Recruitment: Making Our Efforts Count

by Jody Smith, PhD, RHIA, FAHIMA, and Ellen Jacobs, MEd, RHIA

Abstract

Over the last decade, enrollments in health information technology and health information administration programs have spiraled downward resulting in the closure of programs. Reversing this trend is imperative for the survival of the health information management profession.

This research study looked at:

1. how students learned about the HIM profession
2. what attracted students to the career
3. the most effective recruitment methods

Using data gathered from 754 students enrolled in either a coding, health information technology, or health information administration program revealed:

1. students learned about the profession through their employer, college counselors, a health information professional, health information management student, or family friend
2. a variety of career options attracted students to the career
3. the most effective recruitment method is posting flyers in healthcare organizations, colleges, and high schools. Research results support using a multifaceted approach to attract students into the program

Introduction

According to the Bureau of Labor Statistics, health information management (HIM) will be one of the fastest-growing health occupations through 2010.¹ AHIMA predicts a need for 6,000 new HIM professionals per year to meet workplace demands, yet only 2,000 new professionals graduate annually.² Work force research conducted by the Center for Health Workforce Studies reveals good job availability throughout the nation.³ These facts should have students clamoring to enter health information technology (HIT) and health information administration (HIA) educational programs, but this is not the case. A comparison of enrollments for 2001 and 2003 reveals only a small increase in the number of students enrolled, and the percentage of students graduating declined from 33 percent in 2001 to 27 percent in 2003 (see Appendix A). Such trends threaten the future of the health information profession.

This study was therefore conducted to identify characteristics of HIM programs and recruitment techniques that affect a prospective student’s decision to enroll in a health information program. Specifically, the study looked at:

1. how students enrolled in health information programs learned about the HIM profession
2. the attributes that attracted students to the career
3. the most effective recruitment methods

Explored are possible factors associated with recruitment, such as the type of program, enrollment status, program format, type of institution, previous degrees, possession of healthcare credentials or licenses, age range, and region of the nation in which students lived. This report is intended to assist health information professionals to more effectively recruit students into the profession.

Method

This descriptive study used a four-part questionnaire mailed to program directors of accredited master’s degree in HIM, bachelor’s degree in HIA, associate’s degree in HIT, and coding programs. Program directors distributed the questionnaire to students and mailed the completed questionnaires to the principal investigator in the envelope provided.

Population

A nationwide sample included health information and coding programs at public and private institutions, two- and four-year institutions, and independent study programs.

Instrument

The researchers developed a four-part questionnaire to collect information from students. Content review and a pilot study were used to validate the research instrument. Part I addressed recruiting students into HIM programs. Students were asked to:

1. identify how they learned about the HIM profession
2. select three items and indicate if the item was the most appealing, second most appealing, or third most appealing reason for selecting HIM as a career
3. identify which recruitment method was the most effective, which was the second most effective, and which was the third most effective

Part II of the survey asked students to rank their reasons for selecting the educational program in which they were enrolled. Part III requested demographic information, and Part IV was open ended, allowing participants an opportunity to provide additional information that might be useful in recruiting students to HIM programs.

Data Collection and Analysis

In March 2002, a letter was e-mailed to program directors asking their willingness to have students participate in the research study. Program directors agreeing to participate were asked to provide the number of students in the program, distribute and administer the survey to all students in their HIM programs, and return completed surveys to the researchers using the self-addressed, stamped envelope provided. Surveys were not to contain individual subject identifiers. Participants were asked to have surveys completed by April 12. A reminder letter was mailed 30 days later. Of a possible 5,026 students, 754 completed surveys were returned, a response rate of 15 percent. No responses were received from students pursuing a master’s degree in HIM.

Data were entered into the Statistical Package for the Social Sciences and analyzed through the use of percentages and frequencies. The exploratory nature of the study precluded sophisticated statistical techniques beyond the accuracy of the raw data; such techniques may misrepresent the exploratory nature of the investigation. Responses to the open-ended question were transcribed and analyzed to identify themes.

Results

Part III of the survey instrument collected demographic information for the purpose of grouping students for analysis in various ways. Demographic information included the type of program, enrollment status, program format, type of institution, previous degrees, credentials or licenses currently held, respondent age, and the region of the nation in which the respondent lived. The next several paragraphs will discuss each of the categories including the response rate to each.

Type of Program
Of the students responding, 204 were enrolled in a bachelor’s degree HIA program, 477 were enrolled in an associate’s degree HIT program, and 73 were enrolled in a coding program.

Students’ Enrollment Status
Sixty-three percent of the respondents were full-time students (12 credit hours per semester), and 34 percent were part-time students (fewer than 12 credit hours per semester).

Format of Program
Table 1 reveals that the majority of students attended classes during the day (85.0 percent). Classes taken via the Internet (9.5 percent) were more prevalent with HIT students than with HIA or coding students. Weekend classes (5.4 percent) were attended more by HIT students than HIA or coding students. One student indicated enrollment in a coding correspondence course (0.1 percent).

Table 1: Enrollment By Type of Classes

Type of Institution
Table 2 displays the type of institution attended by the respondents. Sixty-five percent of coding students and 69 percent of HIT students attended a community college. Sixty-one percent of HIA students attended a public college or university, compared to 38 percent attending a private college or university.

Table 2: Type of Institution Attending

Previous Degrees, Healthcare Credentials, or License
Twenty coding students (27 percent), 97 HIT students (20 percent), and 41 HIA students (20 percent) indicated possession of a previous degree. Healthcare credentials or licenses were held by 11 coding students (15 percent), 80 HIT students (17 percent), and 28 HIA students (14 percent).

Age Range
Table 3 provides the age breakdown of the respondents. A large percentage of the HIT and HIA students fell into the age range of 18 to 24 years. Further analysis of age by type of program revealed 46 percent of HIT students in the age range of 31 to 49 years, 15 percent in the age range of 25 to 30 years, and 11 percent over age 50. Ten percent of the HIA students were 25 to 30 years old, 17 percent were 31 to 49 years of age, and 4 percent were over 50. Forty-two of the coding students (58 percent) fell into the age range of 31 to 49 years, 10 students (14 percent) were 25 to 30 years old, and 13 students (18 percent) were over 50.

Table 3: Respondents By Age and Type of Program

Respondents by Region of Nation
Table 4 depicts the region of the nation in which the respondents lived. The pattern of participants in the survey coincided with the geographic distribution of accredited coding, HIT, and HIA programs in the United States. Forty-one percent of those responding lived in the north central region of the nation, 18 percent lived in the south central, 13 percent lived in the southwest, 11 percent lived in the southeast, 9 percent lived in the northeast, and 5 percent lived in the northwest.

Table 4: Respondents By Region of Nation By Type of Program

Part I of the survey addressed marketing of the HIM profession. This section includes the primary source for learning about the profession, the reason for selecting HIM the career field, and effective recruiting methods.

Primary Source of Learning About HIM
Question 1 asked students to indicate how they learned about the HIM profession. Analysis of results suggested that the primary source of information varied by type of program. Table 5 compares responses by type of program.

Table 5: Primary Sources of Learning About HIM By Type of Program

The primary source for learning about the HIM profession by coding students was their employer. HIT students indicated a health information professional to be the primary source, and HIA students selected two primary sources: college counselor and health information student. Looking at the respondents in the aggregate, college counselor and health information professional were the co-primary sources, followed closely by a flyer or brochure.

The primary source for learning about the HIM program varied by age range. Table 6 displays the primary source with the highest frequency by age range. For the 18 to 24 year olds, the primary source was a family friend; for the 25 to 30 age range it was a flyer or brochure; those in the 31 to 39 age range selected employer or HIM professional; those in the 40 to 49 age range identified their employer; and students over 50 selected an HIM professional.

Table 6: Primary Sources of Learning About HIM By Age Range

Reason for Selecting HIM as a Career
Question 2 asked students to indicate the most appealing, second most appealing, and third most appealing reason for selecting HIM as their career field. The three major reasons were as follows:

1. variety of career options available (34.8 percent)
2. availability of jobs (25.4 percent)
3. salary (19.3 percent)

Table 7, table 8, and table 9 reflect the responses by type of program. The variety of career options available was the most appealing reason for selecting HIM as a career in all programs.

Table 7: Most Appealing Reason For Selecting Health Information as a Career

Table 8: Second Most Appealing Reason for Selecting Health Information as a Career

Table 9: Third Most Appealing Reason for Selecting Health Information as a Career

The second most appealing reason for selecting HIM as a career varied by age range. Sixty respondents (21 percent) in the age range 18 to 24 indicated the variety of career options as the second most appealing reason. Respondents in the age range 25 to 30 were split between two reasons: 26 (25 percent) selected the variety of career options, and 26 (25 percent) selected availability of jobs. The variety of career options available was the second most appealing reason for the 31 to 39 age range. Availability of jobs was selected by the age ranges 40 to 49 and 50 and older.

Effective Recruiting Tools
Question 3 asked respondents to rank recruiting methods according to their effectiveness. The three top methods, by rank order, were:

1. presentations to high school students by HIM students (19.6 percent)
2. posting flyers in high schools (14.0 percent)
3. posting flyers in hospitals and healthcare organizations (12.3 percent)

Table 10, table 11, and table 12 reflect the responses by type of program.

Table 10: Most Effective Recruiting Tool

Table 11: Second Most Effective Recruiting Tool

Table 12: Third Most Effective Recruiting Tool

Further analysis revealed students in the age ranges of 18 to 24 and 25 to 30 selected presentations to high school students by HIM majors to be the most effective recruiting method. Students in the age ranges of 31 and over indicated posting flyers in hospitals and healthcare organizations as the most effective recruiting method.

Program Selection
Part II of the survey asked respondents to identify factors that contributed to the selection of the program they were attending. Question 4 asked students to indicate the primary, secondary, and tertiary factors that determined their school selection. Responses were as follows:

1. reputation of the program (28.7 percent)
2. reputation of the college or university (25.2 percent)
3. proximity to home (22.8 percent)

Table 13, table 14, and table 15 reflect the responses by type of program.

Table 13: Primary Factor for Selecting Current Program

Table 14: Second Factor for Selecting Current Program

Table 15: Third Factor for Selecting Current Program

Results by Type of Program

Coding

Demographics
Coding students represented the smallest number of participants in the survey (9.6 percent). Fifty-seven percent of those responding were in the age group of 31 to 49, and 48 percent attended school in the north central region of the United States.

Source for learning about HIM Thirteen coding students (18 percent) indicated their employer as their primary source of learning about HIM, followed closely by 12 students indicating a family member as their primary source of information.

Most appealing reason for selecting health information as a career When asked the most appealing reason for selecting health information as a career, 22 students (30 percent) selected the variety of career options available. The second most appealing reason was availability of jobs (27 percent), and the third most appealing reason was projected salaries (9 percent).

Most effective recruiting tool
Twenty-six of the 72 respondents (36 percent) identified posting flyers in hospitals and healthcare organizations as the most effective recruiting tool. Sixty-eight students responded to the questions regarding the second and third most effective recruiting tools. Two recruitment tools—posting flyers in colleges and posting flyers in high schools—were selected by 16 respondents (24 percent) each as the second most effective recruiting tool. Twelve students (18 percent) selected posting flyers in hospitals and healthcare organizations as the third most effective recruiting tool.

Program selection
Twenty-two percent of the coding students indicated the primary and secondary factor for selecting the program in which they were enrolled was the reputation of the program. Thirteen students (18 percent) selected availability of evening programs as the third factor.

Health Information Technology

Demographics
HIT students represented 63 percent of respondents to the survey; 88 percent attended community college, and 28 percent were in the 18 to 24 age range. It is interesting to note that 15 percent of the respondents were in the age range of 25 to 30, and 46 percent were in the age range of 31 to 49. Respondents age 50 and over accounted for 10 percent of students participating in the survey. Forty-seven percent of those responding attended school in the north central region of the United States.

Source for learning about HIM Sixty-two of the HIT students indicated a health information professional to be the primary source of learning about HIM. Fifty-nine indicated a flyer or brochure, and 45 credited a college counselor as the primary source for learning about HIM.

Most appealing reason for selecting health information as a career HIT students concurred with the coding students by selecting the variety of career options as the most appealing reason for choosing a career in HIM. The second most appealing reason was availability of jobs (27 percent), and the third reason given was projected salaries (19 percent).

Most effective recruiting tool Posting flyers in hospitals and healthcare organizations was identified as the most effective recruiting tool by 21 percent of the respondents. The second most effective recruiting tool was posting flyers in colleges (15 percent), and the third most effective tool was faculty information sessions for students who had not selected a major (14 percent).

Program selection Thirty-one percent of the HIT students chose reputation of the program as the primary factor for selecting the program in which they were enrolled. The secondary factor for selecting the program was the reputation of the college or university (24 percent). Proximity to home was the tertiary factor considered for program selection (21 percent).

Health Information Administration

Demographics HIA students represented 27 percent of respondents to the survey. Sixty-nine percent were in the 18 to 24 age range, and 36 percent of those responding attended school in the north central region of the United States.

Source for learning about HIM Two sources were selected as primary for learning about HIM. Those sources are college counselor and health information student.

Most appealing reason for selecting health information as a career HIA students chose HIM because of the variety of career options available (37 percent). Availability of jobs (18 percent) was the second reason, and projected salaries (22 percent) was the third.

Most effective recruiting tool Presentations by HIM students to high schools was identified as the most effective recruiting tool (25 percent). Presentations to students who had not selected a major was the second most effective recruiting tool (16 percent), and third was faculty information sessions for students who had not selected a major (14 percent).

Program selection Reputation of the program was selected as the primary and secondary factor for selecting the current program, with 33 percent of the HIA students choosing reputation of the program as the primary factor and 34 percent choosing it as the secondary factor. Proximity to home was the third factor for selecting the current program (27 percent).

Part IV was open ended, allowing participants an opportunity to provide additional information that might be useful in recruiting students to HIM programs. One student suggested “advertising at the bookstore and libraries.” A second student stated, “Start marketing students early!” A third student recommended educating “other professionals, like MBAs, JDs, MDs, and MHAs, about the HIM profession.” Several students noted the need for online options to allow “incorporating work with school.” Another recurrent theme was the need to educate high school and college counselors about HIM as a career. Many students spoke positively about HIM and the program in which they were enrolled.

Discussion

This study was conducted to identify characteristics of HIM programs and recruitment techniques that affect a prospective student’s decision to enroll in a health information program. Specifically, the study looked at:

1. how students enrolled in health information programs had learned about the HIM profession
2. the attributes that attracted students to the career
3. the most effective recruitment methods

The following paragraphs describe the typical coding, HIT, and HIA students.

Coding

The typical coding student is between the ages of 31 and 49. A coding student attends a daytime program at a community college, but a weekend program is also attractive. This individual learned about the health information profession through their employer or an HIM professional. The student chose coding as a career because of the variety of career options, availability of jobs, and projected salaries. Posting flyers in hospitals or other healthcare organizations is the most effective recruiting tool for coding students. Posting flyers in colleges and high schools is also effective. Coding students select a program based on reputation of the program, proximity to home, and availability of an evening program.

Health Information Technology

The typical HIT student is between the ages of 18 and 24, attends a daytime program at a community college, and has taken online classes. This individual learned about the health information profession through a health information professional or family friend. The student chose HIM as a career because of the variety of career options, availability of jobs, and projected salaries. Posting flyers in hospitals or other healthcare organizations is the most effective recruiting tool. Posting flyers in colleges and faculty information sessions for students who have not selected a major are also effective. HIT students select a program based on reputation of the program, reputation of the college or university, and proximity to home.

Health Information Administration

The typical HIA student is between the ages of 18 and 24 and is enrolled in a daytime program at a four-year institution. The student has taken classes via the Internet. A college counselor or HIM student was the primary source for learning about the HIA program. The student chose HIM as a career because of the variety of career options, availability of jobs, and projected salaries. A presentation to high schools by HIM students is the most effective recruiting tool. Presentations to students who have not selected a major and faculty information sessions for students who have not selected a major are the second and third most effective recruiting tools, respectively. HIA students select a program based on reputation of the program, reputation of the college or university, and proximity to home.

Limitations of the study constrain its generalizability in two ways. First, participation in the research study was voluntary, and some program directors and students chose not to participate. Second, broad-scale nonparticipation will result in an inaccurate portrayal of effective recruitment methods.

Conclusion

Marketing and recruiting students for a coding or HIM program often becomes the responsibility of the faculty and staff of the respective program. A multifaceted strategy encompassing several recruitment approaches is needed to attract qualified students to the profession. The responsibility for developing such approaches lies with all health information professionals. Future research should:

1. expand the demographic data to include gender and race
2. examine the effectiveness of AHIMA’s recruitment tools for attracting qualified students to the profession
3. investigate the challenges program directors incur in recruiting students
4. study the recruitment issues for e-learning programs

Jody Smith, PhD, RHIA, FAHIMA, is the program director and associate professor in the department of health information management in the Doisy College of Health Sciences at Saint Louis University in St. Louis, MO. Ellen Jacobs, MEd, RHIA, is the program director and an associate professor in the department of health information management at Saint Mary College in Omaha, NE.

Notes

1. Hecker, Daniel. “Occupational Employment Projections to 2010.” Monthly Labor Review 124, no. 11 (2001). Available at http://www.bls.gov/opub/mlr/2001/11/art4full.pdf.
2. “The Official Position of AHIMA: Statement on the Health Information Management Work Force.” Journal of AHIMA 73, no. 9 (2002): 36-37.
3. Armstrong, David and Paul Wing. "Data for Decisions: The HIM Work Force and Workplace—Penetration of AHIMA Professionals in the Fifty States.” (2004)  

Appendix A

Enrollment Comparisons 2001-03 At a Glance