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Shortage of Allied Health Workers Strains California Clinics

Good help is hard to find and harder to keep at California’s not-for-profit community clinics, a problem expected to become more problematic as the ranks of uninsured in California grow with the national recession.

A survey released this month showed more than 80% of California’s clinics reported difficulties in keeping allied health positions filled with qualified, trained personnel. The jobs of licensed vocational nurses, dental assistants and case managers are among the hardest to keep filled, according to the survey.

Personnel problems are stretching clinics’ resources and staffs when patient loads are growing because of rising unemployment and fewer people with adequate health insurance, according to the survey commissioned by the California Wellness Foundation.

“With more Californians losing their jobs and with it their health care, this situation isn’t going to get better on its own,” said Elia Gallardo, spokesperson for the California Primary Care Association, a trade group representing more than 700 community clinics in California.

“We’re very much interested in seeing some movement in policy proposals,” Gallardo said.

Long-term Planning Needed

Long-term planning is critical if California is going to contend with a chronic shortage of health care workers, according to Susan Chapman of the Center for the Health Professions at UC-San Francisco. She said allied health workers will become even more crucial as the state’s population ages and California adds 10 million residents by 2020.

“Sometimes allied health workers are called the hidden health care workforce,” Chapman said. “There’s often not a lot of attention paid to their portion of the workforce but it’s actually a fairly sizable portion — some say as much as 60%.”

“You can’t run a hospital or a clinic without these positions,” said Chapman, also an associate professor at the UCSF School of Nursing. “Not having enough people to fill these jobs compromises our overall ability to maintain the system in California.”

Chapman said statewide, as well as regional and local efforts, are needed.

“We tend to look at these shortages as short-term, but this is really about collaborative, long-term planning with community colleges, private educators, key employers, policymakers, work force investment boards,” Chapman said. “The regional approach is the best approach. All of these partners need to come together in a sustained way,” she added.

“These shortages are complex to fill. Training programs are expensive. We need to look at this with a very long-term view at what we need to do to handle things now as well as in the future,” Chapman said.

Critical Workers in Critical Part of Safety Net

Allied health workers — a broad classification representing dozens of jobs providing a range of diagnostic, technical and therapeutic direct patient care and support services — are crucial to most health care institutions, including hospitals, nursing homes, doctors’ offices and clinical laboratories.

Allied health workers are especially critical in community clinics, which, in turn, are a critical part of the state’s safety net.

“Community clinics represent the front lines of our health care system,” said Carmela Castellano-Garcia, president and CEO of the California Primary Care Association. “The economic situation is putting a further strain on our collective safety net, and community clinics are working to meet this demand under very challenging circumstances.”

“Retaining qualified workers, particularly in the allied health professions, is but one of the challenges many of our clinics face,” Castellano-Garcia said.

The equivalent of a two-year associate degree or certification program is required for most allied health professions, such as medical assistants, pharmacy technicians, emergency medical technicians and licensed vocational nurses.

Survey Findings, Recommendations

The scarcity of workers has prompted clinics to try a variety of measures to fill the gaps.

More than half (55%) of surveyed clinics reported having hired temporary workers or outsourced their work, and 72% have increased overtime for existing staff.

Many clinics are turning to neighbors for help. Almost 70% are partnering with local training programs to provide clinical training sites.

The survey also polled clinics on policy recommendations to help increase the number of allied health workers in California. Most clinics favored increasing the number of allied health training programs and expanding loan forgiveness programs for health workers.

Specific findings from the survey include:

  • 81% of clinics said keeping allied health positions filled with qualified, trained personnel is a challenge.
  • 76% of clinics that hire LVNs reported difficulties recruiting and retaining LVNs.
  • Case managers (56%) and dental assistants (50%) were also cited as difficult positions to fill.
  • Overworked staff was the most serious problem (60%) resulting from an allied health worker shortage.
  • Decreased productivity for existing staff (59%), too much staff time required to recruit and train staff (58%), and a limited ability to serve more patients (57%) were also listed as serious problems.
  • 72% of clinics reported increasing overtime for existing staff as a way to deal with this shortage, and 55% have hired temporary workers or contracted services to an off-site provider.

The survey and a Web site examining “The Other Health Care Crisis: California Needs Health Care Workers” were funded by a grant to Fenton Communications from the California Wellness Foundation. The site,, which includes the worker survey, also features a recruiting program: Health Jobs Start Here.

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