Demand for Healthcare Workers Continues to Grow, but Skills Gaps Remain

According to a report on healthcare employment projections by the Center for Health Workforce Studies at the School of Public Health at the University at Albany, State University of New York, although employment rates in the healthcare workforce are growing much faster than in other sectors, not all healthcare jobs are created equally. Overall healthcare employment grew by 20 percent from 2004 to 2014 and is expected to grow by another 22 percent by 2024. By comparison, employment outside of healthcare increased by 3 percent up to 2014 and is projected to grow another 5 percent by 2024. Non-healthcare jobs within the healthcare industry have declined, according to the study, possibly as a result of the recession, mergers and consolidations, and outsourcing. The report notes that non-healthcare jobs in the healthcare industry totaled 4,076,000 in 2008 compared with 3,505,000 in 2014.  

There are still a lot of opportunities in healthcare finance functions, but finding a good job in the healthcare sector requires more than just basic accounting and administrative skills. Jeffrey Helton, a lecturer at the Milken Institute of Public Health and The George Washington University, says he often hears from his colleagues that individuals entering the field of healthcare administration and finance often lack strong data skills, real-world experience, and the ability to connect data to solutions and useful analysis.  

“A lot of people are struggling with finding the unique mix of skills to understand data and to communicate with the normal people and the finance people,” Helton says. “I hate to say it, but a lot of us in finance have difficulty communicating and not talking over their heads. I challenge a lot of students who I work with and say, ‘I want you to make a decision, but explain your rationale.’ There’s so much of the lingo that we use in healthcare finance, but we’ve got to think about the fact that not everybody out there speaks our language.”  

There is also the issue of employers who are looking for individuals with experience to fill entry-level jobs. Those with experience don’t necessarily want entry-level positions, but new graduates don’t have what it takes—in the eyes of the employer—to do the job.

“There are new graduates in the field who have some of the basic skills, but employers are setting these years of experience bars pretty high, so they are disqualifying people who could do the job,” Helton says. “There are a lot of people interested in getting into the field, but they are still trying to find that sweet spot of the mix of academic training plus or minus on-the-job experience. I see the field kind of struggling with what is that sweet spot.”  

Internships and externships can help bridge this gap, and Helton says he has tried to form partnerships in the field for his students to gain experience. It’s difficult to teach some aspects of the job in the classroom, and many students lack an understanding of the revenue cycle. Healthcare education teaches accounting and contractual adjustments, but not a lot of attention is paid to what sort of behaviors and processes are involved with getting paid for services. “I think a lot of employers are finding frustration with the fact that there’s not a lot of depth in insurance and the revenue cycle,” he says.  

Jonathan G. Wiik, MSHA, MBA, principal of healthcare strategy at TransUnion Healthcare, agrees and says there are things that must be learned about health care and the revenue cycle that can’t necessarily be taught in a university setting. He says that many applicants lack “boots on the ground” experience and adds that he learned the most about healthcare and healthcare finance from actually doing the work.  

“I started in a very low, entry-level job, but I learned the ropes. I transported patients, then was promoted to scheduling them, then as I took on more responsibility I learned to check their insurance, then evolved into an operations manager, director, and then ultimately a chief revenue officer,” Wiik says. “I would not be as knowledgeable, passionate, and creative if I had not traveled that path.”     

He adds, “I think graduates in advanced degrees are going to need to put in the time within the space in which they want a career before they get that big position within that field. It helps to know why everything is happening the way it is, especially in our healthcare system. Those skills are not learned in a classroom; they are learned by doing the work in an entry-level position as a financial analyst, scheduler, IT intern, or other job. The time is well spent to ensure success down the line, and it builds the resume. Street versus book smarts need to be in tandem, and it’s integral in health care to get both as you advance your career.”  

There are some generational issues, too, that can compound employment issues after graduation, Helton says. “A lot of the students who I work with think, ‘I can just Google it and come up with the answer.’ I heard someone actually say, ‘I figured I can just Google it and fake the rest of it,'” Helton says. “That may work if you’re trying to slip through a test, but it’s not going to help you in the field. I’m still working on getting that message across.”  

Wiik agrees that generational issues are at play, but in a different way—particularly as an improving economy and job market have created opportunities for better career choices, especially for candidates with advanced degrees.  

“Millennials and other generations are able to get different, relatively high-wage jobs at a Starbucks, software companies, or other outlets where there is more competition for jobs. It is leveling out across all the space as coders, patient access, billers, analysts, and even software engineers are pretty common now,” Wiik says. “Organizations have had to adapt with creative approaches, such as working from home, flexible shifts, job sharing, and more. As we have become more digital and connected, so has the workforce.”    

Taking competition into account for the hiring manager, Wiik says in his experience, the No. 1 differentiator in hiring is finding a well-rounded individual. “Communicative, interpersonal, enthusiastic, and innovative qualities were what I looked for. I hired for talent versus skills, as most things in a hospital revenue cycle can be taught or learned, and they are high-touch areas that require a smiling face and a can-do attitude,” Wiik says. “That’s not to say we didn’t go after folks who had five to 10 years of experience working in a physician’s office, HIM, coding, or registration area, as they were a diamond in the rough. That said, finding and keeping that talent presented various challenges for revenue cycle.”

Entry-level positions in patient access have been difficult to fill, Wiik says, and coding positions have been in high demand. But Wiik says there are issues in finding job candidates with abilities beyond basic hard skills. “I think a skill that seems to be diminishing is ownership. By that, I mean that new hires and candidates often have most of the skills, but they may lack the project management or resource planning elements to ‘own’ a task or project,” Wiik says. “Health care is fraught with change, and adaptation is costly and slow. In that environment, it quickly becomes a clear differentiator in the ‘victim’ versus ‘hero’ camps. Victims allow the changes to happen around them, do not accept additional responsibility, and lack innovation and drive. A hero will ask where they can help, keep their commitments, exceed goals, point out deficiencies, and provide a better solution—constantly. This perspective and skill set may be outside the realm of education and more about being engrained or in the wiring within the person. But you can spot it.”  

Helton agrees that project management is an area that needs additional attention. Many students in healthcare finance today may have difficulty laying out a process for project management and creating a work plan with follow-up. “I hear a lot of my colleagues saying that knowledge base is lacking in new graduates,” Helton says. “A lot of this generation plays it by ear, if you will, and that works as long as you remember everything you need to do. But they also need experience determining what’s a reasonable time frame.”  

That being said, Helton says there are a lot of talented people entering healthcare finance. He adds that educational institutions need to partner with practitioners in the field to help students understand how things work outside of the school walls, and be more open about embracing new graduates and getting them experience. “I think there are great opportunities out there that we are kind of missing out on,” Helton says. “I really think that academia and the practice field have to think about things a little bit differently.”      

Rachael Zimlich, RN, is a healthcare writer from Cleveland.