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Sunday, May 3, 2009

Nursing agency thinks globally

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David Bartholomew has spent two decades in the staffing business, cutting his teeth with a company that placed temporary workers in jobs ranging from warehouse worker to computer programmer.
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Earlier this year, Bartholomew relinquished his chief executive role with Staffmark, the temporary staffing agency that he helped get off the ground nearly 20 years ago, after it merged with CBS/Venturi.

Now, Bartholomew has landed as president at HCCA International, a Nashville-based medical staffing agency that recruits nurses and other health-care professionals internationally and places them at U.S. hospitals.

He comes to the company at a time when U.S. policy has sharply curtailed HCCA's ability to bring in foreign nurses on green cards as temporary workers. That has reduced HCCA International's revenue and sent the company scrambling to lobby for changes in Washington. Bartholomew discussed his background in staffing and his company's evolving business strategy with Tennessean Business Editor Randy McClain.

What's the biggest issue you face as you take over as president of HCCA International?

Retrogression is a term the U.S. government uses to describe when more people apply in a certain category for a visa to enter the country than there are visas available. And that's starting to affect the international recruitment of nurses. We have a backlog of nurses for whom we have jobs, but they can't get into the country.

All the nurses who want to work in the United States can't get into the country even though we have a shortage of nurses here. By any estimate, we have a shortage somewhere between 300,000 to 400,000 nurses nationwide. By 2020, estimates are that the United States will have a shortage of more than 1 million nurses.

President Barack Obama recently called for more training of U.S. nurses at colleges to plug the nursing shortage. Does his stance suggest it will remain difficult to get enough entry permits for foreign nurses to come to this country, even if you have jobs for them?
(2 of 4)

We need more nursing students going through our nursing schools. That's a fact. But our nursing schools can't spit out (graduates) fast enough to fill the needs. I agree with let's grow them at home. We have to do that. But I also think you can complement that (effort) with a small percentage of international nurses that meet proper standards.
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This is a 10- or 15-year issue. Recruiting international nurses can play a role along with producing more U.S. graduates. Primarily, we bring in people from the Philippines and India. The Philippines graduates about 160,000 nurses a year in a country that probably needs no more than
20 percent of that total. They are being trained, and they want to go elsewhere to earn a living. They're going to Canada, the United Kingdom, the Middle East and a lot of places. They're motivated.

What's your client base? Is it exclusively major hospital chains or do you deal with smaller medical facilities as well?

Most of the places that we have nurses are more the border states, Washington, Oregon, California, Arizona, Texas, Florida, the Carolinas — and in Tennessee we have clients because this is our home base.

It really depends on the market. You might have a large academic institution that has such big needs that they've gone to an international recruitment strategy or it might be a smaller hospital that's in a market where they can't find enough nurses.

We're now also starting to bring in physical therapists, occupational therapists and some of these other allied services. You know, it's funny. People assume there are a lot of international nurses working in this country, but the international nurse population in the U.S. is less than 4 percent. Most of them come on 30-month agreements.

Describe your earliest involvement with HCCA. Were you an investor in the company long before you took on a management role?

I got started in the staffing business in 1990 and had a company called HRA Inc., which was based in Middle Tennessee and provided temporary employees to all sorts of companies. It grew from a single branch in 1990 to about 19 branches by 1996. That's when we decided to take the company public.
(3 of 4)

I asked (entrepreneur) Clayton McWhorter to go on our board at that time because I wanted another Nashvillian there. He's a smart man and a mentor. He had just started an investment fund, Clayton and Associates, and I invested in it. That fund became one of the original investors in HCCA.
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Was your original staffing company involved in health care or did it focus mostly on other industries?

It was across the board. It did everything from a warehouse worker to a computer programmer, and it had a ton of health-care clients, but we didn't provide clinical personnel for them. We'd supply office workers.

Looking back, today, I wonder why we didn't get into health-care staffing in a bigger way, but our other businesses were growing so fast. HRA went public in 1996 and by that time we had 100 offices. By the year 2000, we had expanded to 300 offices.

When I first got in the staffing business in 1990, you had to almost sell the concept to someone. It wasn't standard practice to have a temporary associate in the office. By the late 1990s, though, almost everybody had used or wanted to use some form of contingent worker. The industry was growing and that put us in a good place. In 1996, we changed our name from HRA Inc. to Staffmark.

Our strategy was really community driven. It was all about local relationships. We stressed for our staff to get involved locally. If people know you in a community, they want to do business with you.

How did your recent switch to become president of HCCA International come about?

Last January, we made the decision to merge Staffmark with CBS/Venturi, another national staffing firm. Staffmark had become a privately owned company. CBS/Venturi was private as well. We could see the economy was about to slow down; we were about $700 million in annual revenues; CBS/Venturi was a little bit smaller. It just made sense to put the two companies together. I'm still active with the company. I'm on their board and I have an ownership stake. But I gave up the day-to-day involvement.
(4 of 4)

Did you seek out HCCA at that point or did they find you?
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A little bit of both. I had chaired the American Staffing Association in 2005-2006, and because of that I was involved with the industry as a whole and with a lot of health- care staffing companies.

When we made the Staffmark change, I didn't really want to get out of the business completely. But I also didn't want to compete with my old company. I had spent more than a decade building it. So, switching to health-care staffing made a lot of sense. Staffmark doesn't have a problem with it because they don't really compete in that area.

HCCA is an international nurse recruiting business. They wanted someone who could come up with a domestic strategy for them, something to complement their international business. We started talking a little bit, and me coming on board made a lot of sense. The fact that HCCA is in Nashville is a plus, too; most of the people I need to know are here.

What are some advantages of temporary staffing to the business owner?

From an employer's standpoint, if you're outsourcing, you know exactly what it's going to cost you. You don't have to worry about workers' compensation or other issues. If a situation arises with a contingent worker, it's not your issue — it's the staffing agency's issue.

The niche and the level of sophistication in the industry have changed a lot. Some of the best call center operators, for instance, come from a temporary firm. The other thing, too, is that workers don't stay on board forever with a company anymore.

A temporary work force makes it easier to downsize when necessary. If a company isn't making its numbers, they cut back on the work force, and that's easier to do if a portion of it is temporary (employees). You haven't invested 10 or 15 years in training that employee, and then you have to let them go. The pains of laying off aren't so great.

As the economy has slowed down over the past year, how has it affected the temporary staffing business?

When the economy slows down a little bit, our business does pretty well. Companies typically turn to a contingent work force to get the job done. But this economic downturn is worse. We went past the slowdown … to a point where it has affected everyone. But when the U.S. temporary work force starts to grow again, it will be a sign that we're starting to come out of this thing.

We need more nursing students going through our nursing schools. That's a fact. But our nursing schools can't spit out (graduates) fast enough to fill the needs. I agree with let's grow them at home. We have to do that. But I also think you can complement that (effort) with a small percentage of international nurses that meet proper standards.
Advertisement

This is a 10- or 15-year issue. Recruiting international nurses can play a role along with producing more U.S. graduates. Primarily, we bring in people from the Philippines and India. The Philippines graduates about 160,000 nurses a year in a country that probably needs no more than
20 percent of that total. They are being trained, and they want to go elsewhere to earn a living. They're going to Canada, the United Kingdom, the Middle East and a lot of places. They're motivated.

What's your client base? Is it exclusively major hospital chains or do you deal with smaller medical facilities as well?

Most of the places that we have nurses are more the border states, Washington, Oregon, California, Arizona, Texas, Florida, the Carolinas — and in Tennessee we have clients because this is our home base.

It really depends on the market. You might have a large academic institution that has such big needs that they've gone to an international recruitment strategy or it might be a smaller hospital that's in a market where they can't find enough nurses.

We're now also starting to bring in physical therapists, occupational therapists and some of these other allied services. You know, it's funny. People assume there are a lot of international nurses working in this country, but the international nurse population in the U.S. is less than 4 percent. Most of them come on 30-month agreements.

Describe your earliest involvement with HCCA. Were you an investor in the company long before you took on a management role?

I got started in the staffing business in 1990 and had a company called HRA Inc., which was based in Middle Tennessee and provided temporary employees to all sorts of companies. It grew from a single branch in 1990 to about 19 branches by 1996. That's when we decided to take the company public.

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