What healthcare systems need to know before they strike out on their own.
A Three-Part Series (Part THREE)
Healthcare systems are rethinking traditional staffing approaches, now turning towards in-house solutions. The increasing need to reduce costs and the demand for flexibility and autonomy in the workplace have prompted organizations to take recruitment into their own hands. "The move toward internal staffing is a significant step that allows healthcare providers to meet the modern clinician's expectations for flexibility,” says Robert Crowe, EVP, Per Diem and Local Workforce Strategies at Medical Solutions and founder of Matchwell. As internal agencies become more attractive, he advises a thoughtful approach incorporating due diligence and a ‘less is more’ strategy.
In this series' third and final installment, Crowe unpacks the compelling advantages and inherent challenges of internal agencies, underscoring the undeniable rise of workplace flexibility as a driving force in the industry's future.
Q: To start, what exactly is an internal agency?
Robert Crowe: An internal agency is a healthcare system's approach to recruit and retain staff directly, bypassing external agencies. This includes not only rebranding internal float pools but also establishing internal travel programs that strategically move full-time hires between departments or even different buildings for longer-term assignments. Occasionally, healthcare systems invest heavily in their own staffing company.
Q: Why are internal agencies becoming increasingly popular among healthcare organizations?
Crowe: They were first introduced 15 years ago but fell out of favor as healthcare systems realized how much investment it takes to build and sustain one of these internal programs. Now, organizations are crunching the numbers and want to redirect the money spent on travelers to internal programs. More than that, healthcare organizations realize they must have a defined flex work program to attract and retain employees today. Almost every healthcare worker now expects more flexibility and better work-life harmony from just a few years ago due to the growing gig economy and the influences of our modern lifestyle.
Q: What are the benefits and potential drawbacks of incorporating an internal agency?
Crowe: The advantages of offering defined, flexible work programs are significant. Such programs allow us to make it easy for every clinician we touch to work for us, which is critical given the current clinician shortage. When a clinician wants to work for us, we don't have the luxury to say no. Instead, we must ask, ‘How do you want to work for us?’ Whether they want a single shift a week or to work six weeks and then take a month off, we must accommodate them.
However, running an agency has its challenges. It’s a complex and risky operation that requires a dedicated team, a proper budget, and advanced technology. Organizations need to collaborate closely with their legal counsel and HR to stand up and manage various employment categories effectively, particularly when it comes to employees transitioning between different types of work, such as from shift work to a full-time position and back to contract work. Determining who is eligible for benefits, how to compensate flex workers relative to full-time employees, and how to comply with regulations like the Affordable Care Act when flex workers’ hours exceed the benefit eligibility threshold are critical considerations.
Q: What are the key steps to establishing an internal agency in your organization?
Crowe: Most organizations are still in reactionary mode and seeking immediate coverage. Rather than starting with a catchall program, conducting due diligence and defining the specific staffing challenge you face is crucial. For example, losing full-time employees due to a lack of flexible options is a good reason to start a program. Alternatively, an internal program may be ideal if you want to share staff between buildings near one another. Yet, if your goal is to create a per diem float pool for filling last-minute shifts, you'll require a different solution.
You will also need robust technology to onboard and organize staff, post job openings, confirm assignments, handle credentials, and oversee timekeeping. Some scenarios may call for appointing a separate employer of record to avoid adding everyone to your full-time payroll. The landscape has improved significantly from 15 years ago; now, organizations like Matchwell specialize in aiding healthcare systems to develop internal agencies, simplifying what was once a daunting process.
Q: What are your takeaway recommendations for any organization considering starting an internal agency?
Crowe: Embrace flexibility now and consider how these programs might fit into your strategy. As clinicians seek more flexible work options, insisting on only full-time positions means missing out on many who could contribute to your team.
Think of every clinician within a 50-mile radius as part of your potential workforce. Make it straightforward for them to join you, whatever their requirements. The sooner you can offer defined pathways to get them working in your buildings and treating your patients, the better off you will be. Start by addressing your most immediate staffing need and expand later as needed. Be wary of solutions that are too narrow in scope. Remember, most existing technologies were developed with only full-time employees in mind, not a workforce looking for flexibility.
Crowe stresses that the expectation for flexibility in healthcare will only increase. He advises that when searching for a partner to establish an internal agency, it’s crucial to ascertain if they truly understand the needs of the evolving clinical workforce. “The staffing industry has learned a lot by having its fingers on the pulse of what is happening in other industries and how they are embracing flexibility,” he says. “We understand the macro trends and have done everything healthcare systems are now trying to build internally.”