Mending the Gap in Health Care’s Workforce May Prove Challenging

by Christopher Rich

November 2, 2017

The scuttlebutt in employment circles is that many employers in varied industries are currently having a difficult time filling job vacancies. Unfortunately there’s no real-time database that contains the number and type of all available jobs, along with education and experience requirements, plus how long those positions have gone unfilled, and then correlates that with the current training, experience, and education levels of the available labor force; for that we have economists. And because the labor shortage question is complicated, economists approach it indirectly from many angles. 

Employers sometimes struggle to find workers to fill job vacancies. It seems relatively straightforward to point to a general labor shortage when unemployment is low. However, open positions go unfilled for a variety of reasons. Defining the labor shortage for a specific company or industry can aide those who are seeking to solve a shortage issue. The answer to one company’s labor shortage may not be the answer to another company’s shortage; it may not produce the same results, or it may not be feasible.

Health Care Has the Most Job Vacancies

The health care industry has been concerned with a labor shortage for quite some time. According to data from the Oregon statewide quarterly job vacancy survey, the health care and social assistance industry had the most job vacancies of any industry in the state during the summer of 2017; an ongoing trend. Health care and social assistance had 12,417 job openings or 43 percent more openings than construction (8,663 openings), which was the industry with the second largest number of openings.
Results from the regional job vacancy survey for 2016 reveal that in Eastern Oregon, health care and social assistance also had the most job openings at 295. Leisure and hospitality had the second largest number of job openings for the region with 92. Health care and social assistance had over three times as many job openings as leisure and hospitality and represented 33 percent of all job vacancies in Eastern Oregon (out of 893 total openings for the survey) in 2016.

The job vacancy survey also provides data on broad occupational groups with the most job openings. For Oregon in summer 2017, health care support (2,914 openings) was 11th on the list while health care practitioners and technical (2,704 openings) was 12th on the list. These two occupational groups are directly tied to health care. Some occupational groups that are high on the list are found throughout all industries, however these groups may also provide a good number of openings in the health care industry; examples include management, personal care and service, and office and administrative support occupations.

For Eastern Oregon in 2016 health care practitioners and technical (76 openings) was fourth and health care support (38 openings) was 10th on the list of broad occupational groups with the most openings. Office and administrative support occupations was first on the list and personal care and service occupations was second. The Eastern Oregon survey provides a further breakdown to the occupation level revealing that personal care aide was the occupation with the most openings (87), emergency medical technicians and paramedics was fourth (33), and nursing assistants was seventh (27).
Health Care Is a Heavyweight in Online Job Listings

A recent report by Felicia Bechtoldt, one of our Employment Department economists in Salem, highlights that registered nurses is at or near the top of the list for online job postings in all areas of the state. In September 2017, in all non-metro counties combined in Oregon, there were 426 online advertisements for registered nurses; 66 percent more than for truck drivers which was the occupation with the second largest number (257) of openings.

Some real-time data can be found for current job vacancies in Eastern Oregon’s health care industry by using the Oregon Employment Department’s website, Qualityinfo.org. Job seekers can use the search tools on the Find a Job page to search for job listings by geographic area. We can use the same search tools to collect data on current health care job listings. This method of data collection has some limitations. Job listings are found under two sources; those listed with OED and openings from the web. Jobs listed with OED are posted directly through the Oregon Employment Department and the Employment Department has some control over repetition and also some knowledge of whether the job has been filled. Openings from the web are obtained by a computer program that pulls the listings from other job boards on the internet and lists them in our database. For these we have no control over repetition, so some of the listings may actually be repeat job listings for the same job. We also have little knowledge of whether the job has been filled, so an opening from the web may no longer be relevant. Some of these jobs may also be unavailable in the county they are advertised in. They might actually be recruiting efforts for companies with job openings in other counties or states. Real-time data on job openings is also limited by other factors. Not all jobs are advertised on job sites over the internet. Some companies only advertise jobs and accept applications through their company’s website. Other companies may choose to post an opening in the newspaper, place a sign in the window, or advertise through word of mouth. With that being said, the real-time data obtained through QualityInfo.org still holds significant value in analyzing labor demand and shortages in Eastern Oregon.

On October 18th, 2017, I looked at job listings for Baker, Grant, Union, and Wallowa counties. These four counties had a combined 408 job openings listed on QualityInfo.org. One-third of these listings were in the health care industry. Wallowa had the smallest share with only 20 percent of job openings in health care while Grant had the largest share (49%). Union and Baker had 33 percent and 32 percent of job openings in health care, respectively. Registered nurse (38 openings) was the most advertised position among the four counties. Occupations relating to pharmacy work and those relating to physical and occupational therapy also accounted for a large share of job postings.

Difficulty Filling High-Wage, High-Skill Jobs

The majority share of health care openings for the counties were in occupations that typically require at least a bachelor’s degree plus experience to be a qualified candidate. Many of these openings require a master’s degree or higher. While some of these health care openings were support or assistant jobs with a wage below $25 per hour (generally between $15 and $24.99), most of the health care openings were in occupations that can expect to fetch a wage of $25 per hour or more.  

The job vacancy survey reveals that 74 percent of all job vacancies in Eastern Oregon were considered difficult to fill in 2016. The most difficult to fill positions were those that paid $25 per hour or more. Ninety-six percent of these openings were full time, 100 percent were permanent, 88 percent required education beyond high school, and 91 percent required previous experience. In total, 96 percent of job openings with a wage of $25 per hour or more were considered difficult to fill.
The unemployed-to-vacancy ratio is the ratio of job seekers to the number of job openings. This ratio has fallen dramatically over the last few years. In Oregon, the unemployed-to-vacancy ratio was 8 to 1 in winter 2013 and by summer 2017 the ratio stood at roughly 1 to 1. That is, for every one job seeker in Oregon there was one job opening. This ratio is merely a comparison though, and does not take into account skills, experience, or education. Therefore, the ratio does not imply a match of one qualified candidate for every job opening. For instance, for every open nursing position there could be one cook looking for work. In Eastern Oregon in spring 2017, the unemployed-to-vacancy ratio was roughly 2 to 1, or two job seekers for every job opening, not accounting for qualifications.

Additional Complications

Finding qualified candidates for health care job vacancies is one aspect of the industry’s labor shortage. Complications in onboarding new hires and difficulties of long-term employee retention add to the problem. The onboarding process in health care can be slow and unfriendly. Faced with a shortage of qualified and experienced candidates, the health care industry has been actively recruiting educationally qualified candidates who have little or no experience. Companies can generally onboard only a fixed amount of less experienced new hires at a time due to the availability of seasoned staff required for the process, and the length of time it takes to train new hires and get them up to speed. The lack of experience requires a higher degree of personal attention. Training staff have a fixed amount of time to allocate for this, and only so much can be covered in a day.

Some health care administrators have said that even if they had the right number of applicants to fill current openings, they couldn’t hire them all right now due to the challenges of onboarding. A cumbersome onboarding process is one factor that leads to employee dissatisfaction, which can increase turnover rates. Along with dissatisfaction, relocation and career advancement are top motivators for voluntary employee separations (quits). Nationally, employment in health care occupations is expected to grow 18 percent by 2026 and add more jobs than any other occupational group. This creates increasing opportunities for health care workers as companies compete to fill vacancies in a tight labor market that is already struggling with a labor shortage.


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