By Laura Aka for WorkingNation.
Broadcast version by Danielle Smith for Tennessee News Service reporting for the WorkingNation/Public News Service Collaboration
We all witnessed the significant impact the pandemic had on frontline health care workers. One in five health care workers has left their job since 2020, according to one industry report. And the exodus is not over.
"Research suggests that up to 47% of health care workers plan to leave their positions by 2025. The U.S. is suffering from a significant health care worker shortage, and the data shows that this is going to have near-term and long-term effects on both patient care and hospital and physician performance," says Definitive Healthcare.
Nashville, considered a major health care hub, has not been immune to worker shortages. To address its talent pipeline needs, Vanderbilt University Medical Center (VUMC) is collaborating with local education institutions - including high schools, community colleges, and state colleges - to create learning opportunities and fill open jobs.
Where the Shortages Are
Peggy Valentine, Ed.D., vice president of allied health education at VUMC, was brought on in 2021 to help address the organization's need for allied health workers. She says, "There were a lot of positions that were in high demand. You can't really run a hospital without these positions.
"I came on poring through these reports in terms of where the vacancies were located. We found that there were a number of professions where there were over a hundred vacancies, such as medical assistant, EMT/paramedics, pharmacy techs, medical laboratory scientists."
Valentine notes, "When you think of allied health, there are over 200 distinct disciplines, maybe more because it keeps growing. You combine them all together, it represents about 60% of the health care workforce.
"They include the technologists, people who work in the laboratory, people who work in x-ray, people who support the work of nurses, support the work of physicians.
"It may be in the operating room where you're a surgical assistant. It may be doing the CAT scan or the person who runs the machine for ultrasonography - just a very large group of professionals to support this important work," she explains.
Partnerships with local postsecondary institutions are instrumental to VUMC's efforts to grow its talent pipeline. "They already had these programs up and running. There's no need for us to reinvent the wheel."
Nashville State Community College
The first collaboration - launched in 2022 - was with Nashville State Community College (NSCC) with a focus on medical assistant training. The opportunity to learn central sterile processing through NSCC was added later.
"The first cohort of medical assistants was people who worked here at the medical center. Maybe they worked in dietary, delivering food trays, or they worked in environmental cleaning. We had people who worked in various positions who always wanted to go back to school but never had the resources to do so," says Valentine.
VUMC pays for their employees' tuition, books, uniforms, and supplies while they maintain their salaries and benefits, explains Valentine.
After the completion of the first cohort, she says the workforce opportunity was extended beyond employees of the medical center to the wider community, partnering with organizations like Grace Place Ministry and UpRise Nashville. Students from the community are given stipends to help offset the costs of expenses like transportation and childcare. As Valentine says, "Those kinds of things that people worry about."
Nashville is a good representation of what's happening in health care, nationwide, says Donna Whitehouse, dean of the School of Health Sciences at NSCC.
"The reason for the health care shortages - we have the baby boomer retiree exodus. We have the leftovers of COVID burnout that came along with the intensity of, not just the caseload, but just the depth of what caring meant at that point in time with the great loss of people."
Whitehouse says, "We are hearing from our alumni that the billable productivity requirements for rehabilitation professionals such as occupational and physical therapists have significantly increased over time.
"Productivity requirements, especially on our rehab side of things, used to be 80% to 85% of your work time was considered time with patients and then you had some time to do some paperwork. Now they're looking at 90% to 95% of that time to be billable and that's a quick pace in order to be able to get things completed."
She adds that other challenges include the cost and geographic location of educational opportunities, the need for more flexibility around work schedules, and having enough educators to teach the training.
"We have to really credit Vanderbilt with their open-mindedness and their creativity in addressing this workforce shortage," says Whitehouse.
"[VUMC is] also fronting scholarships for our surgical technology students [which requires a degree in order to earn the necessary credential]. Once those students have been accepted into our program, [VUMC is] helping fund any additional costs that they have so they can continue their education," she notes.
Whitehouse continues, "In this case, Tennessee residents who qualify for programs like Tennessee Promise or Tennessee Reconnect can attend school tuition-free. But we know that there are more costs to attend than just tuition, so Vanderbilt has stepped in.
"Vanderbilt has made, not just an investment in getting people on those ground-level positions and getting in those short-term training programs, but they are also investing in their long-term career towards a credential that requires a little bit more extra time and a little bit more extra education through an accredited program."
Whitehouse points out, "We've had over a hundred students who have completed the Vanderbilt-Nashville State MA program. Our first-time MA certification rates are well over 80%. That's the first-time test takers. We have a 100% certification rate, overall. Sometimes it takes more than one time, but we get it.
"Here's the kicker, of those people in that program, 90% have seen it all the way through. You're not going to see those numbers in a whole lot of places. Close to 95% of the people who have gone through the program and then gone to work are still at Vanderbilt."
Tennessee State University
"After COVID, there was a national shortage of respiratory therapists, and there still is," says Brenda K. Batts, D.H.A., director of the cardio-respiratory program, Tennessee State University (TSU).
She continues, "With that, Vanderbilt started a new initiative to recruit respiratory therapists. They started a scholarship program with Tennessee State University's cardio-respiratory program. Within that scholarship program, if [students] accept the scholarship, they have to commit to a time period to work at Vanderbilt for a year or more."
Batts says, sometimes, students have to leave the program, "One of the things we do know is that in the last year, many students at Tennessee State have financial hardships.
"When you have a scholarship that can help lift that heavy burden and help you complete that journey, it's so rewarding. We had 10 that applied to that scholarship program, and they accepted 10. All of them are ecstatic about working at Vanderbilt. Many of them wanted to work there anyway."
According to the Bureau of Labor Statistics, "Employment of respiratory therapists is projected to grow 13% from 2022 to 2032, much faster than the average for all occupations. About 8,600 openings for respiratory therapists are projected each year, on average, over the decade."
Batts says it is crucial to create awareness about the role of the respiratory therapist. "Some respiratory programs have a problem with recruiting people.
"I think people are misinformed because they think, 'Oh, you have to have go to school forever.' No ma'am. We need to identify the two ways that you can enter our profession.
"There's a two-year program that feeds into the four-year program. You can have a two-year degree, but Vanderbilt will invest in you to go back and get the four-year degree."
In addition to the Vanderbilt collaboration, Batts says outreach in the community is important, including afterschool programs. She says, "The Martha O'Bryan Center is one of the largest nonprofit organizations in the middle Tennessee area. We take our respiratory therapy students, who have to do a total of 80 hours of service work over two semesters.
"The respiratory therapy students become teachers of those young people. We showcase our profession, and we take all the tools with us - the mannequins, the intubation of procedures."
Pearl-Cohn High School
Similar to Batts, Tyler Welch, academy coach of the Academy of Health Science and Personal Care at Pearl-Cohn High School, says, "It comes down to exposure. Young people have a hard time, I think, seeing where they fit in the big picture."
"It's actually from their life experiences," says Welch. "When they go to the emergency room or when they go to the doctor's office, everyone they interact with has scrubs on.
"I started realizing they were generalizing - a nurse. When you start looking at, 'Well, I want to become a nurse,' the pathway to be a nurse can be more difficult than some of the [alternative] pathways to become a nurse. I started realizing these certification stacks are what actually can lead to, ultimately, being a nurse. When we say medical assistant certification, they don't really know what that is. But we say, 'Hey, it's a path to nurse.'"
Welch notes that Vanderbilt has visited the high school giving students the opportunity to explore different jobs including - the already-mentioned medical assistant, HR positions, nurse practitioner, traveling nurse, and surgery techs.
By the time students complete high school, they have OSHA and CPR certifications. Additionally, when they finish the medical assisting coursework and an appropriate clinical internship, students may sit for the Certified Clinical Medical Assistant (CCMA) exam. Welch says the Academy has recently implemented a program to teach professional and employability skills.
He offers an observation, "I feel like it's really hard to go from high school to the job. I feel like that's a big jump. I could be wrong, but that's what I feel like. We need to get that postsecondary piece. We have to find a model that really keeps them into it."
Welch says, "To hear what Vanderbilt is doing with Nashville State - if we could learn to build that bridge, 'Hey, prefer our students if they're prepared and ready.' Let's build that bridge where it is.
Changing Family Trees
Welch notes, "We all see that there's a problem and we have to figure out a way to solve that. In the medical field, there's some postsecondary schooling, skills work and it's a long game. Nowadays everything is a sprint, instant gratification so there has to be some other teaching going on than just this is the skeletal system. We have to do our part to prepare the kids so then they can be in that environment to take hold of the opportunities that are there.
"I just feel like that pathway is ready to really explode and do what it's supposed to do."
Tennessee State University's Batts says about the stakeholder collaboration, "It's a partnership within a community - coming together to address the needs of our community."
She continues, "I try to make a difference in my community and that's what drove me to do the different aspects of [my own] education. I wanted to learn more about how to fix a problem that kept me up at times - kids with asthma, people down from COPD, and health disparities.
"A lot of the students come from those same communities. So, they're already vested in it."
Nashville State Community College's Whitehouse says, "If we take advantage of these opportunities to ladder up, it's endless what we can do. And it's just a matter of making the connection.
"I want to talk about helping people connect to these opportunities because we need them. We have seats available. We need people to come in to provide health care services in a variety of different ways. We can get you connected and into a program that is going to put you on that path for success," says Whitehouse. "Not only put you on a path for success, but we know connecting workers to high-wage jobs then changes family trees, right?"
She adds, "Think about times in your own life when people have invested in you and the fact that when someone invested in you, they thought you mattered. That feeling of mattering to someone else is motivation to continue to move forward. And that's exactly what this opportunity is."
Lastly, VUMC's Valentine notes not everyone can go to college right now, "It has been very important to reach young people to let them know that if you don't go to college, there are other options - short-term training programs until you figure out what you want to do.
"Sometimes the work experience you gain at one level can help you at your next level. And courses you take may transfer into that next level. With high school students, it's very important to let them know, 'If you don't go to college, it's not the end of the world. You can go later, but there's some things you can do short-term when you can still earn a decent income until you figure out the path forward.'"
Valentine continues, "They may be the first one in their family to reach this level. It opens up the doors of opportunities for them and generations to come because the children will look at their parents and say, 'Wow, if mommy could do this then I can go back to school and do this too.' It also moves the needle in terms of having a more diverse workforce. We're moving the needle in terms of ridding our communities of health disparities.
"We're setting the examples for the next generation that's coming behind us. And to me, it's the most important work that we can do for our communities."
Laura Aka wrote this article for WorkingNation.
get more stories like this via email
By Kelly Field for The Hechinger Report.
Broadcast version by Nadia Ramlagan for Kentucky News Connection reporting for The Hechinger Report-Public News Service Collaboration
Haley Autumn Dawn Ann Crank thinks she might like to become a teacher. There’s a shortage of teachers in this corner of Kentucky, and Crank, who has eight siblings, gets kids.
“I just fit in with them,” Crank said during a shift one February day at the Big Blue Smokehouse, where she works as a waitress.
For now, the recent high school graduate is taking some education courses at the local community college. But to pursue a teaching degree at a public, comprehensive university, she’ll need to commute four hours roundtrip or leave the town she grew up in and loves.
Neither of those options is feasible — or even conceivable — for many residents of Hazard, a close-knit community of just over 5,000 tucked into the hills of Southeast Kentucky. Like many rural Americans, the people here are place-bound, their educational choices constrained by geography as much as by cost. With family and jobs tying them to the region, and no local four-year option, many settle for a two-year degree, or skip college altogether.
Until fairly recently, that decision made economic sense. Mining jobs were plentiful, and the money was good. But the collapse of the coal industry here and across Appalachia has made it harder to survive on a high school education. Today, just under half the residents over the age of 16 in Perry County, where Hazard sits, are employed; the national average is 63 percent. More than a quarter of the county’s residents are in poverty; the median household income is $45,000, compared to $75,000 nationally.
Now, spurred by concerns that low levels of college attainment are holding back the southeastern swath of the state, the Kentucky legislature is exploring ways to bring baccalaureate degrees to the region. The leading option calls for turning Hazard’s community and technical college into a standalone institution offering a handful of degrees in high-demand fields, like teaching and nursing.
The move to expand education here comes as many states are cutting majors at rural colleges and merging rural institutions, blaming funding shortfalls and steadily dwindling enrollments.
If successful, the new college could bring economic growth to one of the poorest and least educated parts of the country and serve as a model for the thousands of other “educational deserts” scattered across America. Proponents say it has the potential to transform the region and the lives of its battered but resilient residents.
But the proposal carries significant costs and risks. Building a residence hall alone would cost an estimated $18 million; running the new college would add millions more to the tab. Enrollment might fall short of projections, and the hoped-for jobs might not materialize. And if they didn’t, the newly-educated residents would likely take their degrees elsewhere, deepening the region’s “brain drain.”
“The hope is that if you build the institution, employers will come,” said Aaron Thompson, president of the Kentucky Council on Postsecondary Education, which has studied the idea on behalf of the legislature. “But it is somewhat of an experiment.”
Still, Thompson said, it’s an experiment worth exploring.
“To say you need to move to be prosperous is not a solution, and that’s pretty much been the solution since many of the coal mines disappeared,” he said.
At the airport in Lexington, Kentucky, there’s a sign greeting passengers that reads, “You’ve landed in one smart city.” Lexington, the sign proclaims, is ranked #11 among larger cities in the share of the population with a bachelor’s degree or higher.
But drive a couple hours to the southeast, and the picture changes. Only 13 percent of the residents of Perry County over the age of 25 hold a bachelor’s degree or higher, well below the national average of 34 percent.
Michelle Ritchie-Curtis, the co-principal of Perry County Central High School, said the problem isn’t convincing kids to go to college, it’s keeping them there. Though nearly two-thirds of the county’s high school graduates continue on to college, just over a third of those who enroll in public four-years graduate within six years, compared to close to 60 percent statewide, according to the Council on Postsecondary Education.
In Hazard, as in many rural places, kids grow up hearing the message that they need to leave to succeed. But many return after a year or two, citing homesickness or the high cost of college, Ritchie-Curtis said. Sometimes, they feel ashamed about abandoning their aspirations. They take off a semester, and it becomes years, she said.
Those who make it to graduation and leave tend to stay gone, discouraged by the region’s limited job opportunities. This exodus, and the lack of a four-year college nearby, have hampered Hazard’s ability to attract employers who might fill the void left by the decline of coal, said Zach Lawrence, executive director of the Hazard-Perry County Economic Development Alliance.
Ritchie-Curtis said that having a local option would solve the homesickness problem and could save students money in room and board. It could also help stem the region’s brain drain and alleviate a teaching shortage that has forced the school to hire a growing number of career changers, she added.
To Jennifer Lindon, the president of Hazard Community and Technical College, “it all boils down to equity.”
“If we can provide a [four-year] education, and make it affordable, perhaps we can break the cycle of poverty in Southeast Kentucky,” she said.
Converting Hazard’s two-year college into a four-year institution wasn’t among the options initially considered by the Kentucky General Assembly. When lawmakers asked the state’s Council on Postsecondary Education to study the feasibility of bringing four-year degrees to Southeast Kentucky, it offered three approaches: building a new public university; creating a satellite campus of an existing comprehensive university; or acquiring a private college to convert into a public one.
But the council concluded in its report that each of those alternatives was “in some way problematic.” A new university would be prohibitively expensive and might fail; a new branch campus could suffer the same enrollment challenges as existing satellites; and acquiring a private college would be legally complicated.
The council considered the possibility of allowing the community college to offer baccalaureate degrees — something a growing number of states permit — but worried that doing so would lead to “mission creep” and “intense competition” for the state’s dwindling number of high school graduates.
Instead, the council recommended that the legislature study the idea of making Hazard’s community college a standalone institution offering both technical degrees and a few bachelor’s programs “in line with workforce demand.” Starting small, the council suggested, would allow policymakers and college leaders to gauge student demand before building out baccalaureate offerings.
That approach makes sense to Sen. Robert Stivers, the president of the Kentucky Senate, and the sponsor of the bill that commissioned the council’s study.
“I don’t think you can just jump off the cliff into the lake,” he said. “You need to be a little more measured.”
But Andrew Koricich, executive director of the Alliance for Research on Regional Colleges at Appalachian State University, said the region’s residents deserve a comprehensive college. He likened the limited offerings envisioned by the council to former President George W. Bush’s “soft bigotry of low expectations.”
“There’s this idea that rural people should be happy they have anything,” he said.
Koricich pointed to the recent merger of Martin Methodist University, a private religious college, with the University of Tennessee system as proof that the legal hurdles to acquiring a private college aren’t insurmountable.
But Thompson, the CPE president, said that the private colleges in southeast Kentucky are located too far from most residents and the schools weren’t interested in being acquired, anyway. He argued that while a comprehensive university might be “ideal,” it wasn’t realistic.
“In an ideal world, I’d be young again with a great back,” he said. “But in reality, I work with what I’ve got. And that’s what we’re doing here.”
When Stivers was growing up in southeastern Kentucky in the 60’s and 70’s, coal was king. A high school graduate could get a job paying $15 an hour — good money at the time — without ever setting foot in a college classroom, he said.
With mining jobs so abundant, “there wasn’t a value placed on education,” Stivers recalled.
Coal production peaked in eastern Kentucky in 1990, and has been on the decline ever since. Today, there are just over 400 individuals employed in coal jobs in Perry County.
The shrinking of the sector has had ripple effects across Appalachia, hurting industries that support mining and local businesses that cater to its workers. Many residents have migrated to urban centers, seeking work, and once-thriving downtowns have been hollowed out.
By the middle of the last decade, most of the buildings in downtown Hazard were either empty or occupied by attorneys and banks. The only place to gather was a hole-in-the-wall bar called the Broken Spoke Lounge, recalled Luke Glaser, a city commissioner and assistant principal at Hazard High School. When the Grand Hotel burned down, in 2015, a sense of resignation settled in, Glaser said.
The region has also been hard hit by opioids, which were aggressively marketed to rural doctors treating miners for injuries and black lung disease. In 2017, Perry County had the highest opioid abuse hospitalization rate in the nation.
Then, in 2021, and again in 2022, the region suffered severe flooding, which washed away homes and took the lives of almost 50 residents of Southeast Kentucky.
Yet Hazard is also in the midst of what Glaser calls an “Appalachian Renaissance,” a revival being led by 20- and 30-somethings who have come home or moved to the area in recent years. Though Appalachian Kentucky lost 2.2 percent of its population between 2010 and 2019, Hazard grew by 13 percent.
A decade ago, a group of long-time residents and young people began meeting with a mission to revitalize Hazard’s main street. The group, which called itself InVision Hazard, hired a downtown coordinator and brought free Wi-Fi and improved signage to the downtown area.
Over the past four-and-a-half years, close to 70 new businesses have opened within a three-mile radius of downtown, and only eight have closed, according to Betsy Clemons, executive director of the Hazard Perry County Chamber of Commerce. There’s an independent bookstore, an arts alliance that will put on seven full-length productions this year, and a toy store — all run by residents who grew up in Hazard and returned as adults.
The Grand Hotel, which stood as a burned-out shell for years, has finally been torn down, making way for an outdoor entertainment park with space for food trucks and a portable stage, and plans for live entertainment on Friday nights.
As the downtown has transformed, collective feelings of apathy and resignation have given way to a new sense of possibility, Glaser said. Brightly colored murals reading “We Can Do This,” and “Together” adorn the sides of two downtown buildings.
To Mandi Sheffel, the owner of Read Spotted Newt bookstore, the creation of a four-year college feels like a logical next step for a place that was recently dubbed “a hip destination for young people” (a description that both delights and amuses people here).
“In every college town I’ve been to, there’s a vibe, a pride in the community,” she said.
These days, Hazard is feeling that pride, too.
On the vocational campus of Hazard Community and Technical College in February, Jordan Joseph and Austin Cox, recent high school grads, stood alongside a tractor trailer truck, pointing out its parts. In as little as four weeks, they could become commercially licensed truck drivers, a career that pays close to $2,000 a week.
Both men followed dads and grandads into the profession and said they couldn’t imagine sitting in a classroom for four years after high school. Like the sign on the side of the truck they were working on said, they want to “Get in, Get Out, and Get to Work.”
Inside one of the campus’ labs, a pair of aspiring electricians said they doubted many local residents would be able to afford a four-year degree.
“I don’t think you’d get a lot of people,” said Walker Isaacs, one of the students.
Their skepticism underscores a key risk in creating a four-year college in a place that’s never had one: There’s no guarantee students will enroll. Larger forces — including a looming decline in the number of high school graduates, an improved labor market, and public doubts about the value of higher education — could dampen demand for four-year degrees, forcing the college to either cut costs or seek state funding to cover its losses.
Recognizing this risk -and the possibility that employers won’t show up, either – the Council declined to give an “unqualified endorsement” of the idea of turning the community college into a four-year institution, saying further study was needed. In February, Sen. Stivers introduced a bill that calls on the council to survey potential students and employers about the idea and to provide more detailed estimates of its potential costs and revenues.
Converting the college could also cause enrollment to fall at the state’s existing public and private four-years. Eastern Kentucky University, the hardest hit, could lose as many as 250 students in the seventh year after conversion, the council estimated in its report. While the council did not examine the possible effect on private colleges in the region, the president of Union College, Marcia Hawkins, said in a statement that, “Depending on the majors added, such a move could certainly impact enrollment at our southern and eastern Kentucky institutions.”
But on the main campus of Hazard Community and Technical College, there’s growing excitement about the prospect of the two-year college becoming a four-year.
Ashley Smith, who is studying to become a registered nurse, said the proposed conversion would make it easier for her to earn the bachelor’s degree she’s always wanted. With three kids at home, she can’t manage an hours-long commute to and from class.
Another nursing student, Lakyn Bolen, said she’d be more likely to continue her education if she could do so from home. She left Hazard once to finish a four-year degree, and is reluctant to do so again.
“It’s not fun going away,” Bolen said. “We definitely need more nursing opportunities here.”
Dylon Baker, assistant vice president of workforce initiatives for Appalachian Regional Healthcare, agrees. His nonprofit, which operates 14 hospitals in Kentucky and West Virginia, has struggled with staffing shortages and spent millions on contract workers. The shortages have forced the system to shutter some beds, reducing access to care in a region with high rates of diabetes, cancer and heart disease.
“We are taking care of the sickest of the sickest,” Baker said. “We have to give them access to quality healthcare.”
Hazard’s community college already offers some higher-level degrees, such as nursing, through partnerships with four-year public and private colleges in Kentucky. But most of the programs are online-only, and many students prefer in-person learning, said Deronda Mobelini, chief student affairs officer. Others lack access to broadband internet or can’t afford it.
If the conversion goes through, the college will continue to offer online baccalaureates and a wide range of certificates and associate degrees, said Lindon, the HCTC president. She envisions a system of “differential tuition” where students seeking four-year degrees would pay less during the first two years of their programs.
Though the college would still cater to commuters, a residence hall would attract students from a wider area and alleviate a housing shortage made more acute by the recent floods, Lindon said.
Ultimately, the future of the institution will rest with the Kentucky legislature, which must decide if it wants to spend some of its continuing budget surplus on bringing four-year degrees to an underserved corner of the state.
But Lindon is already imagining the possibilities, and the Appalachian culture course that she’d make mandatory for students seeking bachelor’s degrees.
“For too long, we’ve been taught to hide or even be ashamed of where we’re from,” she said. “We want to teach young people to be proud of our Appalachian heritage.”
Kelly Field wrote this article for The Hechinger Report.
Support for this reporting was provided by Lumina Foundation.
get more stories like this via email