¶ … massive shortage of radiologic technologists of the 1990s has abated, there is still some shortage of workers in the field. Most such workers ply their trade in large hospitals, which average 21 imaging workers. Rural facilities have a harder time recruiting workers, so hospitals in the most desirable locations might not even experience a shortage at this point. Key to recruiting for rural hospitals is thus to outcompete the urban facilities, but they must also look to their own areas for talented people who can be guided into the profession. Recruitment and retention are ultimately linked. Factors like training programs for career development solve problems both for facilities and workers. Workers like the control that such programs give them over career development -- this is a selling point both during the recruiting process and thereafter as well. For the hospital, such training results in workers who cost more, but who can do more, and this capacity utilization often has positive financial benefits. The research that has been done on recruitment and retention of radiologic technologists is surveyed and cited to support these core arguments.

Statement of the Issues

Nationwide, there is a shortage of radiologic imaging technologists. While the shortage has improved somewhat in recent years, this remains a position that is in demand, and in some areas of the country the shortage still applies. Medical imaging is an important function, one that every decent-sized facility has a use for. The Bureau of Labor Statistics estimates that there are around 230,000 jobs in the field nationwide. Demand for medical imaging technologists is growing at 9%, faster than the for the average position. Most work in hospitals. The education requirements are for an associate's degree or other training program where one learns how to perform this specific job. A bachelor's degree is not necessary but can often be a help. The median salary for this position is around $58,000 per year (BLS, 2016).

For many years, there was an acute shortage of these professionals. With more people entering training, the shortage is not as severe as it once was, but there is still high and growing demand. This creates recruitment issues for many companies (Bednar, 2008). Most facilities need multiple FTEs worth of technologists, the average for urban facilities being 21, with different specialties such as radiography, mammography, nuclear medicine technologists and other specialties as well (ASRT, 2008). Thus, being able to recruit an adequate number of these different specialists, and retain them, is important for the proper functioning of a modern hospital.

There are also differences between urban and rural recruitment and retention. The needs for rural areas are different, in particular because facilities are often smaller. Rural facilities find that it is important to recruit technologists who want to work in that environment -- retention is less a matter of competing against other facilities in the area as it is about hiring people who are going to be comfortable working in a rural environment long-term (Slagle, 2010). It is important for facilities seeking to improve their recruitment and retention strategies to understand the differences between urban, suburban, and rural recruitment and retention strategies, in order that they have the most effectiveness.

Human Resource Policies

There are several aspects to the recruitment and retention of radiologic technologists. Issues such as pay, benefits, working conditions and responsibilities are all key elements of a strategy. Furthermore, hospitals need to identify the best sources from which radiologic technologists can be recruited. The first step for most organizations is to identify needs. This is typically outlined in terms of FTEs required for each given position within the field (ASRT, 2008). In the best case scenario, there will be few immediate needs to be addressed through recruiting. Successful retention strategies can result in reduced need for recruitment.

Candidates come either directly from school, or for more experienced candidates from other medical facilities. In the latter case, there are many reasons why somebody would change employer, but working conditions and pay are often key factors (Sundheim, 2013). A facility with an insufficient number of professionals in a category might have trouble retaining the remaining ones, if they feel that they are overworked, for example.

One HR policy is setting the signing bonus. Competition for radiologic technologists means that a signing bonus is often offered, sometimes simply enough to cover some of the expenses involved with starting a new job, such as relocating. Around 10% of facilities pay such a bonus, and the amount is usually around $3,000. Signing bonuses are higher for the more specialized positions.

Retention is a different issue altogether. Pay is important, but there are other issues such as benefits,

When one works in a field for which there is high demand, this creates an opportunity to have more control over one's working conditions and pay. The radiologic imaging technologist therefore has some degree of bargaining power over these issues. For a hospital or medical facility, it is important to understand the bargaining position and ensure that the needs of the specialists are met, as a key component of the recruiting strategy. This can mean things as simple as ensuring that they are only doing the work for which they are trained (not being asked to perform other tasks that they are not comfortable with), to having the best equipment, to offering highly competitive wages and benefits packages.
Literature Review

The ASRT's (2008) radiology staffing survey reveals that there is an ongoing need at many facilities for one form of radiology professional or another. Facilities that experience multiple consecutive years without recruiting or retention issues are the exception. For most facilities, multiple practitioners are required. That said, the vacancy rate was 1.5% in 2008, which was an improvement from levels just a few years prior, statistical evidence that the former shortage of professionals in the field is abating.

The BLS figures still show that demand for radiologic technologists is growing at a rate faster than for most positions in the economy. This likely relates to the increase in demand for health care in general, which reflects an aging population, given that older people tend to consumer more health care than younger people do. Further, the Affordable Care Act's promise to expand health care coverage should further increase the demand for radiologic technologists in the coming years, in combination with the further aging of the population. All told, this should create an ongoing challenge for human resources professionals tasked with recruiting and retaining radiologic technologists. While there has been an increase in the amount of training opportunities, younger inexperienced technologists are not in as high demand as more experienced ones. For hospital that have multiple FTEs available, the ideal balance might be to have a senior person on staff, and a cheaper, less experienced one as well in the same role, to provide a balanced between experience and pay.

Slagle (2010) conducted a study of rural and urban demand in Tennessee. In this study, it was found that there are differences in the recruiting strategies between facilities in rural and urban areas. The author found that it was much more difficult to recruit professionals to a rural area. Human resources practitioners noted specifically that rural locations were a hindrance to recruitment. Most open positions at rural facilities are filled by local residents, which can pose challenges when seeking to fill specialized knowledge positions. While rural facilities often set up relocation programs, these were deemed to be ineffective by human resources personnel. Urban human resources practitioners, conversely, found that relocation programs were effective recruiting tools for their locations. It was also found that suburban locations have recruitment challenges relative to urban ones, such that the further from urban cores one gets, the harder it is to recruit people.

There are several factors that influence retention of radiologic technologists. One is professional development opportunities. The Slagle study found that a majority of professionals in the field take advantage of the professional development opportunities that exist. Thus, this becomes an important retention tool. At rural facilities, the technologist might perform multiple roles, allowing for better learning, but at urban facilities the larger size of the facility can help it to spread the cost of professional development programs over a larger number of employees.

Coombs, Wilkinson & Preston (2007) conducted a study of recruitment and retention at the NHS, or National Health Service, the government-run health organization. This is an interesting comparative to American issues, because there is a virtual monopoly, and recruitment issues mainly reflect on the overall attractiveness of health care, rather than competitive dynamics between firms. The authors found that the overall attractiveness of the profession relied on human resources professionals to anticipate demand, and set pay and working condition standards that were adequate to entice people into health care professions. This particular study, however, featured rather scant discussion of radiologic technologists specifically.

Bednar (2008) outlined the state of the profession in 2008. At that time, the shortages that plagued the profession in prior years had abated, in part because the capacity of…