How Health Care Employers Can Build Their Workforces With Apprenticeships

The health care industry is facing a critical worker shortage at a time when demand for medical services is increasing. Health care jobs will be among the fastest growing occupations in the United States through 2026, accounting for about 2.4 million new jobs, according to projections released by the Bureau of Labor Statistics (BLS). Nationally, health care employers across ambulatory settings, hospitals, and nursing or residential care facilities are finding it increasingly difficult to fill positions at all levels. In many states, the projected supply of workers will be inadequate to meet demand, especially for health care support personnel.

To address this challenge, some employers—including Dartmouth-Hitchcock, a health system based in Lebanon, New Hampshire—are turning to the apprenticeship model to recruit, train, and retain top-level talent.

In 2014, faced with the challenge of filling numerous open positions in a market with a limited supply of qualified job seekers, Dartmouth-Hitchcock launched an apprenticeship program that has provided a new pipeline of skilled workers. In the past five years, the program has trained 450 individuals who went on to become medical assistants, pharmacy technicians, nurse assistants, and surgical technologists.

Like Dartmouth-Hitchcock, employers in other sectors with a shortage of talent in the labor pool have begun turning to apprenticeship as a workforce strategy. Since 2015, the number of active apprentices in programs registered with the U.S. Department of Labor has risen 42 percent overall, with increases of 34 percent in health care, 37.5 percent in retail, and 61 percent in hospitality.

The health care industry officially became the largest employer in the United States in 2017. The need for new talent pipelines in health care has been a major workforce challenge for the past decade. Labor shortages in nursing and allied health have ebbed and flowed over the past few years as health care employers have tried to develop new and innovative solutions to build a pipeline of skilled workers. However, demand for workers continues to outstrip supply, and Dartmouth-Hitchcock and other employers are turning to apprenticeships as one way to address the problem.

To help further advance apprenticeships as a way to build the health care workforce, JFF’s Center for Apprenticeship & Work-Based Learning hosted the event Building the California Health Care Workforce: An Apprenticeship Working Session in October 2018. JFF developed this in-person working session in partnership with the East Bay Health Workforce Partnership, the California Division of Apprenticeship Standards (DAS), and the California Labor and Workforce Development Agency (LWDA). Representatives of more than 50 government agencies, educational institutions, nonprofits, and other organizations attended the event to learn about apprenticeships and to discuss how the apprenticeship model could be applied to the California health care workforce.

The session featured an employer panel discussion with representatives of organizations that have built successful apprenticeship programs.

Eric Seleznow, a senior advisor at JFF, noted that employers can be intimidated by the thought of building apprenticeship programs, in part because they may believe that such programs have to be large undertakings. However, while Dartmouth-Hitchcock quickly expanded its program to include hundreds of participants, many employers begin with just a handful of apprentices and then grow their programs incrementally as they see successful outcomes.

Additionally, partners are available to help employers navigate the process and develop a structure. Brittany Brown, manager of recruitment at Nevada’s Renown Health, asserted that having someone do the heavy lifting enabled the health system to establish an apprenticeship program. “Having a partner made it super easy,” said Brown. “We really only had to supply the on-the-job supervision and mentorship.”

That partner was Cheryl Olson, director of an initiative called Nevada’s Apprenticeship Project, a grant-funded program led by Truckee Meadows Community College in Reno. Nevada’s Apprenticeship Project is an intermediary, or an organization that provides guidance, information, and assistance to employers that want to build apprenticeship programs. (You can learn more about intermediaries in the JFF webinar “The Role of Apprenticeship Intermediaries.”)

Olson helped build the framework for Renown Health’s successful certified nursing assistant (CNA) apprenticeship program. Brown said that having guidance and assistance from Truckee Meadows Community College made the process of setting up and running the apprenticeship program easy and rewarding. If she could go back and do it all over again, she said the only thing she would change about the program would be to “do it sooner!”

Dartmouth-Hitchcock also turned to an intermediary for help setting up its apprenticeship program, according to Sarah Currier, vice president of workforce strategy at the health care system, who said she partnered with the Institute for American Apprenticeships (IAA) at Vermont HITEC, an apprenticeship intermediary in Williston, Vermont.

“With just a little bit of support and guidance, it’s a very structured process that provided us with great success,” Currier said.

Currier and Brown agreed that the best way to drum up support for an apprenticeship program within an organization is to identify pain points that an apprenticeship program, and an intermediary, could address.

“Don’t come to a health care employer just offering an apprenticeship,” Currier advised. “To get an employer’s attention, do your homework. Offer the employer a solution—know what keeps them up at night and be able to show how apprenticeships can address that.”

Brown reported that nursing professionals at Renown Health were immediately excited about the prospect of expanding their staff with apprentices from the local workforce and about the opportunity to build mentorship and leadership skills as they worked with the apprentices. “We had staff lining up wanting apprentices in their programs,” said Brown.

To get started building a health care apprenticeship program, employers should get to know the people who work at their state apprenticeship agencies or federal apprenticeship specialists at the U.S. Department of Labor, said Daniel Bustillo, director of a national intermediary organization called the Healthcare Career Advancement Program (H-CAP). Those state and federal government experts can provide valuable assistance in setting up and organizing apprenticeships, and they can help employers register programs with the Department of Labor. (To find out who you should contact, consult this contact list on the Department of Labor’s website.)

In addition to apprenticeships, there are a number of other work-based learning solutions for health care employers. For example, in California’s San Francisco Bay Area, UCSF Benioff Children’s Hospital Oakland hosts a work-based learning program for high school students called the Community Health and Adolescent Mentoring Program for Success (CHAMPS).

Managed by Michelle Ednacot, program manager in UCSF Benioff’s department of community health and engagement, CHAMPS addresses one of the major concerns that health care employers have when it comes to hiring new employees: safety, specifically with regard to liability and patient protections. During their sophomore years, CHAMPS participants go through a semester-long training where they learn about confidentiality practices, medical terminology, and the provisions of the Health Insurance Portability and Accountability Act (HIPAA), which focuses on privacy and security in health care. During their junior and senior years, CHAMPS students go through on-the-job training alongside seasoned health care professionals in departments throughout the hospital.

Building a work-based learning or apprenticeship program is “a good thought process to go through, and there’s a lot of resources to support you along the way,” said Currier. For Dartmouth-Hitchcock, setting up an apprenticeship program has proved to be a successful strategy for building a strong talent pipeline for the future, she added, and said that she hopes more health care employers will pursue similar initiatives.

This blog was funded by the generous support of Salesforce.org as part of JFF’s Apprenticeship Awareness and Expansion Initiative. The national initiative expands apprenticeships and other high-quality, structured work-based learning programs through on-the-ground technical assistance and a resource and communications campaign.

Inside Look: Dartmouth-Hitchcock’s Medical Assistant Apprenticeship Program

Pre-Apprenticeship

Participants in Dartmouth-Hitchcock’s Medical Assistant apprenticeship program begin with 11 weeks of intensive paid pre-apprenticeship training. When they finish that training, they take the Certified Clinical Medical Assistant (CCMA) exam.

Medical Assistant Apprenticeship Program

The pre-apprenticeship is followed by a 2,000-hour, competency-based apprenticeship program that is registered with the U.S. Department of Labor. Apprentices meet monthly with their supervisors to review an established set of technical and professional competencies. During these meetings, they review their performances, identify skills they need to improve, and make plans for further professional development.

Moving Up

With an established apprenticeship program in place, Dartmouth-Hitchcock is now looking into ways to use apprenticeships to help employees advance from entry-level jobs to higher-level positions that require advanced skills. (You can learn more about combining multiple apprenticeship programs to create an upward career path in the JFF report Apprenticeships: The Next Stackable Credential?)

Program Benefits

Sarah Currier, vice president of workforce strategy at Dartmouth-Hitchcock, said the health care system’s apprenticeship program has yielded a number of benefits, including:

• The program pays for itself—it had a positive return on investment within the first year.
• Employee retention has increased because participants need to complete certifications before going elsewhere. Additionally, the time they spend in the program increases their engagement with and loyalty to Dartmouth-Hitchcock.
• Running the apprenticeship program enabled Dartmouth-Hitchcock officials to identify areas in need of process or managerial improvement.
• The program gave experienced members of the staff opportunities to develop leadership skills as they mentored apprentices.
• Young people who participated in the program got good jobs that kept them in the area.