Reeling in the Registrars

Vol. 17 •Issue 19 • Page 14
Reeling in the Registrars

An open cancer registrar position can remain vacant for months. Managers share tips on how to fill it.

Your cancer cases are growing, your registry has a backlog and your trusty certified tumor registrar (CTR) who’s taken care of everything on her own the past 30 years is retiring. Whatever the reason, you need a cancer registrar—and whether you’re set on recruiting a CTR or CTR-eligible candidate, finding someone to fill the position might just be a manager’s biggest headache.

Reeling in the Wrong Crowd

Uzma Rizwan, BS, CCS, CTR, cancer registry coordinator, CentraState Hospital in Freehold, NJ, pointed out that her human resources (HR) department advertised for 6 months and still couldn’t find someone eligible to fill the position. What’s going on?

Often, the problem starts with an HR department or HIM recruiter not knowing enough about the cancer registrar position to hire correctly. Something as simple as an incorrect job advertisement can reel in candidates who aren’t the right fit.

When Ruth Maranda, LPN, CTR, tumor registrar at Rhode Island Cancer Registry, had a hard time filling an open position, she pulled up the job posting online and found it listed as clerical with a high school education requirement.

“It’s ever so much more than that,” Maranda said. “When people come in, they’re saying, ‘Wait, this is going to take hours to learn, plus I have to go back and take classes in medical terminology, anatomy and physiology to even sit for the CTR exam!”

Pulling people in who aren’t qualified is a waste of time for everyone, and Rizwan said it is the CTR manager’s responsibility to educate the HR recruiter personally on what a cancer registry is—its purpose and job duties—so they’ll know exactly what to look for when hiring.

“You have to educate them on what you do,” Rizwan said. “I have sat down with the manager of HR and explained in detail the role of a cancer registrar and why it is important to hire a qualified person.”

This includes letting them know a registrar’s job stretches beyond coding and abstracting to running the tumor board meetings, which requires another set of skills entirely, explained Linda Mulvihill, the National Cancer Registrars Association (NCRA) recruitment and retention director.

“Cancer registrars require coding skills plus organization, public speaking, statistics and technical writing skills,” Mulvihill relayed. “Carefully scrutinize resumes of the candidates. When I was hiring I looked at things like volunteer leadership and continuing education participation. It really helps to round out a person.”

The Pay Doesn’t Weigh

A more challenging obstacle is that oftentimes the pay and benefits the hospital is offering doesn’t make it an attractive option. Not only is the pay too low to attract a qualified CTR, the learning curve is too steep for anyone coming in entry level to justify the effort they’ll have to put in once they get there.

The pay issue usually comes down to recognition. “We aren’t seen as a money-making entity,” Maranda said. “The CEOs don’t understand the info we gather could have a lot to do with their growth.”

So–show them! Rizwan exclaimed, “Look, nobody’s going to come to you, you have to be proactive with your data. Yes everybody’s busy, everybody’s overworked, but if you want to be recognized you have to make an extra effort.”

And what better way to get your administration to recognize you than by turning your data into dollar signs? In Rizwan’s case, she noticed a 2- to 3-year trend of lung cancer cases going to other hospitals for treatment after they were diagnosed at her hospital. For months, she brought the data to her administration to let them know they were losing patients, which equates to lost profits. Her hospital listened–lung care is now a comprehensive program and lung cancer cases are at No. 2.

It may come as little surprise, then, that Rizwan eventually obtained permission from her administration to hire a CTR-eligible candidate at the starting salary of a CTR.

“You have to make the numbers work for you,” Rizwan said. “They care because I’m providing the data they’re interested in. Let them know your department is not just a state requirement but data providers to planning, research and quality improvement departments. You are the data experts.”

No matter what your strategy, the key in talking to your administration is not to tell them what you need, but why they need you, Rizwan explained.

Show them there is a shortage in the number of CTRs applying due to an uncompetitive salary and if the position remains unfilled, you won’t be able to provide this type of up-to-date, prospective information in the future, Rizwan advised.

It also can’t hurt to bring up any awards or recognition a CTR can bring to the hospital. Let them know a decrease in timely and accurate reporting can jeopardize their accreditation with the American College of Surgeons (ACoS) or cause them to lose other awards they currently have.

“For the last 5 years, my hospital has been a recipient of the Timely and Complete Reporting Achievement Award from the New Jersey State Cancer Registry department,” Rizwan noted. “The award is given to hospitals that report 90 percent of all newly diagnosed cases within 6 months of first diagnosis. It’s an honor for the hospital. I told them, I can’t do that if I’m continuously in a crunch.”

Be Creative

So your administration won’t budge on the pay increase and you still can’t find a candidate to fill the position. Your next option would be to create a new position that would give non-CTRs an opportunity to work toward certification.

This is the path Sue Vest, project manager, and Jeannette Jackson-Thompson, operations director, took at the Missouri Cancer Registry in Columbia when they created an entry-level position of data specialist, and re-worked their staffing structure to form a three-tiered track of cancer registrars—data specialist, data coordinator and senior data coordinator.

This new entry-level position allowed them to pull in employees at a lower pay range and enabled the registry to fill the position more quickly by not limiting it to the CTR credential.

“When we noticed a shortage of CTRs coming in, we decided we needed to grow our own,” Vest explained. “Creating a career track gives the data specialist a target; if they work hard they can move up to the next level.”

Rizwan did the same. She created an entry-level position of cancer registry data support, in charge of case finding and other non-abstracting functions. Not only did this enable her to hire more easily at the lower pay scale, it allowed her other trainee time to prepare for the CTR exam.

“Now my CTR-eligible candidate spends less time on case-finding, follow-up and other responsibilities and can focus more on abstracting,” Rizwan relayed.

Another tip is to think outside the box, or rather office walls: “Telecommuting is another way we’ve been able to fill positions,” Vest explained.

Telecommuting is great when you need a registrar to handle the caseload, but you don’t have the room to accommodate him/her, Vest relayed. It also significantly increases your chances at finding skilled candidates because it essentially opens your hiring pool to the entire country rather than just the local area.

“We have one currently in Texas and another in Atlanta,” Vest said. “The first one we hired is still able to work for us no matter where her husband is transferred. It also helps with continuity; if you keep the same staff, it’s less training because any time you turn over there’s a learning curve.”

Vest said managers are often deterred from telecommuting due to fear of losing control, but she affirmed that many employees may even do better on their own.

“If you have someone that’s really good, reliable and dependable, that person is probably going to be more productive out of the office than they would in the office with all the interruptions and interference,” she conveyed.

Cast a Wide Net

Another way to reel in a cancer registrar is to pull from other medical record departments, because the learning curve is not as steep.

Vivian Ehrlich, BS, RHIT, CTR, Memorial Hospital Cancer Center, Colorado Springs, CO, said her favorite place to recruit is from RHIT/administrator (RHIA) personnel. Ehrlich, who in 16 years has hired two coders, a nurse and a unit clerk, says a coder is up and running and comfortable within a year compared to non-coders——where it’s closer to 2 years.

“The main reason I like to recruit from RHIT/RHIA is because they already have the education in anatomy and physiology, they know how to read and understand a medical record and have a sound background in coding principles,” she said. “But you have to let them know the position is available to them. Network.”

Some are casting the net out a little wider and are looking to secretaries in pathology departments, lab techs and nurses. Maranda’s favorite spot to recruit is a nursing program at a nearby vocational school, which has a 3-year waiting list to get into clinical work. Maranda, who is a licensed practical nurse herself, is passionate about letting nurses know a cancer registry is a great place to take their knowledge.

“This isn’t something where they need to start from scratch. They find, ‘Wow, I’m going to keep my medical terminology, human anatomy and physiology.’”

Surprisingly, Maranda said that in doing cancer registry work, she feels more involved in a patient’s story than when she was treating them in person.

“Here it’s like being a forensic detective; you find out the why’s and how’s. Why did this treatment work on 15 people but on the 16th it didn’t? Being a nurse you get to spend 10 minutes of your time with each patient. It’s not as personal.”

Ainsley Maloney is an editorial assistant with ADVANCE.