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Gifford Medical Center Finds Worker Shortage Cuts Into Hospital's Bottom Line

Dr. Bryan Smith, standing, talks with a nurse at Gifford Medical Center in Randolph.
Howard Weiss-Tisman
Dr. Bryan Smith, standing, talks with a nurse at Gifford Medical Center in Randolph. Smith was recently hired at Gifford.

A recent report found that eight the state's 14 hospitals fell short of revenue forecasts in 2018. Gifford Medical Center officials say a workforce shortage is one of the biggest challenges, and it’s having a serious effect on the bottom line.

At Gifford Medical Center, in Randolph, it’s been a long time now since the operating room has been staffed with full-time nurses.

Gifford human resources manager Kim Carboneau said it’s always been hard finding nurses, but lately Gifford has pretty much run out of local options. So, the hospital’s trying something new.

“We just signed a contract with a company out of Florida that recruits international nurses,” Carboneau said. “So heard about it, checked references, talked to them, and just decided, we have to. It’s just ... we don’t have a choice right now.”  

Gifford’s been using local agencies to send in traveling nurses, but even those services are drying up. Anytime a hospital has to work with an outside agency to bring in a nurse or a doctor, Carboneau said it costs Gifford money.

“The company charges a fee. So, like for a traveling nurse it might be, I don’t know, 60-70 dollars we pay per hour,” said Carboneau. “The nurses are only getting maybe 30-32 [dollars]. The travel company — they’ll pay for their benefits, they’ll pay for their housing, maybe a living allowance type thing. So we’re paying that fee.”

Vintage outfits and photos hang on a wall at Gifford Medical Center
Credit Howard Weiss-Tisman / VPR
A presentation at Gifford Medical Center highlights the long history of recruiting nurses at the medical center.

When news broke that Springfield Hospital lost $14 million over the past few years, the Green Mountain Care Board took a closer look at how all 14 of the state’s hospitals were doing.

Many lost money; according to Gifford, its loss was almost $7 million.

Gifford Hospital CEO Dan Bennett said the worker shortage is one of the biggest challenges facing the hospital.

Bennett said when you run an emergency department, or a childbirth center, you need staff available 24/7. If you can’t find local workers, you have to pay for temporary doctors, or locums.

Like the visiting nurses, temporary doctors also cost hospitals more money, and Bennett said it's been cutting into the margin. Last year, the number of surgical procedures performed by a locum at Gifford increased by more than four times.

In a recent report to the Green Mountain Care Board, Gifford Hospital reported that its revenues were down, partly because there were simply not enough doctors and nurses to do the work.

But Bennett said it’s not just the medical staff that is hard to replace. He said whether it’s in IT or food service, it’s increasingly harder to hire — which leads to overtime, low productivity and ultimately less profit.

“Every part of the organization, every role right now, has been pretty difficult to recruit for,” said Bennett. “There just aren’t enough people out there for the positions that are open. And that’s not a Gifford problem, that’s a statewide [problem] — and I would say probably for most, at least in rural areas, an America-wide problem.”

"Every part of the organization, every role right now, has been pretty difficult to recruit for. There just aren't enough people out there for the positions that are open." — Dan Bennett, Gifford Hospital CEO

Gifford Chief Medical Officer Josh White said the staffing problem is putting pressure on Vermont’s whole rural hospital system.

“One of the big problems is effectively we have created an arms race between all of the local hospitals where they’re pilfering each other’s workforce,” White said. “That’s biggest in nursing.”

White said the turnover last year hit the hospital hard because patients who lost their doctor might have moved on to another provider. He said he expects the recent hires to build up their practice as time goes on.

Gifford is starting its own training program, White said, to help staff advance into more technically advanced position. But he said he's also hoping the recent focus on the struggles among Vermont’s rural hospitals gets lawmakers more involved, because White said small hospitals like Gifford probably can’t figure this out on their own.

“We’re going to need help from the state,” White said. “There are things that they can do in terms of things like loan reimbursement. And if the Legislature implements programs for loan reimbursement, it makes a place like Gifford a lot more attractive.”

White said Gifford is trying to be more selective in its hiring, even as it faces worker shortages. He said the hospital wants to make sure new hires understand what it means to live in a small rural town.

Correction 11:45 a.m. 04/21/19  Gifford Hospital hopes to bring in foreign nurses to help with a shortage in the operating room, not the emergency department as an earlier version of this story stated.

Howard Weiss-Tisman is Vermont Public’s southern Vermont reporter, but sometimes the story takes him to other parts of the state. 
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