studying the problem, expanding scholarship opportunities and expanding nursing and radiological technician programs, according to Alice Kirkpatrick, director of public affairs for the Maine Community College System. And in August, York County Community College received agrant from MeHAF to fund a department chair position for its pending nursing program.

The employer's job
In addition, says Sowerby, employers themselves can do a great deal to help over the long run. She says that while she can attract people from other states for interviews, negotiations often break down when potential employees look at the cost of living in Maine and put that in line with the pay scale "There is still a notion that we don't need to pay as much as other states, but the reality is that it's expensive to live here, from food to health insurance to property taxes," Sowerby says. "Our greatest challenge is often to find people with a connection to Maine already ˆ—people who have family here or who want to return here or have some other reason to want to live in Maine. But to just pull people out of another city elsewhere in the country and get them to work here is a challenge."

Better benefits are one potential solution, but even that isn't a sure thing. Pinkham of St. Andrew's Hospital says she has trouble hiring housekeeping and maintenance staff because the facility competes with local resorts for workers. "Many resorts don't give benefits like we do, but they pay higher wages, so it can be a challenge for us," she says.

Another area of concern is that employers may need to make changes to make health care workplaces more attractive. Although Mayhew recognizes that many health care environments, particularly hospitals and nursing homes, are stressful and nothing will change that, she thinks more can be done to make them more bearable, such as improving communications, teamwork and morale and helping employees, especially women, better balance home and work schedules.

Pinkham says her hospital does many of these things already and offers a "positive, collaborative" environment for workers, but she worries about how to effectively "get word out to those people who are looking for some specific type of work environment like ours."

Finally, say researchers, employers could help more directly in getting their employees started on a path toward more education. "We have an incredible response from the current workforce that they want or need education to move ahead," Tipton says. "Employers are often not in a position to help, not because of lack of finances but often a lack of any policy at all. And it doesn't have to be paying for tuition, either. For some employers, it could be making workplaces more flexible for people who want to go back to school."

Currently, there aren't any "big success stories" in terms of solving the problems with health care shortages, whether at providers or schools or elsewhere, McFarland admits. "But with the research going on and the attention being brought to this issue, we are beginning to see a light at the end of the tunnel," he says. "It has to start somewhere."