Patients at Cambridge Hospital can communicate with doctors inPortuguese through Isabel Pinto-Franco, work out billing problemswith help from Grace Da Silva, and access medical records though acomputer system being retooled by Dr. Hilary Worthen.
Pinto-Franco is a medical interpreter, Da Silva is a patient-relations manager, and Worthen is medical director of informationsystems - the physician who advises the hospital's computer gurus onwhich new systems will actually help doctors do their jobs.
All three jobs are relatively new to the world of health care,which is struggling to adapt to new technologies, the strains ofmanaged care, and the needs of an increasingly diverse, savvy, anddemanding patient population.
The changing medical landscape is creating new careers andtransforming old ones, even as the total number of health-care jobsdeclines. Despite the economic boom, 15,700 health-care jobs havedisappeared from Massachusetts since 1997, mainly because of Medicarecuts, according to a study, released in May, commissioned by theMassachusetts Hospital Association.
Even so, health care provided 13.3 percent of the state's jobs in1998, employing 420,000, according to the study by Standard andPoor's DRI. Employers are scrambling to find enough workers, both fortraditional jobs such as nurses, and newer ones such as medicalinterpreters, which are especially coveted since a new state lawrequiring emergency rooms to interpret for non-English speakers waspassed.
Every career in the medical field is going through dramaticchange, not all of it positive. Ask almost any doctor, nurse, oradministrator, and you will hear that medicine today is bothexhilarating and frustrating.
On one hand, technology makes it possible to do more for patientsthan ever before. On the other, managed care has brought health-careproviders more paperwork, less autonomy, longer days and tighterbudgets, and made it difficult to get cutting-edge care to everyone -contradictions that are reflected in career trends.
Tired of managed care and the constant merging and reorganizing oflocal hospitals and clinics, some physicians have been lured by new-economy opportunities. They have taken their expertise to computercompanies that design medical software; or to venture-capital firmsthat try to pick winning health-care startups.
Others remain at hospitals but step back from patient care inhopes of having a broader impact: Worthen gave up his privatepractice to help Cambridge Hospital network its neighborhood clinics,something he thinks will improve care for thousands of patients.
With most hospitals short-staffed, job openings for nurses arelegion. The reason, according to the Massachusetts NursesAssociation, is that salaries and job satisfaction have not kept pacewith demands on nurses to serve more patients in less time andshoulder more responsibilities. In addition, a nursing glut in the1980s prompted many nursing education programs to shut down, a movethat some now say was short-sighted. To offset the shortage, localcolleges and hospitals, including New England Baptist Hospital, areforming partnerships that pay for a student's nursing education inreturn for a commitment to work at the hospital for a set period oftime.
Like physicians, nurses are increasingly seeking work outsidedirect patient care, offering their services as expert medicalwitnesses or becoming lawyers with an expertise in health care.
Hospitals argue that nurses can find interesting new opportunitieswithout leaving. For example, at the Lahey Clinic's cosmetic surgerycenter, nurses can perform some kinds of laser surgery, says DeborahBurkholder, director of employment.
Even clerical and technical jobs are becoming more sophisticated,she says: "Medical secretaries need to know anatomy and medicalterminology, be PC savvy, work a spreadsheet . . . develop a slide-show presentation for their physician."
As a result, it's hard to find people skilled enough for the job.Massachusetts General Hospital currently has 83 unfilledadministrative clerical jobs, says Traci Knoblauch, human resourcesoperations manager.
The hospital also has scores of postitions paying $14 an hour andup for "technologists" - people who help operate the dizzying arrayof new equipment used in medicine, from three-dimensional CAT scansto anesthesia technology.
The wide variety of technical jobs require credentials rangingfrom a high school diploma to a two-year associate's degree and statecertification.
Hospitals also have growing need for Web designers, for their ownsites and for affiliated ventures such as WorldClinic at Lahey, whichprovides medical advice over the Internet.
The current job market has led hospitals to do much of theirhiring through their own Internet sites. "The Web is the No. 2 waywe fill all of our jobs," Knoblauch says. "It gets the person rightinto the full description. There's a shopping cart feature, so youcan apply for more than one job."
Pinto-Franco used a less high-tech method when she moved here fromPortugal six years ago. She happened upon Cambridge Hospital's"interpreter services" department by flipping through the phone book.
What began as a tiny operation in 1983 is now a $2 milliondepartment, with 100 freelance interpreters making $16 to $18 anhour, and six full-time positions that are hard to keep filled.Because it attracted non-English speakers from all over the region,it's credited with helping the hospital more than double itsoutpatient visits.
Pinto-Franco, 32, likes the job because it offers differentchallenges every day - such as the time she had to not only translatefor a partially deaf man, but evaluate his speech patterns to see ifhe had had a stroke. And she knows that without her, many of herclients would find communicating with a physician nearly impossible. "I like to be useful," she says.
The problem, said her boss, Loretta Saint-Louis, is that even if aperson is fluent in several languages, they cannot effectivelyinterpret without detailed knowledge of medical terminology. A newcourse in medical interpreting at Cambridge College should help withthat, she says.
But the relatively low salary may be another barrier to findingthe caliber of person she is looking for, i.e., "someone verybright, diplomatic, and personable."
Grace Da Silva, 24, originally from the Azores, speaks Portuguese,Spanish, and some French in addition to perfect English. A formerreceptionist, she was a low-cost way for the hospital to improvepatient relations. She now cruises the hospital, chatting withpatients and helping them work out administrative problems - or justvent gripes. "They love communicating," she says.
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