Shortage of nurses, docs hurts CR staff hiring, retention rates
Shortage of nurses, docs hurts CR staff hiring, retention rates
Salary is chief obstacle
Clinical research sites are continuing to struggle finding and retaining trained staff in an environment in which physicians, researchers, and nurses are in ever shorter supply.
The United States will need one million new nurses by 2016, and it appears that the nation's nursing schools will have difficulty keeping up with the demand, according to reports at 2008 meetings of the U.S. Senate committee on health, education, labor, and pensions.
Government and industry groups now project a physician shortfall in coming years. The Health Resources and Services Administration (HRSA) has projected that the nationwide supply of primary care physicians will be about 65,000 fewer than needed by 2020.1
It appears that both similar and separate marketplace trends may impact the supply of clinical trial researchers.
According to testimony at a U.S. Senate committee on health, education, labor, and pensions meeting in March, 2008, years of underfunding the National Institutes of Health (NIH) has made it far more difficult for young physicians and scientists to receive research grants. And this has had a compounding affect of discouraging a generation of researchers and, ultimately, leading to fewer treatments being tested in clinical trials.2
The research field also is struggling with having difficulty finding clinical trial staff to work with investigators.
Research directors continue to struggle to hire and retain clinical research associates who have the training and experience necessary to work for a clinical trial site, despite some recent increase in interest in these jobs, experts say.
"There has been a trend of people that want to get into the clinical trial field, and they truly don't have any experience," says Tamara Dowd Owen, RN, MSN, MBA, director of clinical trials at Pinehurst Medical Clinic in Pinehurst, NC. Owen is a member of the editorial board of Clinical Trials Administrator.
"We have had a big influx of nurses who are interested in going into research, but when you read their resumes you see that they really don't have any experience in trials," Owen adds. "It's increasingly difficult to find experienced staff."
For clinical trial jobs that are entry level and which traditionally have been good places for nurses and other health care professionals to make a transition to research, there appears to be the opposite trend of too little interest among health care professionals.
"These jobs aren't paying well enough to convince nurses to take those positions and stay in them," says Elizabeth E. Hill, PhD, RN, an associate chief of staff for research at the VA Sierra Nevada Health Care System in Reno, NV.
So as research sites try to grow their research programs, a chief obstacle emerges in how to find people who know what they're doing in clinical trials, she adds.
"There's no formal education for people who will manage clinical trials at the baseline," Hill says. "I think that's a real problem because you need more expertise at this level."
Two of the main reasons why there are increasing hiring problems are because the clinical trial jobs are becoming more complex due to increased regulations, and, secondly, the salaries are not on par with the expected workload, says Ramesh Gunawardena, MBA, director of clinical trial operations in the clinical trial office of Beth Israel Deaconess Medical Center in Boston, MA. Ramesh and Hill also are members of the editorial board of Clinical Trials Administrator. (See the CTA salary survey story, inserted in this issue.)
Clinical trial coordinators are expected to complete a lot of paperwork, and they have a huge burden to learn a lot of information in a short period of time, Gunawardena adds.
This is why there is such a great turnover of employees at clinical trial sites, he says.
"One of the reasons we've identified for the high turnover rate is because clinical trial work is identified as a transitional job," Gunawardena says. "It's not seen as a professional career path, unfortunately."
Another issue is matching an employee's educational level with the job and career track, Hill notes.
"I came here from an academic environment at a big university, and I was managing a master's program in clinical research," Hill says.
"I think there's a missing piece there," she explains. "If you have people educated at the master's level, then they're not people who want to be on the frontline managing a clinical trial; they'll want to manage their career and move up."
The problem is that the clinical research industry doesn't recognize the difference between these master's level professionals who have additional research education and people who move into the field in the more traditional way of shifting from clinical work to trying research work, Hill says.
"I have a former student who has a job at a big clinical research organization, and he says, 'I'm not using anything I learned; they start everyone at the same place, and then they move people up,'" Hill recalls. "He said he was bored because he wasn't doing what he was trained to do."
There soon might be either a solution or another contributor to the clinical trial site staffing shortage, depending on CR directors' preferences.
"One trend that I've seen is there seem to be contract services now, a new business sprouting up," Gunawardena says. "Two companies have called me to say they have a pool of study coordinators at different levels, and they could provide us with these coordinators for a certain fee."
It seems these new contracting companies are training staff themselves and creating a new career path for entry-level CR associates, he notes.
"That's a good reason why we're seeing less direct applications to us," Gunawardena adds.
Probably the best way CR directors can improve their staffing problems is by working harder to retain employees once they hire them, the experts say.
Retention is a huge issue, Owen says.
"Some people don't stay more than a couple of years at the job -- if that long," Owen says. "It might be because they came in here and decided research is too complex and harder than they thought."
Some nurses will try to treat the CR coordinator job as though they were continuing to work in a clinical setting, Owen adds.
So the million dollar question is how to attract the best and keep them.
"If you can get good people in, how do you get them to stay?" Owen says. "One thing we've discussed is trying to create some incentive within the department, such as a career ladder where staff could see some progression."
Reference
- Steinwald AB. Primary care professionals, recent supply trends, projections, and valuation of services. Testimony before the Committee on Health, Education, Labor, and Pensions, U.S. Senate. Feb. 12, 2008; GAO-08-472T.
- Faust DG. Why consecutive years of flat funding of the NIH is putting a generation of science at risk. Testimony before the Committee on Health, Education, Labor, and Pensions, U.S. Senate. March 11, 2008.
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