“The last three years have been the toughest to predict that we’ve ever seen.”
– Judy Goldetsky, president of On Call Clinicians

The combined forces of the Affordable Care Act, rapidly advancing technology, and the growing demand for home care have healthcare staffing professionals reeling. I’ve talked to several of them in recent weeks to gain some perspective on what’s happening in their niche, and it’s anything but clear. Business is up pretty consistently across the board, which is great, but the previously listed variables are looming overhead like a storm. To take the analogy further – which I find suiting since predicting business conditions can be a lot like predicting weather – some say the winds will bring sunny and cloudless skies, others predict long periods of drought or heavy downpour, while others think it may just pass right by.

On the Rise, But For How Long?
As I mentioned above, the vast majority of healthcare staffers I spoke with report steady rises in their numbers. Cindy Ackerman, director of healthcare resources for Healthcare Staffing, said their placements rose in 2012 and have continued to rise in the first half of 2013 (and she expects them to remain relatively steady for the final two quarters).

Kristin Kinczel, director of physician and K_Kinczelclient services with Main Street Locums, reports similar successes.2012 was a year with higher placement numbers than ever … and 2013 is off with a bang,” she said, adding that she’s finding job orders easier to fill than before. “The unusual-but-not-unexpected trend in physician placements is geared toward highly specialized physicians right now.”

Judy Goldetsky, president of On Call Clinicians, yet again reports gains from 2011 to now, but she’s holding out optimism as the industry continues to change. “We’re at about a 15% upward trend and there’s lots of new buildings going up, but it still seems like people are hanging out waiting to see what’s going to happen,” she said.

These hesitations, Judy says, in part derive from anticipated changes like ACA (which we’ll talk about more below), but also shifts that can already be seen in the landscape. For one, there’s an ever-increasing number of competitors entering the niche. For another, the demographics of patients are shifting more toward the baby boomer generation, which is great because of their large number, except they’ve got new expectations.

“I’m seeing a downward push toward home health,” says Goldetsky. “It’s being done by anybody and everybody – some doing it well, and others not so much. Those people are paid abominably low levels and their dependability is sad – and it’s even sadder that it looks like that’s where healthcare is moving. It’s a big trend, not necessarily a good one, but a trend nonetheless.”

The technological advancements in medicine are staggering, and while most everyone will agree that they’ve bettered the field, staffers may not share that enthusiasm. In some instances, new gadgets replace jobs. For example: “It used to be that rehab involved someone working with a patient for four to six weeks,” Judy began, “but now they can strap a machine to their leg and achieve a similar effect. It’s unreal.”

Another difficulty, Judy points out, is that healthcare providers are rethinking when they add staff. “It used to be they’d staff based on their census – one person would leave, so they’d hire another to replace them – but now it’s tied to productivity numbers,” she said. “Everybody’s being much more careful.”

Kinczel agreed, adding that ACA may be playing a role in just how careful they’re being. “Hospitals, hiring managers, and department chiefs are looking much more closely at current staffing levels and really starting to analyze their current physicians’ ability to maintain and increase patient volume. While specialists have always traditionally been understaffed, the often-referred-to ‘physician shortage,’ created in part by the ACA, has forced healthcare execs to reassess their current and future physician resources and capabilities.”

The Impact ACA Will Have on Staffing
Up until recently, when it was announced that ACA wouldn’t go into effect until 2015, all anyone in staffing was talking about was Obamacare. You couldn’t go anywhere without hearing people ranting about employee mandates putting them out of business, while others within earshot were predicting record numbers for their staffing company. In spring, during what seemed like the height of the divisive hullabaloo, I got in the middle of a conversation with two guys who staff for the healthcare industry.

Their take on the situation was simple. Starting Jan. 1, they said, newly insured people would start flocking to hospitals for care and, realizing how under-staffed they are, hospitals would scramble to find staffing companies to help fill the void. “We’ll be rolling in it,” they predicted. However until ACA goes into effect, they likewise insisted, the niche would take a steep downturn.

Sounded like a reasonable deduction to me, but as I soon found out there’s much debate as to what impact ACA will have on healthcare staffing. In fact, while both Kinczel and Ackerman agreed that the passage of ACA has helped increase their placement numbers of late, they also both disagree with the gentlemen above.

“I am the rare healthcare staffer who feels that the increase of ‘insured’ individuals will have little impact on the current patient volumes. Here’s why,” Kinczel began. “Just because you suddenly have health insurance doesn't mean you can afford to use it. There has been so much attention placed on the uninsured and how providing access to health insurance is the holy grail of a healthy population. Personally I think that's a single-cause argument filled with assumptions. Forcing someone who already has limited funds to invest in a health insurance premium merely depletes their already low cash on hand. Great that you have coverage, but how do these folks afford their co-pays, co insurance, and deductibles? (And heaven help them if they need a prescription because they probably don't have the extra $30-70 bucks to fill it.)”

As for what the next 18 months will look like (until ACA kicks in), no one agreed with the doom-and-gloom that those guys predicted. In fact, most say placement numbers will slow slightly, if at all. “Since the employer mandate was delayed, the impact will not occur until Jan 2015,” Ackerman said. “… I think placements will remain steady until the smoke clears on the ACA. Healthcare is a business and most facilities are taking a very conservative approach.”

Kinczel agreed, but added that some firms will work hard with employers in the meantime. “I don't think healthcare placements will be slow for the agencies that work to understand the ACA and how it impacts their market areas. Hiring managers are stepping up their recruitment efforts to prepare and they are partnering with agencies that provide more than just a candidate. They are looking for consultants and a ‘helpmate’ in their healthcare recruiting.”

The simplest way to summarize all this, as Goldetsky noted, is that everybody’s hoping for the best but doesn’t know anything for sure. JudyGoldetsky

“After doing this for 25 years, I’ve taken the approach that it’s like the stock market. I don’t understand how people make connections to why it goes up. People make predictions not based on anything real, just their supposition. There’s always gonna be people who are gung ho, ambitious, and optimistic, but I tend to have a more level approach. It’s a wait-and-see,” she said.

However, when it comes down to it, the healthcare industry is defined by change; so whether it’s because of ACA or baby-boomers or you-name-it, a change is gonna come.

“Something will come along and change our industry,” Goldetsky added, “because it always does.”

Tags: Obamacare, Affordable Care Act, Kristin Kinczel, Main Street Locums, ACA, Industry, Judy Goldetsky, On Call Clinicians, Cindy Ackerman, HealthcareStaffing