For Alexander Pruitt, working at Dartmouth-Hitchcock Medical Center runs in the family. Six years ago, when he was in high school and looking for a job, he joined his mom at the hospital working for dining services. On Saturday, he stood serving baked goods behind a counter at DHMC. About a dozen people waited in line, and another dozen or so sat eating.
A Plainsfield resident, Pruitt said what he appreciates most about his job is its proximity to his house. Plainsfield is about a 25-minute drive from DHMC. But in a region of sparse towns without much transportation infrastructure, DHMC’s stable jobs draw in workers from across the Upper Valley.
DHMC, which has 9,120 employees, serves as the Upper Valley’s largest employer.
The majority of the hospital’s employees are affiliated with health care practices. DHMC employs more than 1,400 doctors, residents and fellows, in addition to slightly more than 1,700 nurses and more than 1,160 other clinical staff. But at DHMC, nearly 40 percent of employees are not involved with patient care or clinical services.
Upper Valley Haven, an organization that supports those struggling with poverty, executive director Sara Kobylenski said these employees work in areas such as housekeeping, maintenance, dietary services and transportation, in addition to administration.
She said that in the Upper Valley, though service-level jobs are easy to find, it is difficult to find jobs that pay enough money.
“Finding jobs isn’t the problem — findings jobs with a livable wage is the problem,” she said.
Kobylenski said blue-collar, well-paying industry jobs used to be common in the Upper Valley, but most manufacturing has moved out of the area. Now, there is a stark divide between the jobs that require a high level of education, like those at technology companies and service jobs, like those in the hospitality and care industries.
Lebanon resident Rob Williams said his maintenance job at DHMC is his second job — he cleans local office buildings at night. He said that between these two jobs, he can support his family, but he wishes he had more time to spend with them at home.
Williams said that his job at DHMC is the most steady position he holds.
Public policy professor Charles Wheelan said that because demand for health care does not vacillate with macroeconomic flows, health care jobs tend to be more stable.
Kobylenski said that at lower levels of the employment ladder in the Upper Valley, employees often leave their positions because of non-work related problems like transportation and housing.
Working Bridges is a program at DHMC that operates on the belief that people’s lives get in the way of their ability to perform their jobs, Kobylenski said. Such barriers might include access to childcare or reliable transportation. The program, run by local service organization Granite United Way, aims to help low-income wage earners solve their personal problems to help keep them on the job, Granite United Way senior director of regional impact Suzanne Stofflet said.
“When you’re stressed out about something, you’re not as good at your job,” she said.
Stofflet said six companies are participating in Working Bridges so far, including DHMC, King Arthur Flour and Simon Pearce. The College and the Co-op food store are among the companies that are on the waiting list for the program, according to a Working Bridges report.
Stofflet said since the program began in February, coordinator Prudence Pease has assisted about 200 employees across the Upper Valley.
“We’ve had absolutely tremendous feedback from employers,” Stofflet said. “There’s never been anything like it, in the difference it’s made in both companies and for their employees.”
She said transportation and housing are two of the most common problems particular to rural areas like the Upper Valley. Public transportation is inadequate, and people cannot afford reliable cars, Stofflet said.
Wheelan said it is uncommon for health care organizations of the scale and specialization of DHMC to be located rurally, but they can support a diverse socioeconomic labor ecosystem. Aside from clinicians, hospitals need ancillary management, accountants, wealth managers and people to support infrastructure, he said.
Economics professor Douglas Staiger, who has studied health care economics, said health care organizations lend stability to their surrounding area because of the nature of demand for health care.
“Employment growth in health care organizations and providers has been steady and strong, even in downturns,” Staiger, who has published on nurse employment and hospital productivity, said. “People still get sick, and a lot of people are insured — you don’t have to pay for it like cars and other big-ticket items.”
He added that hospital employment has risen overall in the last couple years, especially because the increase in insurance coverage through the Affordable Care Act has led to greater spending and demand for health care.
Staiger said there is an “enormous” push for more efficient health care that has spurred hospitals to consolidate and specialize, but the greater effects of these transformations are unclear. With more pressure to find efficiencies, care could move out of hospitals to smaller clinics or could surge in larger systems like DHMC, he said.
“DHMC’s such a big employer — these changes could have real impacts on the community,” he said. “If they suddenly boom or cut back, it’s going to affect property values, pressures for development and pressure on the town and neighboring towns.”
