It will surprise precisely no one that there's been a steady and significant growth in the size of hospital IT departments in recent years. HIMSS Analytics data shows that staff sizes have grown considerably, from an average of 24 full-time equivalents in 2008, to 35 FTEs in 2012.

That, of course, is "primarily driven by the fact that we have so many more systems being deployed," says HIMSS Analytics Executive Vice President John Hoyt.
"There's another issue to which we do not have a definitive answer," he adds. "How much of that growth is driven by the fact that CIOs are picking up some other responsibilities, such as bioengineering or telecommunications?"

Even if those newfangled duties are accounting for some of the uptick, there's no question that the majority of the most pressing IT needs for hospitals have to do with implementing and running clinical and financial systems – and helping their facilities wrangle with pressing federal mandates such as meaningful use and ICD-10.

And make no mistake: Even as staff sizes have grown, the workload has grown even faster. But even if hospitals have the will and the wherewithal to hire more help, the competition is fierce for quality talent.

There are many reasons for that, says JoAnn Klinedinst, vice president of professional development at HIMSS. One barrier is a hospital-specific twist on the old Catch-22 for young people trying to break into the workforce: "I can't get a job because I don't have Epic experience, and I can't get Epic experience until I get a job."

Another challenge, even for whip-smart IT pros who might be tempted toward the booming healthcare industries from other corners of the economy? "Coming in from other industries, there's a language barrier," says Klinedinst. "I'm not talking English, French or Portuguese; it's understanding the language of a healthcare setting. That certainly takes time as well."

Klinedinst offers some advice for those looking to break in that might be surprising to some. "If you can, volunteer, first and foremost.," she says. "If you're not in a degree program, look for internships.

At the least, "Be willing to take a lower level job," she says. "If you're a project manager with 15 years experience in financial systems, if you want to work in health IT you might need to take $15,000 to $20,000 pay cut to get in. Or you might get lucky and get hired into the financial services department to help ramp up their revenue cycle efforts."

Conversely, those already in the clinical realm, with laser-sharp IT smarts, can expect to command a hefty payday. Hospitals are desperate to attract top talent, and they're not averse to throwing lots of money at qualified candidates.

"A director of applications development making $190,000 in a small community hospital?" says Klinedinst. "It's like, 'Holy cow.'"

Even so, says Hoyt, hospitals "are doing as best they can for money but honestly they cannot compete with the staff augmentation firms" – so-called "body shops" – "because those are the people that do sign-on bonuses and steal away the certified employees from the providers – and then you end up buying back the employee who used to work here last week at a higher rate."

Unfortunately, says HIMSS Analytics Senior Director of Research Jennifer Horowitz, many hospitals are becoming "places where IT folks are getting experience and then getting lured away to other places that can pay them more money."

And that's having a tangible adverse effect on many important hospital initiatives at a pivotal time for the healthcare industry.

Projects are getting delayed, says Horowitz. "I was just talking to someone at a health system and they were talking about having to look at the projects they were doing over the next year and having to prioritize them, based on the resources they have available. Organizations are, to some extent, having to pick and choose what they're doing."

The problem is especially acute for those small facilities "who don't even have the luxury of having an IT department," she says. "They're having to find other ways of accomplishing these things."

To put it mildly, that's not an optimal state of affairs for an industry in such flux as healthcare, with such big and transformational goals. In a very real way, says Klinedinst, these staffing problems are threatening to put the brakes on health IT's forward momentum.

"You have hospital boards applying pressure to CIOs to transform care, and yet the CIO doesn't have the talent to do it," she says. "So then what do you do? Spend lots and lots of money brining the consulting firms in and hope that the expertise and knowledge gets transitioned to the existing staff. Or you delay. Or you move ahead with substandard staff that don't have the skills and/or the resources to do a proper job."

"We for years thought the top barrier to IT implementation was financial considerations," says Horowitz. "Two years ago, for the first time, I saw IT staffing for the first time edging out financial considerations – the fact that folks couldn't get enough IT staff."

To compensate for these shortcomings, hospitals are getting creative with their personnel, says Klinedinst.

"One of the things you're beginning to see is a shifting within organizations," she says. "You have the clinician moving from the bedside into IT to fill that informatics role. So you have a shift internally, and then you have a shift externally, from organization to organization. It's almost a cannibalization of talent – robbing Peter to pay Paul."

Moving forward, it may be that "hiring managers are going to have to relax their standards," she adds. "They're going to have to be willing to train people. A candidate might have some of the qualities but not all."

Barring that, "the easiest fix is to hire from within the organization," says Klinedinst. "Those are the people that know the culture and know the language of patient care."

The good news is that, even it you "can't train an IT person to be clinical," says Hoyt, "you can train a clinical person to be IT. Our idea is to get the clinical people away from doing patient care into IT. They have to have an interest in it. They have to have an aptitude, and there are times where you might not pay them as much as they used to make – just a little less. But you know what the appeal is? You don't have to work nights and weekends, and you're not on call at Christmas."

"I think it's critical that work-life balance is alive and well in the healthcare setting, and that these folks are treated with appropriate benefits and incentives and rewards, so they remain where they are and these organization can benefit from their expertise," says Klinedinst. "Because when that experience walks out the door, you've gotta start over."

[See also: Staff scarcities have healthcare CIOs strapped]