Why health care providers in Salem still struggle to hire

written by Pam Ferrara for the Salem Reporter

June 27, 2023

Is the health care industry in a hiring crisis?

One Salem area health care provider has placed a billboard on Lancaster Drive in southeast Salem advertising $4,000 sign-on bonuses for medical and dental assistants.

In addition, an internet search produces many articles about health care staffing shortages from, among other sources, the U.S. Chamber of Commerce and Kaiser Permanente, a large health care provider. There’ll be more on the Kaiser Permanente article later.

Employers had difficulty hiring for some health care occupations before the pandemic. There has been a shortage of nurses for over a decade, and lower-paid health care occupations such as nursing assistant have been on the Oregon Employment Department’s “jobs that are hard to fill” list for many years. Is there a health care hiring crisis in the Salem area?

To answer this question, let’s take a look at the industry, how it’s recovered, and some expert opinion on how to improve hiring in the industry.

The health care industry is the largest employer in the Salem area. It is 15 percent of total employment, some 28,000 workers in Marion and Polk counties.

The Salem area health care workforce consists of:

  • Approximately 26 percent in Social Assistance – these include services to the homeless, counseling, job training and child care;
  • 34 percent in Ambulatory Care settings, that is, doctors’ and dentists’ offices, clinics and the like;
  • 21 percent in Hospitals; and
  • 19 percent in Residential and Nursing Care facilities.

How did the industry fare during Covid?

Employment in two areas of health care took huge losses during the first months of the pandemic. These were Ambulatory Care services and Social Assistance. Job losses in these sectors weren’t surprising as some of these services could be postponed for a time. And all involved person-to-person contact which could have exacerbated the spread of Covid.

Hospitals and Nursing and Residential Care facilities also lost employment during the early months, but not as dramatically as the two sectors described above.

It is surprising that there weren’t more job losses. A new study from the federal Bureau of Labor Statistics reports that health care industry workers were ill with viruses (mostly Covid) at a rate five times that of all workers during 2020. All workers had an illness rate of 40 per 10,000 workers; the health care industry’s rate was 196 per 10,000, and the rate in nursing homes was nearly 600 per 10,000 workers.

Given these illness rates, and the stress levels among health care workers during Covid, it is perhaps surprising how well the industry has recovered. In May of 2023, the Health Care industry was up nearly one thousand jobs from February of 2020 in the Salem MSA (Marion and Polk counties combined).

More detailed current employment estimates aren’t available. But detail is available in the Quarterly Census of Employment and Wages, compiled by the Oregon Employment Department from employer reports, which is an actual count of jobs.

If we compare the fourth quarter of 2019 (just before the pandemic) to the fourth quarter of 2022 (the most recent available, we see that:

  • By the end of 2022, overall, Health Care employment was recovered to pre-pandemic levels; and
  • Ambulatory Care Services and Residential and Nursing Home care were still short several hundred jobs from pre-Covid levels.

Salem area hospital employment can’t be compared over the time period, because 2019 hospital employment numbers were suppressed due to confidentiality issues. But we can look at how Oregon hospital employment fared over the same time period and assume that Salem probably wasn’t much different. Hospital employment was still down nearly three percent statewide in the last quarter of 2022 from its pre-pandemic level. It is likely that Salem area hospitals haven’t recouped to pre-Covid employment levels.

From these comparisons it can reasonably be concluded that employment in doctors’ and dentists’ offices, and in hospitals, are not totally recovered from Covid job losses. And it is almost a certainty that Nursing and Residential Care employment is not recovered. So yes, employers are still having difficulty hiring in some health care occupations.

That brings us back to the billboard on Lancaster Drive.

Medical and dental assistants, and three additional occupations – registered nurses, nursing assistants, and home health aides – account for 63 percent of projected health care job openings in the Salem area over the next ten years. That’s 15,000 openings out of a total of 24,000 in all health care occupations.

Some pertinent facts about each of these:

  • Home health care aides are needed in medical settings and private homes, and the median wage is barely above minimum;
  • Registered Nurses have been striking in New York and California since January of 2023, and Providence nurses in Portland and Seaside went on strike on June 19 for better pay, better mental health care, and more paid time off;
  • Certified Nursing Assistants, the mainstay of Residential and Nursing care staff, are paid at the lower end of the scale and the job is stressful and physically demanding; and
  • Medical and dental assistants require costly training and pay at the lower end of the scale.

How will Salem area health care employers be able to hire for these occupations over the next ten years?

The answer may have to do with more than hiring difficulties.

Kaiser-Permanente is an organization that has provided health care to millions for nearly a century . Kaiser advocates a system-wide approach to staffing shortages, the premise being that hiring alone won’t solve the problem.

The work itself needs to change to address burnout, and to address overall inequities in the system with more diversity in the health care workforce. Working in teams and embracing technology and innovation will help reduce staffing loads and encourage more flexible staff schedules.

Kaiser now has its own medical school, school of Allied Health Sciences, and a Mental Health Scholars Academy, where the system-wide approach is being put into practice.

The U.S. spends more on health care than all other wealthy nations, with mostly poorer outcomes.

We have to do better.

Pam Ferrara of the Willamette Workforce Partnership continues a regular column examining local economic issues. She may be contacted at [email protected]