Tom Lilly can still manage a joke about losing his job as a senior vice president at St. Mary’s Medical Center, although it’s not hard to tell the loss stings. Lilly was with St. Mary’s for 10 years, after all.
“You don’t know anybody that needs a hospital administrator, do you?” he said with a gentle laugh.
Lilly, who turned 54 on Wednesday, was one of 73 St. Mary’s Health employees whose jobs were eliminated this month in response to a host of economic challenges dogging hospitals across the country. St. Mary’s has said most of those employees were nonclinical workers, including some administrators, although it will not identify them. Lilly said three of six senior vice presidents were let go — a small sampling of the roughly 4,700 positions he said were eliminated nationally by Ascension Health Catholic health care system, St. Mary’s parent company.
The former St. Mary’s executive — his last day was Friday — praised the faith-based health ministry as “an incredible place of people and mission and community.” The business of caregiving itself, he said, is undergoing a transformation.
“There are some significant changes coming in health care. Every organization needs to be prepared,” Lilly said.
Employment statistics suggest those changes will not make health care a less attractive profession for workers, but jobs and care are shifting from hospitals to outpatient settings such as doctors’ offices and ambulatory care centers.
Hospitals lost about 6,000 jobs nationally in May, the U.S. Bureau of Labor Statistics reported, but the creation of 7,000 jobs in home health care services and 4,000 new jobs in outpatient care centers more than made up for the loss. The additional 11,000 health care positions were among 175,000 jobs added in May.
Hospitals nationwide are facing the consequences of shrinking reimbursements from government and commercial payers, significant growth in a Medicare population whose coverage reimburses at below-market rates and fewer people with private insurance to make up for it. “Sequestration” budget cuts and other reductions to Medicare reimbursement also have taken their toll.
Hospitals have responded with efficiency and outpatient care coordination measures designed to drive down expenses and readmissions, but those are also hurting revenue by reducing hospital use.
Local higher education leaders overseeing training programs for health care careers report that hiring has been consistently strong. It’s just that the hiring is different now.
“For a long, long time, people that graduated from our programs, about the only place they had as an opportunity — or a vast majority of the time that the only place they had for an opportunity — was in the hospital,” said Ann White, dean of the University of Southern Indiana’s College of Nursing and Health Professions.
“Now there are community agencies, and some of them are private. Some are where individuals are starting their own organization, and they’re going to provide services to individuals that allow them to move through that transition of care (from hospitals to outpatient settings).”
Hospitals will still hire plenty of the College of Nursing and Health Professions’ nearly 2,000 students, said White, who credited St. Mary’s and Deaconess health systems with exploring ways to adapt.
But three ventilators in the College of Nursing and Health Professions’ respiratory therapy lab tell a story by themselves. Asked about the ventilators during a tour of the College of Nursing and Health Professions, White smiled.
“Pretty much, if a patient was on a ventilator, they were in the hospital or they were in a skilled nursing facility — and now we’ve been able to set it up so that they can go to their home with people coming in, such as health care professionals, respiratory therapists,” she said. “(Patients) can now be in their home and be on a ventilator. We’ve seen that shift.”
Ivy Tech Community College reports an enrollment of 1,115 students in all health care fields as of the fall 2012 end of term — a startling 55 percent increase over the previous year’s 720 students. Ivy Tech officials offered reports forecasting substantial health care workforce shortages and booming job growth in several related occupations.
Among the reasons: Health care coverage for millions of previously uninsured individuals under the Patient Protection and Affordable Care Act of 2010, a Medicare expansion as baby boomers turn 65 and presumably require more care, aging of physicians and simple population growth.
Lynn Penland, dean of the University of Evansville’s College of Education and Health Sciences, cited widespread predictions of shortages in nursing, health care’s largest occupational group.
“We’re going to be serving more people, and we continue to want and really demand higher quality health care, and we know that patient health outcomes are better when facilities are more adequately staffed with nurses,” Penland said.
‘Very Powerful Motivation’
Reports foreseeing physician aging, health care industry growth and hospital workforce shrinkage can be cold, impersonal. Penland cited a consideration she said will always aid hiring in health care fields — one she called “a very powerful motivation” for caregivers in training.
“There is an appeal to a profession where you feel as though you can make a contribution to the world, and so there are a lot of people — a lot of 16-year-olds, 17-year-olds, 18-year-olds — by the time they get ready to go to college, who really feel like this is where they want to spend their life’s work,” she said.
“The people who enter the health profession are motivated many times by more altruistic goals.”
Mary Ann Sellars, vice chancellor for academic affairs at Ivy Tech, said some students in health care training there would not be deterred even if the prospects for careers in those fields were poor.
“We see that every year we have students that sometimes have to wait to get into some of our more selective programs. They’re willing to wait. They want to be in health care. They want to help other people,” Sellars said.
If Hannah Thompson typifies the future of professional caregiving, it will not lack for enthusiasm.
Thompson, a senior at USI, began as a nursing major but switched to occupational therapy because she believes it will give her more opportunities to interact with patients. Having become a certified nursing assistant in her senior year of high school back home in New Castle, Ind., the 20-year-old spent considerable time around nurses in a previous nursing home assignment.
“They didn’t have time to talk to their patients because they were constantly on the go,” Thompson said, snapping her fingers. “And for my personality type, I have to talk to people. I chose to be an OT so I could have more of an ongoing relationship.”
Before switching her focus in fall of last year, Thompson shadowed an occupational therapist to make sure she really wanted to do the work. Now she is set to begin pursuing a master’s degree in the field next fall.
Nursing might offer more job opportunities, Thompson said, but “there’s a lot of positions (for occupational therapists) opening in geriatrics, especially with the baby boomer generation and things like that.” Ultimately, she said, she wants to work in a clinic setting with children with Down syndrome.
It is Thompson’s earliest notions of becoming a caregiver that buttress the belief that dedicated individuals will always make themselves available.
The older sister of quintuplets by two years, she recalls being inspired by the men and women who cared for them in an intensive care unit.
“I was able to see everything in action to save the lives of my brothers and sisters,” Thompson said. “There were some complications and I got to see it all worked out. I saw a huge difference being made, and I just wanted to be a part of that.”