Most large brick and mortar retailers use an inventory system that monitors the stock of items that they sell, and it either reorders automatically or alerts those responsible for restocking. This keeps items on the shelves so that when a customer needs an item, it is available.
Unfortunately, it is not so cut and dry with the HTM profession. As the inventory of experienced biomeds and imaging professionals is depleted, the effort to replace them is becoming more of a challenge. In this case, it’s more than just a matter of disappointed customers who can move on to the next retailer. Patients and clinicians are dependent on a fully stocked contingent of HTM professionals in every health care setting. There is little wiggle room.
The problem is a matter of timing. The second largest sub-population in America are the baby boomers. They are defined as those people born between 1946 and 1964. In 2011, the first of the baby boomers hit retirement age and the entire 76 million are either retired or approaching retirement.
It is estimated that a fifth to a quarter of the entire HTM field will retire in the next 10 years and many already have. This requires a “restocking” of sorts to ascertain that staffing remains at levels that can sustain the demands of every health care system and facility.
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Adding to the issue is the stealth nature of the HTM profession; a profession that is so “behind the scenes” that most high school students have no idea it exists and most career changers have never heard of it. At the intersection of retiring baby boomers and this obscure profession lies a challenge that needs to be addressed. How will the restocking work? And, just as troubling, how do you replace on-the-job experience?
“I believe we are starting to see the effects of an aging workforce in HTM. Many employers are recognizing the gap that is coming and a limited supply of incoming technicians,” says Roger A. Bowles, MS, Ed.D, CBET, professor of Biomedical Equipment Technology at Texas State Technical College in Waco, Texas.
“Many people still do not know what a biomedical equipment technician does and we are competing with other higher profile occupations to attract and retain students. This is especially true with high school age students,” he says.
Barbara Christe, Ph.D., program director of healthcare engineering technology management and associate professor in the engineering technology department at the Purdue School of Engineering and Technology, Indiana University-Purdue University in Indianapolis, adds that the concern is also related to academic expectation.
“I believe the profession is facing some hurdles in hiring for today and planning for retirements. Many institutions are not as forward-thinking as they should be; in my opinion. The desperate search for employees has set-aside discussion of academic quality or reputation,” she says.
“The demands for academic credentials for some positions, when these requirements were not prevalent in the past, will continue to challenge HTM professionals who see shifts in credential expectations without pathways to achieve them,” Christe adds.
Giovanna Taylor, MHSA, director of continuing education-health and medical at Saint Petersburg College in Clearwater, Florida finds an interesting dichotomy in the state of the HTM field today.
Giovanna Taylor, MHSA, Director of Continuing Education-Health and Medical at St. Petersburg College
“From one perspective, it is a career field wherein relevant technology is advancing much faster than the skills of the current workforce. Clinical engineering departments are challenged to attract skilled workers from a limited pool of available candidates. Many hospitals simply ‘steal’ qualified candidates from other employers, thereby creating an endless shifting of the labor pool, but never truly filling the gap,” Taylor says.
She points out that providing ongoing training for the current workforce is limited by budgetary constraints and the number of candidates whose motivation and education make them a good investment.
“Even in the case where a good candidate for advanced training may exist, obtaining such training makes them more valuable in the employment market at large, thereby putting the employer’s investment at risk of flight for higher pay with another company,” Taylor says.
“In the fortuitous event the employee is committed to the employer and chooses to stay after receiving advanced training, the employee becomes the only resident ‘expert’ and may not be physically able to meet all of the employer’s needs in servicing that technology. The employer must then rely on the employee’s willingness and ability to share that information with fellow technicians,” Taylor adds.
She says that this reality leaves employers in a constant state of crisis as they seek to maintain a workforce that is both sufficient in number, and adequate in the level of training, required to meet the demands of technological advances.
John Noblitt, M.A. Ed, CBET, BMET program director at Caldwell Community College
“I’m getting calls from hiring managers with companies and hospitals I have never heard of. There does seem to be a big void of qualified candidates, as it appears that many employers are having to throw a much wider net to find suitable candidates,” says John Noblitt, M.A. Ed, CBET, BMET program director at Caldwell Community College in Hudson, North Carolina.
Noblitt recalls another recent example that illustrates the state of the field. He says that an X-ray service company contacted him offering employment opportunities to graduates without imaging experience. They were willing to take on much more training for new hires than in previous years.
“Also, I’m receiving calls from health care organizations asking if they could participate in our internship program. However, when these facilities are too far away for the student to drive, they are not in a position to participate at the hospital with entry-level openings. Facilities might have to provide housing and possible paid internships to get these potential hires in their HTM department,” Noblitt says.
There are more examples.
“A company offered a recent graduate an internship after graduation. This internship was not an offer of permanent employment but was a paid position with no benefits,” he says. “Only a few weeks into the internship the student was offered a permanent position at another hospital and the student took the permanent job. Employers may not have the luxury of evaluating candidates over a longer period of time.”
The reality of this state of affairs is affirmed by managers.
Rodney Nolen, Manager of the biomedical engineering department at the University of Minnesota Health
“Yes I have a technician retiring this Friday. I am seeing a shortage of BMET IIIs right now. I currently have two open positions that I have no qualified applicants for,” says Rodney Nolen, manager of the biomedical engineering department at University of Minnesota Health.
“I am doing nationwide recruiting to fill these positions working with all professional organizations and groups,” he adds.
A requirement for seasoned biomeds and a scarce availability is seen in the southwest as well.
“At Banner, we are definitely starting to see the baby boomer demographic exit the organization into retirement,” says Perry Kirwan, MSE, CCE, vice president of Technology Management for Banner Health.
“The job market for biomed is scarce whether they be experienced technicians or new technicians but for different reasons. The experienced biomed is almost like free agency in athletics,” Kirwan says. “Not only do you have to work hard to attract talent; you have to figure out how to retain talent because these are sought after individuals. For new grads; it’s a slightly different problem because most prospective employees are being trained to be repair humans and not really biomeds.”
Retirements Create Challenges
The mass retirement of baby boomers is not a problem relegated to the HTM profession. The departure of this generation from the labor market is being felt everywhere.
With roughly 10,000 baby boomers retiring daily through 2030, the exodus of experienced workers is a reality that impacts many industries. That is the year that the last of the baby boomers turn 65, and at that time, 18 percent of the population will be 65 or older.
One factor that could blunt this departure rate, to a degree, for HTM and other industries comes out of a study by The Associated Press-NORC Center for Public Affairs Research. The study found that more than half of older Americans plan to work past the traditional retirement age of 65.
In the 2017 TechNation State of HTM Survey, extracted from the 375 responses, it was revealed that 15.3 percent of respondents anticipated retiring in 12 to 15 years.
More remarkable is that 8.3 percent of respondents reported that they planned to retire in one to three years and 11.5 percent reported plans to retire in four to seven years. That means that a fifth of HTM professionals, in a limited sampling, plans to hang up their test equipment and exit the profession in seven years or less.
Another 15 percent expected to retire in eight to 11 years. More than a third of the profession plans to retire over the next decade based on the survey results.
The topic of what traits employers are hoping to find in new hires was on the agenda at the 2017 AAMI conference in Austin.
Barbra Christe, Ph.D, Program director of Healthcare Engineering Technology Management
“The discussion at AAMI in the employer-educator roundtable was very interesting. In the session entitled ‘The Dream Employee: What are Employers Looking for Today,’ I heard employers characterize a wide variety of skills including hands-on competence: folks who know how to change their own oil and can select the correct size screwdriver on the first try by assessing the screw head size as well as higher level skills like project management and quality assurance,” Christe says.
“I believe we are trying to fill a wide variety of positions with graduates from just a few bench-tech training programs. While attending that session, I expressed my surprise that employers hadn’t mentioned that their dream employee had three to five years of experience. That’s the request I hear most; yet this experience (beyond an internship) isn’t something my program can provide,” she adds.
Fine Tuning Training
Many HTM training programs include advisors who are experienced biomeds and many HTM departments offer internships, which give students hands-on experience. Some employers see the need to be proactive to assure qualified candidates are prepared to work within their departments.
“For our entry-level folks; we have had to build an internal training program to supplement what is either de-emphasized, or not taught at all, in the programs that we have in our community,” Kirwan says.
“We are also working to put advisors on educational boards to help shape the curriculum so that the programs are teaching/training the students on what they need to know in order to be successful. That too, has risks because competitors let you do the training and then poach your employees by offering them a dollar or two more,” Kirwan adds. “Certainly no easy answers to this one; but we try to stay very engaged with it.”
Christe agrees with this approach. She says that debate is abundant as folks consider what is adequate preparation and what is appropriate preparation.
“I believe most folks would ideally like to hire a graduate of an academic institution who has participated in a clinical internship. However, when no candidates are available with those credentials, employers must still fill the position with someone,” she says.
“My contention is that employers must work to improve the number of available graduates available by partnering with academic institutions as other professions have done rather than to give up expectations of academic credentials or quality academic credentials,” Christe adds.
Taylor also says that employers can drive the curriculum process.
“Clinical engineering departments have the opportunity to influence the training and education of future biomeds by reaching out to educational institutions to bring attention to the need for more advanced training,” she says.
“This is the ideal model for creating new educational programs. Too often, academic programs are created by educators who are not actively engaged in the field, or whose experience may be decades old, thus creating educational programs and degrees that do not accurately reflect the current skills needed in the field,” Taylor adds.
Noblitt says that fewer training programs and fewer graduates is a double-edged sword. He says that it is great for the recent graduate, but it appears to be straining many employers. He says that the program at his college has gone from 30 to 40 students eight years ago to 15 to 25 today. The good thing is that enrollment for the current class is at the top of that range.
“So, Caldwell will see about 35 students in the first and second year. Of 25 that will start the program, I only see about half of those students actually graduate and seek employment in the industry,” he says.
He has taken a creative approach to helping attract new students through more awareness of the profession.
“I have recently begun video interviews with former graduates to highlight their careers and opportunities. Hopefully these interviews can help market the program to perspective students, whether they be career changers or high school graduates,” Noblitt says.
This type of recruiting method, that gives a student some sense of what the HTM profession is all about, and why they might want to pursue this career, is one example of what is needed to reach high school students. Christe says that it is this population that is not hearing the siren’s call.
“When the economy is good, fewer people attend technical training programs. Workforce retraining money, and career changers who are unemployed, are less common. As a result, many HTM programs report fewer attendees. However, I believe that one of our downfalls may be that HTM academic programs do not attract traditionally aged students – those who come to college directly from high school,” she says.
“That population continues to attend college at high rates, just not enrolled in our discipline. Surveys at several institutions, including my own, show that the most common way a student learns about this major is through someone who is employed in the profession. That word-of-mouth method is not a sustainable recruiting technique, in my opinion, to meet the needs of the workforce,” Christe adds.
“I have not reached capacity in my classrooms and wish I could recruit more students. I have tried multiple approaches (as have many other academic institutions) including visiting high school classrooms, attending career fairs, and collaborating with student groups such as HOSA-Future Health Professionals. My efforts have not been particularly successful,” she says.
Bowles agrees with this assessment.
“Our program has seen a slight downturn in the number of students. We have visited many high schools over the past couple of years but high school recruiting has always been less effective for us than plain ole ‘word of mouth’ advertising,” he says.
“The majority of our students — at least the ones who are serious about it — are career changers; some transitioning out of the military, others looking for a stable career after trying others. The average age of our students is about 28 and that has been holding steady. Most of our students came here because someone they know works in HTM or another field in health care and told them about it,” Bowles says.
Taylor also points out that there are challenges both with the development of biomed training programs and for students seeking educational funding.
“There are several challenges to maintaining a biomed program; the most significant of which is probably hiring qualified faculty. Since the field itself is still relatively unknown, academic institutions have not endeavored to create an academic pathway that supports bachelor’s and master’s degrees in the field. This is significant since the path to accreditation requires faculty that have the required academic credentials. For a regionally accredited school, that generally means a master’s degree with at least 18 graduate credits in the field (or specified related fields), such as in the case at St. Petersburg College. Finding faculty who have both the academic credentials, and the career experience, is vitally important for the success of the program, and equally as difficult to achieve,” Taylor says.
“A related challenge is that programs that lack accreditation may have limited access to federal tuition assistance such as Pell grants and subsidized loans. As a result, students may pay higher tuition costs out of pocket. This further limits the pool of students coming into the program,” she adds.
She says that since most schools are challenged to find sufficient numbers of faculty, some schools have over-utilized existing staff, which necessarily limits class size and offerings, resulting in a small number of enrollees and an even smaller number of graduates. All of this can spell impending disaster for a program, as unproductive programs are routinely found on the fiscal “chopping block,” Taylor says.
Steps to Improve the Numbers
Taylor says that employers can help ramp up the pool of candidates by being the squeaky wheel. She says that hiring managers, who have challenges in obtaining a prepared workforce, should make noise and be vocal.
“Seek help from local community colleges and technical schools. Most colleges have continuing education departments. Theses departments are much more flexible and nimble than credit-bearing academic departments and tend to focus on filling the needs of the local workforce. Reach out and ask them for help,” she says.
She also suggests that employers may want to send an email to the local community college or technical school president and ask for a meeting to discuss your industry’s needs.
“Most will quickly extend a welcoming invitation or extend a connection to the appropriate dean or department head,” Taylor says.
“Talk with the local Workforce Board. These tax-funded agencies focus heavily on the local job market and are able to fund training programs through local training entities. They also often have grant funding that may not only provide training, but may even subsidize the training and hiring of new employees,” she adds.
Bowles says that more help for training programs could improve things.
“Get more skin in the game; provide more scholarships, donate newer equipment (manufacturers could do more here), and be present on campus,” he says.
Christe echoes this theme.
“Collaborate with academic institutions around you, connecting current HTM educators with nearby programs to offer training in our discipline. Recognize that waiting for qualified applicants for open positions may not produce results – proactive efforts with long-term benefits may be the best way to fill future positions – which I acknowledge is not what hiring managers want to hear,” she says.
Christe advocates for scholarships, training programs, apprenticeships and other academic partnerships to help employers “grow” the people they need.
Noblitt says that hiring managers may have to look into paid internships or possibly making job offers during internships or before.
“I do see hiring managers having to be much more aggressive in their pursuit of the very best candidates coming out of any BMET program,” he says.
“I recently had a top candidate graduate and have to decide on three job offers. In 25 years, I can’t remember a graduate with three offers on the table at one time,” Noblitt adds.
The solution will require input and active cooperation for all segments of HTM.
“Finding qualified applicants is not a simple problem with an easy solution. Our profession needs a multipronged approach that involves forward thinking individuals and collaboration,” Christe says.
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