An antidote to supplier shortages: in-house travel staff

Last month, the University of Pittsburgh Medical Center (UPMC) announced that they will be the first health system to offer their own travel agency: UPMC Travel Staffing. This couldn’t have come at a better time. Hospital staff shortages are at the forefront of national attention as health workers leave the field in record numbers and the Omicron wave further weakens hospital capacity. Even before Omicron, health workers at Kaiser Permanente and Catholic Health, in addition to UPMC, were on strike against stagnant wages amid pandemic burnout and staff shortages. Meanwhile, travel agencies have become popular among nurses in recent years, allowing nurses to travel to healthcare facilities in the US and earn stipends and significantly higher hourly rates in areas of increased demand.

The official goal of UPMC Travel Staffing is “to reduce reliance on outside staffing and to enable UPMC employees to travel to UPMC hospitals in Pennsylvania, Maryland and New York—where and when the need is greatest.” Essentially, it is a system owned travel agency offering 6 week stints in some limited health system owned locations. The personnel will be UPMC employees and will be deployed only at UPMC locations. UPMC Travel Staffing is becoming the goldilocks of labor flexibility in healthcare. Not as narrow as traditional nurses who rotate between departments within a single hospital, but not as wide as travel nurses who send staff across the country.

This step makes sense for UPMC. Through its own agency, UPMC can hire two nurses or technicians for the price of one externally hired staff member. They can guarantee a flexible safety net for labor and deploy staff efficiently. In the event of extreme shortages, they can even continue to use external agencies, unless their internal competition prevents them from using them. In addition, in an age of labor shortages in the healthcare sector, the in-house agency can provide a competitive advantage in recruiting and retaining scarce healthcare workers, as Jared Dashevsky suggests.

The in-house employment agency also offers an excellent opportunity for healthcare employees. The benefits of travel nursing — higher pay, short commitments, the ability to travel (albeit in a somewhat more limited way) — still exist. However, limiting travel to a system’s coverage area provides a more sustainable lifestyle for employees with families and other location-dependent obligations. This model also makes it more feasible for employees to pursue higher education. In addition to enabling employees to strategically take shifts at times and locations convenient for their academic programs, UPMC plans to provide tuition. Growing up in UPMC’s coverage area, I know several entry-level nurses who jump at the opportunity to join UPMC Travel Staffing.

The proprietary model also allows for more efficient transitions between movements. Standardized processes and consistent electronic health records ensure that travel staff can travel seamlessly from location to location. With established locations and a defined workforce, the health system can be more agile in scaling staff in response to seasonal needs or future pandemics. You can imagine how, after years of exploration as part of the staffing agency, a travel nurse will feel comfortable in specific locations and grow social networks throughout the system. Not only will this familiarity lead to more efficient travel, but it also encourages travel staff to find their niche (geographical, professional, social) in the system, providing a natural opportunity to become permanent staff in a location where they are likely to stay .

Of course, there are some potential drawbacks to the program. For employees, there is a risk that the health system (employer) gains too much power in the employment relationship, forcing employees into endless travel services without employee input. Indeed, internal employment agencies represent a trend towards further consolidation of the health system (labour). Some fear that health care labor consolidation is giving health systems too much power over health workers, so much so that the Federal Trade Commission (FTC) is including it in its antitrust calculations.

There are also risks to patients, as travel staff can be at the expense of traditional full-time jobs. In this scenario, healthcare systems can allocate their already scarce staff in such a way as to create slight shortages in locations across the board as a cost-saving mechanism. Fragmented part-time work can undermine the efficiency associated with working in the same role with the same people over time. Allowing part-time travel staff may provide a more attractive employment option that ultimately reduces the overall healthcare workforce. Finally, there is a chance that in-house travel agents will source labor from smaller, less attractive hospitals and clinics.

Overall, in-house travel agencies represent another powerful way for major health systems to further leverage their consolidated footprint. UPMC’s decision to set up their own in-house travel agency was a no-brainer for the health system. Other major health systems would — and probably will — follow suit.

Logan Choc is a medical student at the Icahn School of Medicine, co-leader of the Health Policy Program at Mount Sinai, and a member of the advisory board of MedPage today‘The laboratory’.

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