For Valley-area hospitals, clinics and nursing homes, a looming staff shortage has been on the radar for some time now, and health managers are taking steps to address it.
From financial incentives to partnerships with local colleges to career planning, Valley providers have programs in place to avoid a projected shortage of 44,500 nurses, 4,100 physicians and 600,000 home care workers in California by 2030, according to a report from the California Future Health Workforce Commission.
For example, Kaiser Permanente has started a $130 million workforce development program for its employees in California, as a condition of the tentative agreement announced last month between the national health organization and the Coalition of Kaiser Permanente Unions to avoid a strike.
“A lot of details still have to be decided,” said Sean Wherley, media relations specialist for the union SEIU-United Healthcare Workers West. “This program will help expedite the placement of those needed workers in a way that the current system through our community colleges and universities and for-profits are not necessarily delivering.”
Also, the Kaiser Permanente School of Medicine in Pasadena is slated to open in summer 2020. The school, a projected 80,000-square-foot building with a total capacity of 192 students, began accepting applications in June for the inaugural class of 2024 – and is offering free tuition for the first five classes of students who enroll, erasing the $54,719 annual burden per student. Each class is expected to have roughly 48 students.
Kaiser’s four-year curriculum is designed to graduate “the next generation of physicians,” according to the organization’s website.
Funding for the program is set to begin in January.
Officials at Kaiser Permanente opted to wait on releasing more program details until the union agreement has been ratified.
Safety net pipeline
Another local monetary incentive was developed by LA Care Health Plan, a health insurance agency devoted to providing coverage to low-income Los Angeles County residents.
LA Care’s Elevating the Safety Net program will help the physician shortage specifically for the next five years.
The program is in its second year and provides $31 million per year to help medical students every step of way, starting with scholarships for medical school, funding for residency training programs, salary subsidy grants and loan repayment plans. Funding also goes toward training community health workers.
“We seek to fund students to reduce their student debt, so they can choose specialties of their choosing and not be driven by concern about the uncertainty of their student debt,” said Dr. Richard Seidman, chief medical officer of LA Care, regarding the scholarship thread of the Safety Net program. “Students with financial need and students with a commitment to stay in Los Angeles County and serve in the safety net, those recipients are a very diverse group.”
The first group of scholarship recipients, four men and four women, attend David Geffen School of Medicine UCLA and Charles R. Drew UCLA Medical Education Program.
LA Care has spent $5 million so far on scholarships, and another $5 million to fund residency training program slots for primary care, as well as pediatrics, internal medicine and family medicine.
After residency, LA Care plans to deliver salary subsidy grants: “We provide grants to employers, to private doctors or to staff model medical groups that hire physicians,” explained Seidman. “If they’re able to hire a physician new to Los Angeles County, new to our network, we provide grants of up to $125,000.”
The health insurance agency has awarded 92 grants so far through Safety Net. Recipients include Valley Community Healthcare in North Hollywood, Bartz-Altadonna Community Health Center in Lancaster and Kids and Teens Medical Group as well as Northeast Valley Health Corp., both in Pacoima.
For Paula Wilson, chief executive of Valley Community Healthcare, incentives like LA Care’s salary subsidy help community health centers recruit and retain physicians who would have passed up the opportunity because of pay.
“When I make my trips up to Sacramento and talk to our elected officials, that’s the message we bring. I could go and talk to a health plan, but it’s more impactful if 60 L.A. County (health centers) go to LA Care and say, ‘We don’t think we can meet all these measures that you are requiring because we don’t have the workforce, so help us,’” Wilson said. “That’s what Rich and his team did.”
Employers have hired 61 physicians with a total commitment of $11 million, according to Seidman.
“In terms of impact, each new physician can support a patient panel of approximately 2,000 patients. That’s another 120,000 people that have access to care in the safety net that we might not have without this kind of salary support,” said Seidman.
Individual hospitals are feeling the physician shortage too, according to Jodi Hein, chief nursing officer at Providence Holy Cross Medical Center – Mission Hills, and are taking steps of their own to stem and restock needed doctors, along with registered nurses.
“What we’re doing now, and we’ve already started that here, is you’re going to see a lot more nurse practitioners and (physician assistants) hired. Physicians can’t handle their loads now,” Hein explained.
A lack of reimbursement, the cost of medical school and a tightening of treatment requirements as a national mandate are all contributors to the physician shortage, Hein said.
“We get bundles that come out – bundles are a plan of treatment that says according to evidence and research, this has been the best treatment for sepsis, so we expect you to treat them all like this,” she explained. “It will get to the point that if a physician does not treat them like that, they will not get reimbursed at all.”
The last thread in LA Care’s Safety Net program is to pump more community health workers into the industry, with Seidman citing them as “critical, very effective members of our care teams.”
Community health workers are not licensed health care professionals and often have insights and familiarity with LA Care communities, Seidman said.
“They can really help people navigate the health care delivery system to get the care they need and the social services they need,” he added.
For national organizations like Kaiser, internal upward mobility for health care staff and partnerships with nearby universities have been ongoing endeavors to keep staff numbers up.
“In partnership with our unions and educational trust funds, Kaiser Permanente develops an internal pipeline of staff for where shortages exist, and provides formal cross-training of specialties within a career field and upskilling,” said Jerry Spicer, regional chief nurse executive at Kaiser Permanente Southern California.
“Our relationships with community-based organizations serving displaced workers in underserved communities provide a pool of candidates who are eager for training and gaining access to the health care industry.”
Currently, Kaiser has formed two apprenticeships for surgical technologists and sterile processing technicians to fill specific shortages in Southern California and plans to expand apprenticeships to meet other expected shortages based on data.
Henry Mayo Newhall Hospital in Valencia relies on engagement and internal educational development to recruit and retain nursing and physician staff, in addition to rotations with colleges.
“I think over the last five or 10 years we have been able to add a lot of specialty services here that has made us grow from a community, rural hospital to a medical center,” said Mark Puleo, chief human resources officer at Henry Mayo. “That’s helped, because nurses have better opportunities (here).”
Staff at Henry Mayo have the opportunity to learn needed specialties in the ICU, operating room, ER and labor and delivery.
“We feel that’s the best way to fill those specialty areas instead of relying on recruiting from the outside,” added Puleo.
Currently, Henry Mayo has a 3 percent vacancy rate for registered nurses and 8 percent turnover – much lower than the average when it comes to hospitals in Southern California, Puleo said.
Local providers such as Valley Community Healthcare use partnerships with nearby universities such as College of the Canyons to bring in and retain staff, registered nurses specifically.
If approved by the California Board of Registered Nursing, nursing students at College of the Canyons will come to Valley Community to learn more about the health center and leadership positions within the industry. The program will start tentatively in November and run for six weeks.
“This will help open a pipeline and keep grads coming to us. They wouldn’t have gotten exposure to a community health center if it wasn’t a part of the curriculum,” said Wilson. “They think of us like a family doctor’s office. When they come here and they see we have optometry, dental, mental health, team care projects, homeless programs, HIV programs – it’s so much more than a doctor’s office.”
Health providers choose overwhelmingly to pull from the Valley’s regional talent pool for nurses.
Henry Mayo hires almost all of its nurses at a local level. Providence Holy Cross hires 90 percent local, while Kaiser recruits at the local and national level, depending on the position and specialty.
“Finding licensed and experienced behavioral health professionals, imaging professionals, pharmacists and health care specialists can be challenging, and may require a national search,” said Kaiser’s Spicer.
“Our marketing efforts are local to the Santa Clarita Valley and some into the San Fernando and San Gabriel valleys,” added Puleo. Like Kaiser, Henry Mayo does not overlook out-of-state candidates for certain specialties, especially because Henry Mayo requires nurses have their bachelor of science degree in nursing or be enrolled in a BSN program to be considered for employment, rather than just getting a two-year associate’s degree.
The requirement stems from a state initiative to increase the percentage of BSN-prepared nurses.
Once hired, nurses tend to be promoted quicker in a hospital setting, according to Puleo.
“Here at the hospital we have an organizational development (planner), a person that aids in organizational development, that would help with succession planning,” he said. “We try to identify those nurses early and give them training so they’re better prepared to move into a supervisory role, a charge nurse role, a management role.”
Providence hospitals tend to fill the gaps in staffing on a short-term basis with traveler and registry nurses, who are brought on temporarily during busy times of the year.
“We know that we’re going to be really busy between January and April, or even December,” said Providence’s Hein. “This year, we had to call for travelers in the summer which we usually don’t do at all, but our census didn’t drop at all this summer. We were very, very busy. Part of that is because we’re a trauma facility, and trauma doesn’t stop.”
Health centers tend to attract nurses that have been in a hospital setting and need a change of pace, potentially opening slots for new grads at hospitals, according to Marirose Medina, nursing director at Valley Community Healthcare.
Nurses come to workplaces such as Valley Community because they have more time with patients and can focus on preventative care.
“In the hospital they’re usually pretty sick, they’re in the final stages of diabetes or they haven’t been taking care of themselves,” added Medina. “Here, we have diabetes educators, behavioral health. We have resources here to hopefully prevent those long-term effects.”