The health care safety-net system, a patchwork of programs and providers that serve Californians with low incomes, faces unique challenges in recruiting and maintaining its clinical staff due to workforce shortages and inequitable distribution of health care providers across California. To address these shortages, many health care systems serving patients living on low incomes turn to the temporary workforce to fill their needs. Staffing agencies play an important role in supporting these health care organizations with recruitment, given that many have few resources to maintain a temporary provider pool or a sizeable human resources (HR) department. In recent years, technology-enabled staffing services have emerged and addressed some limitations of traditional staffing agencies, including limited transparency and high cost. This paper reviews the barriers to hiring providers in this specific sector of the health care system, the role of the temporary workforce, and the emergence of technology-enabled staffing companies as a potential alternative to traditional staffing agencies. This landscape analysis is intended to inform investors and entrepreneurs invested in or working on these issues to help them understand the unmet needs and opportunities ripe for tech-enabled innovation. It is also intended to help provider organizations encountering these challenges to understand the emerging class of technology solutions that may meet their needs. To understand the recruiting and HR needs of safety-net organizations, the authors conducted a literature review, interviewed five leaders of technology-enabled staffing companies, and talked with HR executives from 13 safety-net organizations. Among the HR executives, seven were hospital leaders (either county hospitals or private nonprofits) and six were executives at multisite clinics. Six of the organizations are located in the Central Valley, five in Southern California, and two in Northern California. While this sample size is small, the organizations represent a range of size and location (geographic, and rural vs. urban), as well as varying degrees of temporary workforce needs, and thus provide information likely applicable to the workforce recruitment practices and experiences of similar organizations throughout California. The data for this paper were collected before the COVID-19 pandemic. The impact of the pandemic appears to have increased the need for temporary workers. Although there are limited data, initial reports and interviews conducted for this paper indicate that the use of temporary workers has increased. One recent study of traveling nurses found that at the height of the pandemic, job postings for temporary nurse positions had tripled and increased faster in places facing extreme pandemic conditions. While it is still early to predict lasting changes, the COVID-19 pandemic highlighted the continued importance of the temporary workforce in the delivery of health care.
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