Montana's changing demographics and a growing industry with too few workers in the pipeline spell good news on the job front, with any number of health care occupations ripe for the taking.

But it's also challenging the state's hospitals and rural clinics, as well as educators who are charged with preparing the next generation of workers needed to replace the wave of retirees.

Both issues – job opportunities and unmet needs – converged at the Health Professions Career Fair and Expo at Missoula College. Boil it down and there aren't enough students or training opportunities to meet industry demands.

“We like to advertise that annually there's 1,300 job openings in Montana in the health care field,” said Martha Robertson, program coordinator with the Western Montana Area Health Education Center. “Statistically, they're saying that will carry through 2020.”

In his September Labor Day Report, Gov. Steve Bullock cited health care as one of Montana's fastest growing industries, though it may not be growing fast enough. The number of Millennials coming into the system are too few to fill the vacancies created by retirees, Robertson said..

That has left a shortage of nurses and other health care workers, including radiologists and physicians. The problem is amplified in rural areas of the state, she said.

“Recruitment and retention is such a challenge that it's putting at risk the facilities staying open,” Robertson said. “They can recruit, but it takes a particular type of person to stay in rural Montana.”

Linda Barnes, director of nursing at Missoula College, said her program graduates 18 students a semester, or 36 each year. The vast majority stay in Missoula, looking for a job at one of the larger area hospitals, and few venture off to practice in rural Montana.

But even if the program wanted to increase its output, Barnes said it's not able to do so. The challenge isn't a local one, she said, but a national one.

“We can't take more nursing students than we already have, because we don't have clinical sites for them,” Barnes said. “At St. Pat’s, they're completely full with nursing students. They're saturated and just can't take any more. It's that way all across the state.”

At a recent meeting of the Montana Board of Nursing, the barriers to turning out more registered nurses took center stage. Along with lack of clinical sites, Barnes said, nursing schools are forced to turn away qualified applicants due to a lack of instructors.

Like other nursing programs, instructors at Missoula College must have a nursing background, and many have specialized training and a master's degree. But the compensation doesn't match that earned in the field.

“Frankly, my people with a master's degree who've been nurses for 20 years and are brilliant people are getting paid about the same as our new grads get paid when they get out of school and get their first job,” Barnes said. “We do it for the love of the students and the job, but it's going to be more of a problem as time goes on.

“I personally think it will be a patient safety issue. We can't possibly safely care for any more patients than we're already given.”

Despite the challenges, Robertson said some hospitals and clinics are trying new techniques to recruit health care workers and keep them. Some facilities who bring a worker to their community find an accompanying job for the spouse.

They're also investing in their employees' education to get them to stay, she said.

“The director of St. Luke’s in Ronan said on average, they invest roughly $60,000 to bring a new professional on board,” she said. “If you invest that and they leave in two years, you've lost that. So a lot of hospitals are providing the funds for their professionals to further their education.”

Other companies short on health care workers have also launched their own training programs, including Hestia In-Home Support. The company, based in Missoula, plucked one LPN at Friday's career fair and it was looking to promote its array of job opportunities to students.

“There's a shortage of people who are in health care, so we're training people on our own and have developed our own CNA program because our patients really need it,” said Maurika Moore. “I love that unemployment is at an all-time low, but that makes it really hard for us to find great people. We feel like it's our responsibility to train people so they can provide that care.”