The state's hospitals are facing increasing shortages of therapists, technicians and other staff needed to take X-rays, guide rehabilitation and manage ventilator patients, the Maryland Hospital Association reported yesterday.
Vacancy rates rose most sharply for respiratory therapy technicians, with 22.5 percent of hospital positions unfilled last year, up from 9.8 percent in 2004, the association found in its annual survey. Shortages increased for physical therapists, radiographers and occupational therapy assistants.
The shortages are not severe enough to affect emergency care, said Catherine Crowley, the hospital association's vice president for work force issues. But patients may have to wait longer for some routine procedures and tests, such as routine screening mammograms, she said.
To ensure necessary coverage in some slots, hospitals are turning to staffing agencies, paying more overtime and increasing hours for part-time staffers, driving up costs. Crowley said the association didn't have a measure of the impact of the staffing problems on the average hospital bill.
The increase in vacancies is more the result of increased demand - an older population leading to more and sicker patients - rather than a falloff in the supply of workers, Crowley said.
For example, while the number of respiratory therapy technicians increased - from 309 full-time equivalents to 325 - that wasn't enough to keep up with the number of positions added.
New programs also add to the demand for more services.
When Kennedy Krieger Institute, a children's hospital in East Baltimore, opened a new center to treat spinal cord injuries, "we needed 20 physical therapists immediately," an increase of about 50 percent over existing staff, said Tina Buddemeyer, human resources recruitment manager.
Hospitals have resorted to various strategies - including hiring and retention bonuses - and new training methods to try to fill the jobs.
Kennedy Krieger has raised pay scales every few months, and still has a 14 percent vacancy rate for physical therapists, 9 percent for speech-language pathologists and 6 percent for occupational therapists, Buddemeyer said. It has about 60 people in each of those classifications. Pay for those staff members now starts "in the high 40s," she said.
On top of that, Kennedy Krieger pays a signing bonus of $4,000 to $6,000, according to Buddemeyer, and offers smaller "commitment incentives" to staff who agree to stay for at least two to four more years. It also offers to repay student loans up to about $10,000.
When nurse vacancies topped 15 percent in 2001, the state created a fund from hospital revenue to support training more nurses. Linda H. Aiken, a professor of nursing and sociology at the University of Pennsylvania, said the Maryland program is one of the more promising ones she's seen, and should pay off in a few years as more nurses graduate.
Hospitals also recruited foreign nurses, increased salaries and took other measures to fill nursing jobs.
The vacancy rate for nurses has hovered about 10 percent for three years in a row, although a hospital association study projects that shortages will increase over the next decade because of increased demand.
Nursing has gotten the most attention in part because it is the largest category of hospital worker. About 30,000 nurses work in the state's hospitals, according to Crowley, compared with about 700 respiratory therapists and about 1,000 radiographers.
It takes time for shortages to correct themselves, Crowley and other experts said. When trained people are in short supply, community colleges and universities can't hire enough teachers to train more. Even when programs are enlarged, it takes several years to train the students and get them on the job.
And the amount of training time for some positions is increasing. For example, Crowley said, the only school in the state that produces physical therapists, the University of Maryland, Baltimore, recently switched to doctoral-level training. "While we would have had a class after five years," Crowley said, "now it's going to be six or seven."
Also contributing to shortages in the hospitals are the increasing job opportunities outside hospitals for nurses and allied health staff, including home health care and "disease management" programs run by or for insurers.
While hospital vacancies increased in some fields, others showed declining vacancy rates, such as specialist nursing technician, where the shortfall dropped from 11.4 percent to 6.1 percent.
The vacancy rate for respiratory therapists - people with more advanced training than the technicians - dropped as well, from 17 percent to 10.7 percent. Crowley said some the technicians may have upgraded to therapist.
The hospital association surveys 41 job fields in all. Overall, Crowley said, the work force problem is about as serious as it has been in the past few years.
In response, some area hospitals are getting involved in training more respiratory therapists.
Stacey Brull, director of professional development at Good Samaritan Hospital, said her hospital agreed to provide instructors, space and funding for an on-site training program for respiratory therapists supervised by the Community College of Baltimore County. An 18-month program for about a dozen students began in February.
Brull said Good Samaritan has used a similar approach to launch programs for nursing assistants to become registered nurses and for RNs to get advanced training. In those cases, she said, current employees work full time - three 12-hour shifts a week - and attend class one or two days a week.
Running training programs on its own campus builds loyalty by helping employees advance their careers, she said, and gives the hospital a chance to offer "hand-holding and positive support."