Vol. 14 •Issue 21 • Page 28
Shortage of Experienced Registrars Continues
A boom in the numbers and types of clinical registries nationwide is creating a huge demand for experienced, certified registrars—a demand the industry is struggling to meet.
Classified by the Bureau of Labor Statistics (BLS) as “medical records and health information technicians,” clinical registrars are part of the occupational group that is expected to grow much faster than average for all occupations through 2010. In fact, the BLS projects that 97,000 new registrars, medical records technicians and health information technicians are needed over the next decade to fill new jobs and replace workers who leave the field. However, only about 2,000 join the profession each year–about one-third of what’s needed. As a result, the industry will experience a shortfall of at least 4,000 qualified new practitioners per year.
Supply vs. Demand
The root cause of the critical shortage of clinical registrars is basic economics: the demand for qualified registrars grows exponentially with the numbers and types of clinical registries, which today include cancer, trauma, birth defect and cardiac. However, the current supply is not sufficient to meet the existing demand, much less future needs.
Each registry is dealing with its own unique challenges when it comes to maintaining appropriate staffing levels. They are challenges that, if not met, could ultimately impact the amount and quality of data that is collected, particularly in light of the rapid growth in data to be tracked and the number of state requiring reporting.
For example, the National Cancer Registrars Association (NCRA) reports that there are 3,959 cancer registries in the United States, including 1,438 American College of Surgeon (ACOS) approved programs and between 2,041 and 2,455 oncology programs that are not ACOS approved, as well as 53 state/territorial-based central registries. Currently, there are only about 3,400 credentialed cancer registrars—a number that grows by only about 300 a year.
So critical is the shortage of cancer registrars that in October 2003, the NCRA published its Rationale for a Cancer Registrar Workforce Study, in which it stated: “Without an adequate number of well-trained cancer registrars, accurate, dependable and timely cancer research and statistics reporting will be compromised. To best prepare for the future, before the quality of cancer research and statistics are adversely affected, a formal evaluation of the labor trends of the cancer registry field needs to be conducted.”
Trauma registries, which are used primarily to monitor and evaluate trauma care at the hospital, regional and state level, are also struggling to keep up with staffing demands as the number of states with registries grows rapidly. According to the U.S. Department of Health and Human Services (HHS), there are currently 37 states that maintain a trauma registry that includes information on patients treated within designated trauma centers, up from 18 states in 1993. Of those, 15 states mandate that patient data be entered for trauma patients treated at non-designated centers, further adding to the demand for experienced trauma registrars.
Each Level I trauma center is required to have at least one registrar, with most larger centers requiring more than one. The American College of Surgeons suggests one full-time registrar for every 500-1,000 patients admitted annually. However, information as of January 2004 indicates that there are just 1,013 trauma registrars to staff the 1,219 hospitals listed as trauma centers. Adding to the demand is a growing number of facilities seeking to become trauma centers, which carries the requirement of having trauma registrars on staff.
According to Michelle D. Pomphrey, MLT(ASCP), RN, CSTR, trauma register course coordinator with the American Trauma Society (ATS), HRSA has focused its grant money for the past three years on the development of trauma systems. Now, they are shifting that focus to the data itself, including who collects it and the quality. That attention, said Pomphrey, will hopefully attract new professionals into the field and slow the turnover rate that is depleting the ranks.
“There is a large turnover rate for trauma registrars and I personally feel that it is because of a lack of understanding of their role,” she said. “Many people are held responsible for this vast project, and are rewarded with minimal pay and long hours.”
Another growing area is that of birth defect registries, which provide researchers with basic information about the rates of birth defects and help identify trends nationwide. Established in 1996 by the Centers for Disease Control and Prevention (CDC), the Centers for Birth Defects Research and Prevention today has centers in seven states, while all but nine states have formal monitoring programs and registries. The military also has its own registry to track the health of military infants.
Speeding the growth in the number of birth defects registries—and further adding to the demand for qualified registrars—was the 1998 adoption of the Birth Defects Prevention Act, which called for a national study on the incidence of birth defects. Also, the Trust for America’s Health (TFAH) has called on the CDC to fund birth defect programs in every state and, in collaboration with the National Institute of Environmental Health Sciences and the Environmental Protection Agency, fund up to 10 state pilot studies that examine the links between the environment and birth defects.
According to TFAH’s report, Birth Defects Tracking and Prevention One Year Later: One Step Forward. Two Steps Back, more than 600,000 births in 2000 were not covered by an operational registry, while almost 300,000 births occurred in states with no registry at all—statistics they believe justify their call for more funding for the establishment of additional registries.
Shortage Equals Opportunity
For experienced registrars in particular, the worsening shortage combined with growing demand means there are now more career options than ever in the registry field.
According to the NCRA workforce study, the increased demand for current comprehensive cancer data and changes within the industry itself have expanded employment opportunities for cancer registrars to every level of the cancer surveillance community including: regulatory agencies, accrediting organizations, researchers, pharmaceutical firms, software vendors and contract services providers.
“With the shortage of experienced cancer registrars and the increase in the number of facilities nationwide required to report cancer data, a wave of independent contractors and consulting companies have appeared in the market,” according to the report. “Many of these contractors or consultants provide ser-vices from abstracting data to total outsourcing of the cancer registry department.”
Expanded opportunities are not limited just to cancer registrars, particularly in terms of outsourcing opportunities. As with cancer registries, many birth defect and trauma registries are finding it necessary to outsource some or all of their services. That means that experienced registrars with good abstracting skills can maintain a full-time job and earn extra income through an outsourcing firm by working on short- or long-term assignments on the weekends or evenings, or even use vacation time to travel for temporary positions. For those who prefer full-time consulting, time can be divided between several facilities, so consultants can pull in a respectable income while working at their discretion.
For those interested in entering the registrar profession and those with limited experience, opportunities exist, but are typically harder to come by. Because so many registries are now required to employ only certified registrars—New York and New Jersey, for example, require certification for cancer registrars, while the ACOS has mandated that every registry be run by a certified registrar—many are finding it necessary to pursue formal training rather than learning on the job, as was possible in the past.
Those entering the occupation from positions in medical records and health information management (HIM) are best suited for on-the-job training. Their related work experience and degree in HIM better prepares them to pick up the highly specialized knowledge required for work as registrars. Others, however, require formal education.
For cancer registrars, formal education comes in the form of a two-year college program specifically designed for cancer registry and to prepare them for the requirements of the certified tumor registrar (CTR) credential. For more information on schools, seminars and online education, visit the NRCA Web site at www.ncra-usa.org.
For trauma registrars, the ATS offers basic and advanced courses, as well as a certification examination to earn certification specialists trauma registry (CSTR) status. More information on trauma registry education and programs can be found on the ATS Web site at www.amtrauma.org.
In summary, clinical registrars play a vital role in the health care industry. It’s a challenging, rewarding career that, thanks to the expansion of registries, offers variety and opportunities for those with the right mix of skills.
Sam Nagel is group vice president, HIM/Medical Records and Special Services for Kforce HealthCare, a division of Kforce® Inc. that provides contract and direct hire staffing services for HIM departments and consulting services, including onsite and/or offsite delivery of coding specialists, APC and DRG audits, HIM directors, transcriptionists, certified tumor and trauma registrars and other outsourced personnel.