Allied Health Services Avoiding Crises (1989) / Chapter Skim
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6 The Health Care Employer's Perspective
6 The Health Care Employer's Perspective
Pages 206-234
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From page 206... ...
In the past, cost-based reimbursement, the absence of competition, and a generally adequate supply of allied health personnel allowed administrators to make the salary adjustments that were needed to maintain their 206
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From page 207... ...
In this chapter the committee focuses mainly on what personnel administrators, corporate human resource administrators, and department heads in all types of health care facilities hospitals, nursing homes, freestanding facilities might consider doing to help relieve or prevent personnel shortages. It discusses two types of activities that can produce gains in personnel supply: (1)
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From page 208... ...
This is readily apparent today as facility administrators in some parts of the country struggle to hire physical therapists when, for example, respiratory therapists are plentiful. The expectation is that in many parts of the nation and for many employers of allied health practitioners the labor market will be tight.
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From page 209... ...
For many facility administrators, it would mean giving human resource management a higher priority than in the past. Yet such investments or efforts would be repaid if the service dislocations that could result from tight labor markets were avoided.
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From page 210... ...
For example, in one locality in which there is an oversupply of dentists and a shortage of hygienists, an HMO uses dentists to perform the hygienists' tasks. In some allied health fields, however, the freedom to substitute personnel is constrained by regulation.
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From page 211... ...
For example, when there was no difference between the earnings of baccalaureate nurses and associate degree nurses, students realized that the economic return to the 2-year education was higher than the return to the 4-year program, and the number of associate degree graduates eventually exceeded the number of baccalaureate graduates (Buerhaus, 1987~. Pay levels affect the supply of allied health practitioners at each point at which an individual makes a career decision.
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From page 212... ...
First, compensation for allied health practitioners should be understood in the context of women's earnings, because women dominate many allied health fields. In 1986 women earned on average 69.2 cents for every dollar earned by men (Mellor, 1987~.
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From page 213... ...
Others were chosen to show how compensation for a lesser educational investment compares with compensation in allied health occupations. The table indicates that starting salaries for allied health fields in some cases do not compare unfavorably with other occupations requiring similar educational investments or that students might consider as alternative careers.
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From page 214... ...
Engineering technicians, who are described as "semiprofessional," and computer operators are included in technical support operations and can be considered equivalent to medical laboratory and medical record technicians with associate degrees. Engineering technicians start at salaries roughly $150 per month higher than the equivalent allied health fields; computer operators start at roughly $100 per month lower.
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From page 215... ...
In the face of price competition and prospective payment, hospital f~nancial administrators feel they have reason to be reluctant to increase salary expenses. At a recent Senate Finance Subcommittee hearing, a spokesman for the American Hospital Association said that the level of Medicare payments constrained hospitals' revenues so that nurses' salaries could not be increased (Health Professions Report, 19871.
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From page 216... ...
The review also noted that, of 157 articles related to human resources, 71 percent were published in Nursing Management. The committee's own search of the Cumulative Index of Nursing and Allied Health Literature (which covers nursing and allied health personnel)
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From page 217... ...
Experience shows that it is not until labor markets become tight that upper management supports serious efforts to retain and attract allied health practitioners. The previous section suggested that nav increases would enhance the 1 ~ supply of allied health personnel.
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From page 218... ...
The full utilization of the work force will require integrating blacks and Hispanics into the labor market, but that means overcoming the fact that they are also the least advantaged groups in our society with respect to skill levels and educational backgrounds (Hudson Institute, 1987~. Employers using an allied health work force that is largely composed of women will want to pay attention to findings about what makes a job appealing to women.
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From page 219... ...
One important difference between nursing and allied health in this regard is that although allied health practitioners hold administrative jobs managing laboratories, dietary services, radiology departments, and . 1 · 11 1 I I ~ I 1: ~ ~ ~ ~~ 1~ ~ ~ ~ ~.~.~ ~~A~ ~~ so on there IS usually no umbrella Alec nealln aamlnls~raror posl~lo~l ro promote the interests and raise the level of visibility of the allied health work force.
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From page 220... ...
Because of similar concerns with issues of compensation, job security, and meaningful work involvement, professionals and whitecollar workers are identifying with blue-collar workers and with unionized groups (American Hospital Association, Department of Human Resources, 19861. Thus, health care employers cannot rely on their employees' sense of professional status to avoid unionization.
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From page 221... ...
Allied health practitioners working in health care facilities of all types become part of a larger group of workers with an organizational structure. The "medical model" of autonomous work, which is pursued by the many physical therapists, speech-language pathologists, and laboratory technologists who become independent consultants, is not always either realistic or attainable in complex medical settings or for most practitioners.
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From page 222... ...
A still different approach is to examine ways of using the existing work force more productively and effectively. In the early part of this chapter, it was noted that when demand for allied health practitioners exceeds supply, market forces will drive up the wages and salaries employers must pay to hire the needed personnel.
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From page 223... ...
More generally, as revenue restrictions force administrators to examine ways to control labor expenses, employers are becoming interested in increasing labor productivity by decreasing specialization, as evidenced by the American Hospital Association's sponsorship of a number of workshops on the multiskilled concept. A 1986 national survey of medical laboratory managers indicated that 46.3 percent said they could use cross-trained personnel (Watrous, 19871.
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From page 224... ...
In this section the committee discusses the predicaments of two of these employers rural health care facilities and nursing homes and other long-term care sites. The committee also suggests some strategies they might find useful in trying to cope with their needs for allied health manpower.
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From page 225... ...
Operating margins, admissions, and occupancy rates have fallen more and are lower in smaller hospitals. These data show why raising salaries to attract allied health practitioners is not feasible for many small rural hospitals.
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From page 226... ...
For rural hospitals, allied health employment problems can be viewed TABLE 6-4 Geographic Distribution of Selected Allied Health Professions, 1980 Number per 100,000 Population Nonmetro Ratio as Percentage of Allied Health Profession Nonmetro Metro Metro Ratio Dietitian 26.0 30.9 84 Speech therapist 14.4 19.5 74 Health aide (except nursing) 99.9 138.5 72 Inhalation therapist 16.6 23.1 72 Dental assistant 53.2 75.2 71 Health record technician 5.0 7.2 69 Radiologic technician 31.0 46.3 67 Physical therapist 12.7 21.1 60 Clinical laboratory technician 68.9 120.5 57 Dental hygienist 12.3 23.1 53 Occupational therapist 3.5 9.3 38 SOURCE: Hamburg (1985)
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From page 227... ...
Less work has focused on the maldistribution of allied health practitioners. Some lessons can be drawn from what is known about other types of health care practitioners.
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From page 228... ...
In 1977, 59% of graduates of programs that have clinical training sites outside of Birmingham tookjobs outside of the city, while only 34~0 of the graduates who had no clinical affiliation outside Birmingham left the city. An evaluation of the linkage program after 11 years found that 66 percent of the graduates who remained in allied health fields returned to their home counties to work (Cooper, 1982~.
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From page 229... ...
If an individual's education is tailored to an employer's requirements, the employer can use the practitioner efficiently, and thus maximize the results from his or her salary. The third type of problem of rural health providers finding allied health personnel with the special skills needed for employment in small rural settings can also be alleviated by linkages with educational programs.
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From page 230... ...
In the course of this study the committee uncovered a concern among the providers of longterm care that educators and practitioners in many allied health fields are both unwilling and unprepared for work with elderly patients and patients with chronic conditions. Remarks like the following were often heard: "Physical therapists would rather work in sports medicine and with the acute phase of trauma rehabilitation than with frail, confused, nursing home patients." Long-term care facilities in some regions are not perceived as giving high-quality or sometimes even adequate care.
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From page 231... ...
Lower level personnel nursing aides and orderlies have fewer opportunities in the acute care sector. Yet for these individuals the average hourly salary of $5.15 for nursing aides in nursing and personal care facilities might not be competitive with alternative employment in such places as fast-food restaurants, which pay more, require no formal postsecondary education, and in which working conditions are less stressful (Kerschner, 1987~.
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From page 232... ...
The committee also recommends that chief executive officers, human resource directors, and other health care administrators develop methods for the effective utilization of the existing supply of allied health personnel. Such methods must grow out of experimentation with new ways of organizing work efficiently and distributing labor among skill levels while ensuring that the quality of care is not compromised.
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From page 233... ...
:641-645. American Hospital Association, Department of Human Resources.
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From page 234... ...
1987. Human resource management in hospital administration.
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