Health care jobs: Local market escapes national shortage trend

Vacant jobs for both doctors and nurses have plagued much of the nation, but the effects may not be as severe in southwest Missouri.

A study conducted by the American Medical Association and the Association of American Medical Colleges looked at the 1997-98 to 2001-02 school years and reported a decreased number of residents or fellows in the areas of family practice, internal medicine, neurology, ophthalmology, ear-nose-throat surgery, pathology, physical medicine, urology, psychiatry and general surgery.

The Association of American Medical Colleges reported that after a six-year decline, the number of applications to U.S. medical schools in the 2003-2004 school year increased by 3.4 percent over the previous school year.

Locally, the question of whether there is a physician shortage depends on what type of physician needed.

"It looks like the work force in general for physicians may be becoming smaller in the future, but I believe in this area, with health care as the top two employers in town, not only do we have a great community, we've got great health care services," said Lori Barnes, director of recruitment services for St. John's.

Barnes said an average of 50 new physicians have been hired by St. John's in each of the last three years. Eighty percent of physicians hired by St. John's each year are new physicians coming out of training, she said, adding, "So as far as this area or St. John's Clinic, I wouldn't say that we are having any trouble with physician shortages or lack of access for our patients."

Steve Edwards, senior vice president of CoxHealth, said there are no great shortages of physicians in the area, but there may be shortages of certain subspecialties.

Increased numbers of physicians are pursuing high-end specialties. "Those that go into internal medicine, a higher portion of them are continuing on to subspecialties, Edwards said. "Instead of someone going through their three years of residency and then becoming an internist and practicing here, they're going on for more education and filling up these subspecialty categories."

In primary care, family medicine and pediatrics, Edwards said CoxHealth has been successful in recruiting and has low turnover rates of less than 3 percent. "When we're adding it's because of growth, not replacement."

Edwards said CoxHealth can be highly selective when choosing physicians to fill positions because there are only a handful of openings at a time. But, he adds, "We are recruiting two to three years out from when they even graduate from their fellowship, just because recruitment is so difficult for some of these specialties."

CoxHealth relies on nontraditional ways to recruit. For example, rather than mailing en masse and waiting for physicians to knock on the door, Edwards said recruiters make contact with candidates, fly to their residency programs, and talk them into visiting Springfield.

Both St. John's and CoxHealth have found that Springfield sells itself to prospective physicians.

"If I can get somebody here to take a look, they love it," Barnes said. "We bring people in from large metropolitan areas and they're pleasantly surprised."

Edwards said the biggest challenge in recruiting is the fact that Springfield is not well-known to many candidates who have trained in large metropolitan areas. Thanks to the October 2003 issue of the trade journal Modern Physician, the word may be out. Modern Physician ranked Springfield as the 53rd the best place to practice medicine in the United States. Neither Kansas City nor St. Louis made the list of the top 354 metropolitan areas to practice medicine.

"I know the industry's struggling and the shortage issue is around the corner for many areas, but we're in a great position in Springfield. Even though we have some isolated areas of shortages, it's a great and an easy community to recruit physicians to," Edwards said.

At Ferrell-Duncan Clinic, recruiting isn't always so easy. "We're all chasing after the same doctors. Everybody across the country is looking at a smaller pool of candidates," said Carol Murrow, director of physician development. Murrow recruits for the specialty arm of Ferrell-Duncan Clinic, a division of CoxHealth, seeking out specialists.

Murrow is filling positions, but says some of them are taking longer than they probably would have five to 10 years ago. But, she says, she is having better luck than many of her peers across the country. "We've signed several physicians over the last year and a half at the clinic. I still have about nine open positions. Some of the specialty areas are a little more challenging."

Murrow said she is concerned with a recent report from the AMA stating that 38 percent of the physicians in the United States are over age 50, and by the year 2020 the United States is expected to be short 150,000 to 200,000 physicians.

A surplus of physicians in the early 1990s led to medical schools limiting enrollment, Murrow said. "We thought there were too many (physicians) then, we started cutting back, people stopped going to (medical) school, and now we're faced with that shortage," Murrow said. "It takes a while to get caught up with that when you consider these guys go to school for many years. Change is not going to happen overnight."

Change at Ferrell-Duncan comes in the form of recruiting in new ways. Murrow looks at international medical school graduates, osteopathic physicians, and is considering job sharing for interested physicians. Once physicians are hired, retention is emphasized to reduce turnover.

Creativity counts in such a competitive market. Murrow said perks such as sign-on bonuses, monthly stipends while in medical school and flexible hours are being requested by some specialists.

Nursing

An estimated 434,000 registered nurses and 136,000 licensed practical nurses will be needed nationwide by 2020, according to the Missouri Hospital Association's report, "The Shortages Continue: Workforce Status in Missouri's Hospitals."

While the rest of the United States might lack nursing staff, nursing schools in the Ozarks are busy preparing nurses of the future to take up the slack.

"We actually increased our enrollment a little over a year ago from 50 new students twice a year to 60 new students twice a year," said Virginia Mayeux, director of the associate degree nursing program at St. John's College of Nursing of Southwest Baptist University.

Graduation is held twice a year, with 40 to 50 graduates at each ceremony. Within a year, Mayeux hopes to see the numbers increase to 50 to 60 graduates at each ceremony.

The Missouri Hospital Association reported that approximately half of students enrolled in Missouri's registered nursing programs do not graduate, but St. John's School of Nursing is an exception. "During 2003, our graduation rate was 88 percent," Mayeux said, adding that the school's graduation rate usually runs between 70 and 85 percent.

Mayeux attributes the nation's nursing shortage to several factors.

One factor is the aging population of the public and nurses, with the majority of nurses in Missouri between the ages of 40 to 49. As nurses retire, Mayeux said, "there have been fewer coming behind them in the same roles."

In the Ozarks, younger students are studying to enter the field. "In the last seven years, we've seen our average age go from 30 to 24 or 25," Mayeux said.

Other factors causing the nursing shortage, according to Mayeux, are the many career opportunities previously not available to women and the fact that nursing is hard work. "It takes a lot of physical, mental and emotional strength."

Teresa Moore, dean of enrollment management at Lester L. Cox College of Nursing and Health Sciences, has seen an increase in enrollment as well. "We have, over the last couple of years, pretty much doubled our enrollment. But from last fall to this fall, we've had an increase of about 19 percent," she said.

In addition, pre-nursing courses are in demand at both St. John's and Cox schools.

Enrollment is picking up at nursing schools across the country, Moore said.

"The word is out that if you want to have a well-paying position with flexibility and also have the opportunity to have upward mobility, nursing is one of those areas."

The Missouri Hospital Association reports many hospitals are offering incentives to recruit nurses. About 90 percent of students at St. John's School of Nursing take advantage of an employee assistance program.

Reimbursement of up to $12,000 is provided if the student works at St. John's while in school and meets certain guidelines, such as grades and attendance. A similar program at Cox Nursing School reimburses students up to $10,000.