Keeping Quality Staff: HI Professionals Share Efforts to Improve Recruitment, Retention

When his coding manager retired after 40 years, then-health information management (HIM) director Lance Smith, MPA, RHIA, CHPS, CCS-P, CHC, CHPC, stretched his staff to cover the extra coding duties while he worked to hire a new manager.  

Months went by, but the pool of qualified prospects remained small.  

“After three or four months, I only had two quality candidates,” says Smith, who has worked in health information for 27 years and recently took a new position as director of compliance at St. Peter’s Health Partners Medical Associates in Albany, NY. “I didn’t know if it was lack of advertising, lack of people who could do the job, or the location, which was a small city.” 

In the end, Smith hired one of the candidates, and nearly five months after the search began, the new manger was trained and Smith’s team was intact again. 

Smith’s story reflects the recruitment challenges that many health information (HI) teams are facing, particularly amid an aging workforce. 

A workforce survey by NORC and AHIMA found that payrate limitations and availability of local candidates are among the top challenges to recruitment of health information (HI) professionals. Compensation limitations include local pay constraints, meaning salaries are not competitive within the local market, and national pay constraints, meaning salaries are not competitive with remote positions offered by organizations elsewhere in the country. 

Survey respondents also ranked “limited local talent pool” as a primary recruitment challenge, with higher responses from rural areas compared with urban and suburban locales. 

Even when recruitment problems are overcome and quality staff hired, HI organizations often confront another frustrating obstacle — high turnover. 

“Especially for entry level positions, a lot of employees see that they can go to say, a fast-food restaurant, and make almost as much starting out as with an entry level HI position,” says Jami Woebkenberg, MHIM, RHIA, CPHI, FAHIMA, senior director for HIMS operations at Banner Health in Phoenix, AZ. “It has been hard to compete with that.” 

Reasons for High Turnover 

With a growing remote workforce across industries, Woebkenberg adds that some employees leave to take on more flexible, virtual positions.   

“That’s definitely had an impact,” she says. “There are more people who want to work from home, and some HI jobs just don’t lend themselves to working from home.” 

Of survey respondents, 21 percent reported lack of flexibility for remote or hybrid positions as a key driver of HI professional turnover. 

Compensation was the top driver of turnover by far, with nearly half of respondents (47 percent) identifying low pay as the most impactful reason employees leave jobs. Respondents working in rural or suburban areas were more likely to report low pay as the most impactful driver of turnover with those in urban areas. 

Nearly 30 percent of respondents ranked employee burnout as the second most impactful driver of turnover for HI professionals. Respondents working in revenue cycle vendor settings were more likely to report burnout as the top driver of turnover (41 percent) compared with respondents in hospitals (27 percent) and non-hospital provider settings (28 percent). 

Some survey respondents expressed concerns that HI professionals are also retiring and aging out of the workforce faster than people are entering. The US Bureau of Labor Statistics notes that a majority of the projected openings for HI professionals over the next nine years will be due in part to workers exiting the labor force.    

Smith says over his career, his HI colleagues have primarily been from older generations, and that many entered the industry later in in life.  

“I have found that many didn’t go the traditional route of entering the field in their 20s,” he says. “I was nearly 40 when I went into health information. Because of this, there are fewer younger workers and many are also retiring earlier or switching careers.” 

The impacts of turnover intersect with other employment challenges in the HI sphere, leaders say. Burnout, for example, can trigger turnover, and high turnover at an organization can also drive burnout. High turnover also leads to understaffing, and unhappy, understaffed teams can trigger more turnover.   

“The cost of turnover hits an organization in a multitude of ways,” says Sandy Pearson, MHA, RHIA, CHDA, vice president of enterprise health information management at Intermountain Health in Broomfield, CO. “It’s expensive.”  

How to Improve Recruitment, Retain Staff     

Pearson’s team will soon launch a coding apprentice program that aims to improve recruitment and retention. The program will enable leaders to hire inexperienced applicants, such as new graduates of coding certification programs, who otherwise wouldn’t be considered for inpatient coding positions, she says. 

“As part of the program, they [will] go through a structured and rigorous in-house training program and eventually transition into an inpatient coder position,” Pearson says.   

The initiative is still under development, but plans to kick off later this year. 

Increased training opportunities are among the strategies HI organizations are deploying to solve recruitment challenges. Survey respondents said increased pay (45 percent), increased number of remote workers (40 percent), and increased training opportunities (28 percent) are primary ways their organizations have addressed recruitment issues. Increased automation and machine learning (22 percent) is another strategy respondents reported.  

However, 20 percent of survey respondents reported their organizations are taking no action to address HI hiring challenges.

Source: Health Information Workforce: Survey Results on Workforce Challenges and the Role of Emerging Technologies. NORC and AHIMA. 2023

As more members of the HI workforce retire, Smith emphasizes the importance of getting younger workers excited about the HI profession.  

Making job assignments and work hours more flexible could help, as many younger workers seem focused on flexibility, he says. Having a social media presence and using social media channels for advertising could also be beneficial.  

“The traditional ways of advertising that worked for older generations are less effective now,” he says. “The question is: ‘How do you make HIM [and] how do you make coding exciting in a TikTok video?’ ” 

As reported by survey respondents, HI leaders also stress the need to raise pay for entry level and other HI positions. Widening the pool of candidates by removing qualifications when possible could also improve recruitment, Pearson adds.  

For example, Pearson says when recruiting for positions at her organization, her human resources team regularly asks whether a credential is really necessary for the position or if a certain amount of experience could work just as well.   

“Unless it is a more technical position, like coding, we’ve removed some of our credential requirements for certain positions, opening up the pool of candidates,” she says.   

For Susan W. Carey, MHIM, RHIT, FAHIMA, system vice president of IT patient services and HIM for Norton Healthcare in Louisville, KY, a unique piece of their hiring process has strengthened retention.   

After a strong candidate is identified through several interviews, leaders invite the candidate to meet with their future coworkers. The meeting helps candidates get a better idea of what the job entails and ask questions they may not normally ask future bosses, Carey says.  

Through the discussion, the candidate develops a better understanding of what they’ll be doing from people already working the job and get a more realistic picture of the position before they commit, she says. 

To keep quality staff, it’s also imperative to acknowledge their work, give compliments, and make sure any criticism is constructive and educational in nature, Smith says.  

“A lot of people don’t leave for the money,” he says. “They leave because they weren’t getting the recognition or they were overworked.”  

Alicia Gallegos is a freelance healthcare reporter based in the Midwest.