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Get it together, man

Monday, May 20, 2024 - Posted by Rich Miller

* My weekly syndicated newspaper column

Back in April, the executive director of the American Nurses Association Illinois, Susan Swart, told my associate Isabel Miller that advanced practice registered nurses are losing their jobs because of ongoing and severe state licensing delays.

Swart said some of those nurses are waiting “a year to 18 months” to get their licenses from the Illinois Department of Financial and Professional Regulation.

“The nurses apply for [jobs] because they’re accepting this position, and [licensing] is taking so long, they’re losing positions,” Swart said.

And it’s not just nurses having problems getting state licenses.

Licensed social workers are not required to take an exam to obtain their state licenses. They self-report background issues, so they aren’t required to undergo state background checks. Their only real licensing requirement is to show they’ve obtained a master’s degree in social work.

And yet, the Illinois Department of Financial & Professional Regulation still takes three to four months to process license applications for LSWs, according to Kyle Hillman with the Illinois chapter of the National Association of Social Workers. The applications are “the easiest thing to review,” Hillman said. It’s basically a rubber-stamp operation.

Needless to say, these delays are completely unacceptable. The General Assembly passed legislation last year to give the IDFPR some breathing room on licensing renewals so it could focus its efforts on first-time licenses. And yet, here we (still) are.

In response to Hillman, an IDFPR spokesperson revealed the agency has only eight workers processing license applications for 80 health-related professions.

That’s an astoundingly low number of employees for the immense task they’re charged with tackling.

Eight?

For 80 health-related professions?

What the heck?

There are thousands upon untold thousands of people in licensed health-related professions here. No wonder people have to wait months on end for their license approvals.

Up until that response, IDFPR would only say the agency was “under-staffed” when groups like the National Association of Social Workers tried to find out how many employees it had assigned to process applications. Now those groups know, and they’re not happy.

The IDFPR also previously refused to tell the NASW if it was separately processing the no-brainer licensed social worker applications to speed things along. But the agency’s statement admitted the social worker apps were in the big pile, along with all the other health-related professions.

That makes no sense. Take a few days and get the easy stuff out of the way, for crying out loud.

Gov. J.B. Pritzker has talked a good game about workforce development. But it does no good to help train and attract nurses, social workers and a host of other much-needed professionals if his licensing agency can’t even figure out how to deal with fruit that is literally sitting on the ground, let alone the low-hanging variety.

The IDFPR spokesperson claimed the licensed social worker processing time is down 60% from eight months ago. But it’s still a ridiculously long wait.

Pritzker’s proposed state budget includes money “for the procurement of a new licensing system” for IDFPR, but that project is way behind schedule.

Last year, the legislature gave IDFPR three months to build a new computer software system and have that system up and running in three months. Well, the department is now at its deadline to have the system running, but it hasn’t yet even finished the procurement process to buy the software.

And the governor’s proposed budget would only increase IDFPR’s headcount by a mere 28 people across the department’s four divisions (after significant hiring this fiscal year).

Meanwhile, a February report by the Illinois Economic Policy Institute’s “The Illinois Update” revealed that more than half of Illinois registered nurses are over the age of 55, and one-third say they plan to leave the profession within 12 months. As a result, the report said Illinois “is projected to see an RN shortage of 15,000 by 2025.”

Last week, the General Assembly passed legislation (HB5047) that would extend the time period that license-pending practical nurses and license-pending registered nurses could work to six months, up from three, before their employment is terminated. But even that may not be enough time for IDFPR.

According to the governor’s proposed budget, the number of licensed professionals outside of cannabis is expected to be 1.35 million people by the end of next fiscal year. But that relies on the state getting its act together.

       

45 Comments
  1. - TNT - Monday, May 20, 24 @ 7:52 am:

    Anyone who works on constituent services in a legislative office can tell you this is not only maddening, it’s an embarrassment to state government.


  2. - Annon3 - Monday, May 20, 24 @ 7:57 am:

    IDFPR- insert most agencies initials and you would see same results. State hiring is an embarrassment and CMS has zero accountability for this fiasco.


  3. - Carol Taylor - Monday, May 20, 24 @ 8:10 am:

    In February 2024, my cousin in Will County sent in his form and check to renew his 2015 Security license so a Hotel could hire him. He told his current employer to stop scheduling him as he would be working elsewhere in March. It took three months for his check to clear the bank and as of our Text exchange yesterday he still hasn’t received his Security license renewal, hasn’t worked and doesn’t qualify for unemployment since he resigned. Despite Personal Income taxes rising from $14 billion to $25 billion in the past couple years the State of Illinois can’t provide basic services. Sad and pathetic.


  4. - Maverick - Monday, May 20, 24 @ 8:16 am:

    The director of IDFPR was in charge of building the new computer system at IDOC when it was done and that was and is an absolute disaster. Not sure why you would expect different results here.


  5. - DuPage Saint - Monday, May 20, 24 @ 8:22 am:

    I was sorta curious about how many job openings the state has for everything. in other words how understaffed the state is. iI did not want to just ask because Rich would say the Google is your friend. So I Googled it did not get number but you will be happy to know the state has hiring process under control. From the Google

    Heads Up! The State of Illinois recently upgraded our system to improve the hiring process. As we work through this transition, there will be a smaller number of job postings listed.


  6. - Give Us Barabbas - Monday, May 20, 24 @ 8:25 am:

    I believe this was the agency Rauner used to point to as being an all-paper-based workplace with little to no modern automation. Said he was going to fix it by changing BCCS into DOIT. Seems like a place where AI tools could speed things up, but IT contracting for the state is still a dumpster fire, and CMS slow hiring is legendary.


  7. - JS Mill - Monday, May 20, 24 @ 8:30 am:

    =the report said Illinois “is projected to see an RN shortage of 15,000 by 2025.”=

    It is already hard enough to get a school nurse, now it could be just about impossible. The numbers look like what happened with teachers between 2012 and 2017.


  8. - been there done that - Monday, May 20, 24 @ 8:33 am:

    portal opened May 1 for RN’s you are forced to voice mail from opening until closing. “please press# and we will get back to you in 3 hours, if not call tomorrow. Tried 13 times one a day bubkus. So the response is my wife cannot work????


  9. - Tequila Mockingbird? - Monday, May 20, 24 @ 8:35 am:

    Any of the chronyism or ghost workers on the payroll that seems to permeate other Illinois state agencies? It sure seems to be endemic.


  10. - OneMan - Monday, May 20, 24 @ 8:43 am:

    Swart said some of those nurses are waiting “a year to 18 months” to get their licenses from the Illinois Department of Financial and Professional Regulation.”

    That’s nuts, and I don’t think anyone would disagree with that.

    “In response to Hillman, an IDFPR spokesperson revealed the agency has only eight workers processing license applications for 80 health-related professions.”

    My wife is an APRN in Illinois and has been one for 20 years. She had some adventures with getting part of her license renewed; she overpaid a fee (it needed to be clarified how much it was because it was for reinstating part of her license). I will not go into the details, but her professional association was a lifesaver. Trying to get ahold of someone there can be a challenge at times. I am sharing this so you know where I am coming from regarding this.

    The license fees have been explained as needed to cover the costs of managing the licensing.

    Let us take a look at the numbers

    There are about 240,000 active RNs in Illinois
    https://www.ncsbn.org/active-rn-licenses

    They pay a $40 license fee every two years, that 2.4 million dollars a year just in RN license fees. That should be enough to cover the cost of 10~20 people with benefits to deal with those.

    There are roughly 18,000 APRN licenses in Illinois.

    An APRN needs an RN license, an APRN license, and, depending on their practice, a controlled substance license (along with a controlled substance license from the DEA). You pay X for the initial license (outside of the exam fees) and then pay a different amount for your renewals. That is outside the certification fee (which is paid to a different entity and on a different cycle, but the work done by the certification entity in providing the certification might serve as a baseline and reduce the overhead of processing her licensing).
    My wife pays the state $170 every two years for all of her licenses. I will use a number of 10,000 APRNs in Illinois, which is low, but I will use and average the 2-year fee down to $140 for those who don’t have a controlled substance license. That works out to $1.4 million

    That is $700,000 a year in fees paid by the APRNs, which should cover at least 3~4 people.

    Where is that money going?

    I can’t even imagine completing an MSN or DNP (Doctor of Nursing Practice, a degree that wasn’t really an option when my wife went to school) and hope you don’t run out the clock on the license pending if you take an APRN job. Most programs for these degrees require you to go full-time at some point. So you quit your job to complete the degree, get a new job, and hope the state only takes as long as the pending license allows?

    Why is DPFR not shouting from the rooftops about this? I realize it is embarrassing, but something needs to be done, and hiding the problem isn’t the answer.


  11. - NickNombre - Monday, May 20, 24 @ 8:44 am:

    “IDFPR- insert most agencies initials and you would see same results. State hiring is an embarrassment and CMS has zero accountability for this fiasco.”

    This, exactly.

    In addition, most agencies frequently get new programs and mandates added to them without increases in their budgets. You get what you pay for.


  12. - SWSider - Monday, May 20, 24 @ 8:44 am:

    Who knows, another 3,4 terms and JPB might get around to figuring out who’s responsible for running his departments.


  13. - Sladay93 - Monday, May 20, 24 @ 9:06 am:

    Illinois just needs to pass legislation to join the multi-state health Care compacts for physical therapy and nursing. Illinois is already a member of the medical compact that covers doctors but the other two it’s not. It would allow people license in other states to come here and work without having to get another license. https://jacksonllp.com/healthcare-license-compacts-illinois/


  14. - Candy Dogood - Monday, May 20, 24 @ 9:09 am:

    I think Rich does a great ob stating the problem. Hopefully this story is picked up by Pro Publica so the governor reads it and becomes aware of the problem. Hopefully the Governor response by figuring out which of the people in his staff is responsible for this fiasco and made sure he didn’t really understand or know about the magnitude of the problem and then fires them. Screw ups like this — a screw up we’ve known about for a long time that has continued for a long time and that the agency, which almost certainly has known about it for a long time, need to be understood as career in state government ending scenarios. Not because of the problem, but because it has continued to exist for years and years and years. The Pritzker Administration is destroying peoples lives. This failure has victims. If you think that’s hyperbolic, well, a job is pretty important and so is being able to see a healthcare provider.

    Are these 8 folks allowed unlimited overtime yet? Is the agency doing anything that illustrates that they understand the problem?

    Certainly — they’re not hiring people. We can blame CMS, sure, but how many years of not hiring positions required to meet basic statutory requirements can we really just blame on CMS?

    We’ve long reached the point where names should be involved in identifying who is responsible. Right now the only name we have is JB Pritzker. An out of touch billionaire who doesn’t understand that his administration as many thousands of funded vacancies and his state agencies aren’t able to do the jobs that they exist to do.

    It isn’t just the IDFPR. I wish it were just one agency. But it is all the agencies. This is happening at all of the agencies and the only thing that spares those agencies from more attention is that they’re also very good at lying about or pretending like the problems that understanding and incompetent middle and upper management cause don’t exist.

    The only reason why those agencies are able to do that is because the bubble that they have made around Governor Pritzker and reinforced with concrete, steel, and a flaming moat, works both ways. People can’t get to Governor Pritzker to influence him and diminish their influence, and they can’t spot who is lying them because they’ve distanced themselves so dramatically from the state agencies that they’ve left Rauner appointees to run for them.

    It’s like a bad episode of Veep but instead of a punchline there’s Illinoisans that can’t see a healthcare provider and nurses that can’t pay their bills.


  15. - Is It June Yet - Monday, May 20, 24 @ 9:15 am:

    The delays are ridiculous but it’s also hard to blame them for not meeting that procurement deadline. 90 days was a pipe dream considering how cumbersome the procurement code is. Add procurement to the list of fixes needed, right behind IDFPR, DOIT, and CMS hiring.


  16. - This is ridiculous... - Monday, May 20, 24 @ 9:37 am:

    State hiring is a nightmare. I’ll just say that at an agency I’m familiar with, hiring has ground to a halt due to specific problems in the hiring process and software. It’s taking anywhere from 12-18 months to hire a single employee and that was before the stoppage. We aren’t able to hire the staff we need even when there are funds for it.


  17. - Chicagonk - Monday, May 20, 24 @ 9:43 am:

    Lawmakers pass hundreds of bills every year - Maybe one of those can improve the efficiency of CMS and IDPFR. Kudos to Rich for really digging into this issue.


  18. - Res Melius - Monday, May 20, 24 @ 9:44 am:

    Not privy to all of the details, but it appears, at this crisis point, it’s time for some focused, results-oriented, business process reengineering utilizing qualified, external assistance.


  19. - Ron - In Texas - Monday, May 20, 24 @ 9:52 am:

    Illinois has a long history of taking forever on anything the state gov agencies have to process for a “license”

    heck, when I got out of the services I had waited like 3 months waiting on a FOID card and called a buddy who was an investigator that investigated doctors and nurses for revoking their license…

    He made 1 phone call and I had my FOID in 4 days in the mail.

    Then I went to get licensed as armed security (to get a job while I went to college). Again had to call friends after months to get it moving then, bang… within 10 days I am good some how.

    Most of the departments are not incented to move this stuff along. Whether there are hundreds of apps waiting and only a couple going out every day or just a couple of them waiting and hundreds going out… They have no motivation to move fast, be efficient, etc.

    Want to speed it up. Take the head of the department and the managers and comp/bonus them on this and it would go away…


  20. - Ron - In Texas - Monday, May 20, 24 @ 9:55 am:

    “Not privy to all of the details, but it appears, at this crisis point, it’s time for some focused, results-oriented, business process reengineering utilizing qualified, external assistance.”

    In the private sector when you have an issue like this you bring in someone that has a track record of running a successful department and have them fix it.

    Who in Illinois gov has that record of running an efficient department and a background in righting the ships? very few as there is little to no motivation to do so.


  21. - Honeybear - Monday, May 20, 24 @ 9:57 am:

    This is exactly what I’m talking about. 9000 is what Afscme estimates we are missing in unfulfilled positions. The legislature may budget a lot of positions but they
    Aren’t being filled
    CMS isn’t posting them

    You can’t make the candy with a skeleton crew of Oompa Loompas

    So my question is,
    Is unfilled state worker salaries the new slush fund for agencies?
    Or is this an anti union tactic to deprive Afscme of paid dues members ?
    Again, it’s getting results that Rauner could only dream of.


  22. - Candy Dogood - Monday, May 20, 24 @ 9:59 am:

    ===Not privy to all of the details, but it appears, at this crisis point, it’s time for some focused, results-oriented, business process reengineering utilizing qualified, external assistance. ===

    You mean that the Pritzker Administration, being too incompetent to fill funded state positions, now must contract out the work?

    I think the issue is that the Pritzker Administration, being too incompetent to fill funded state positions, does not have the ability to demonstrate that they made any meaningful efforts to address this.

    “People just don’t want to work any more” is not a public policy, and if people don’t want to work for the state anymore they should consider visiting why that might be.


  23. - Honeybear - Monday, May 20, 24 @ 10:00 am:

    I would venture to say this is the case at every agency.
    Come journalists there’s your lead.
    Investigate it
    What is the number of unfilled positions at each agency and how does that impact vital services?


  24. - Rich Miller - Monday, May 20, 24 @ 10:27 am:

    ===pass legislation to join the multi-state health Care compacts for physical therapy and nursing===

    Dems won’t do that because of several states’ abortion laws punishing providers.


  25. - Back to the Future - Monday, May 20, 24 @ 10:33 am:

    Hat Tip to the Sun Times and the Millers.
    This is a great example of why we need to support our newspapers and the high quality journalists we have in Illinois.
    A story like this one takes a lot of time, journalists with sources that trust them, the ability to fact check everything and the writing ability to cover the issue in a way that readers can understand.
    Could comment more on the substance of the of column, but Candy Dogood (as usual) did a great job on and I share her view.


  26. - H-W - Monday, May 20, 24 @ 10:36 am:

    Is it at all possible to shift workers from one agency to another temporarily to help resolve the backlog? For example, could legislative aides help when the Legislature is not in session, or other state workers in Springfield/Chicago? As a professor, I could easily see asking college faculty or graduate students to assist with the backlog.

    Asking seriously.


  27. - MG85 - Monday, May 20, 24 @ 10:54 am:

    Several strong and right comments on this post but I’ll add my own continuous call to right the ship of hiring with state government. There are 3 fundamental problems with state hiring:

    1) Right-sizing. We over-rely on technology to do jobs when the reality is you still need humans to perform the work. JB didn’t start this Reagan-era trend but he certainly hasn’t helped it. The state needs more headcount. Period. Rauner lambasted bloated government yet not one of his directors could tell the general assembly where they could afford to cut staffing. Not one.

    2) Hiring process: Not that the paper/fax methods of the arcane CMS 104 was great, but it at least was a simple process everyone understood. It was tedious to be generous. Success Factors is a failure. The only factor that system provides is ensuring there is no success. I could count the ways - but the results speak for themselves.

    3) CMS: Too much oversight and duplication causes great delays. You can’t post a job until the vacancy is actual (e.g. we know person A is retiring in March but it’s February and we cannot go ahead and post the vacancy). Agencies must get approval for a vacancy they already have budgeted from CMS that, ironically, itself is understaffed. Every step that an agency should have an ability to do freely must be checked by all-knowing, overseeing CMS. It does far more harm than it has ever done for good.

    The solution to all of these problems is the same - eliminate CMS as an overseeing, decision making agency. I would say eliminate entirely but that’s like asking for an elephant to stop growing. Instead, it should be an oversight agency only. It should write policy. It should “audit” agencies. It should not, however, be in the decision-making process. It should offer “findings” of agencies. Let the agencies, however, make decisions.

    JB can do this. He can make big things happen. The problem with JB’s thinking, however, is this sort of change requires a lot of attention and focus but the results will not help him capture the Democratic nominee for President in 4 years. That is where is focus is and is hurting our state government.


  28. - Zoe - Monday, May 20, 24 @ 10:59 am:

    “IDFPR- insert most agencies initials and you would see same results…….”.

    So true, unfortunately. Try getting a corrected copy of your birth certificate. It takes 12+ weeks according to the IDPH website. When you call their number the message indicates they cannot take calls.

    When I did a Google search to see how long to obtain a corrected birth certificate, NY was at 90 days. Other states were between 5 days to 2 weeks.

    Very frustrating. I can only imagine how horrible for the person who can’t get a job as a result of delays.


  29. - This Crowd - Monday, May 20, 24 @ 11:13 am:

    Sadly this team would rather focus on lining the Gov up for a presidential run than run state government. This is one of many examples.


  30. - Anyone Remember - Monday, May 20, 24 @ 11:34 am:

    How about a simple flow chart (with timelines) comparing the expedited DCFS hiring process vs. the CMS / AFSCME “Rube Goldberg” hiring process?


  31. - Honeybear - Monday, May 20, 24 @ 12:59 pm:

    Anyone Remember- Afscme has nothing to do with the hiring process. Additionally DCFS are AFSCME’s as well. We don’t hire or make the management decisions. This is all on management. We’re the ones holding it together with duct tape with a skeleton crew.


  32. - Unionman - Monday, May 20, 24 @ 1:01 pm:

    As a former IDFPR employee, this is an old problem. The licensing team in Springfield is perpetually understaffed. At the same time, they keep on hiring new associated and assistant directors. The people on top also seem more focused on putting out press releases and attending events.
    One of the areas that gets overlooked at IDFPR is the way employees are funded. The license fees for each profession cover the employees for those professions. The problem is that those employees get locked in. So a Social Work funded employee cannot be tasked with processing Nursing applications. There are even statutory references to the employees devoting all of their time to their specific area.
    I believe that a few professions got language put into their specific acts regarding minimum staffing and time devotion because IDFPR would prioritize other professions at their expense.
    Also, since IDFPR is a revenue generating agency. Depending on the year, and if they have a lot of extra cash sitting around, there is a tendency for the money to get swept to cover other budget areas.


  33. - Nothing - Monday, May 20, 24 @ 1:02 pm:

    “Anyone Remember- Afscme has nothing to do with the hiring process. Additionally DCFS are AFSCME’s as well. We don’t hire or make the management decisions. This is all on management. We’re the ones holding it together with duct tape with a skeleton crew.” You can thank the pensions eating up way too much of the budget for that.


  34. - Flyin'Elvis'-Utah Chapter - Monday, May 20, 24 @ 1:03 pm:

    Why, it’s almost like having has many state employees per capita as Mississippi, along with a pension system that anyone with options would turn down isn’t the best idea after all.


  35. - Nothing - Monday, May 20, 24 @ 1:04 pm:

    “Why, it’s almost like having has many state employees per capita as Mississippi, along with a pension system that anyone with options would turn down isn’t the best idea after all.” You can thank the pensions taking up way too much of the budget for that too.


  36. - This is ridiculous... - Monday, May 20, 24 @ 1:04 pm:

    MG85 has been much more specific than I was and they are exactly right. If you can’t even hire the staff you need and have federal funds to pay, then there’s a fundamental problem that needs to be addressed.


  37. - thisjustinagain - Monday, May 20, 24 @ 1:07 pm:

    When I renewed my private security registration (the “PERC”), it took IDFPR only about 72 hours. Weird how some licenses/certifications/registrations are so quickly done, and others sit in piles waiting to be finished. But Illinois gov’t is full of pockets of inefficiency, useless policy/procedure, and under-staffing.


  38. - Rich Miller - Monday, May 20, 24 @ 1:16 pm:

    ===a Social Work funded employee cannot be tasked with processing Nursing applications===

    Did you not read the column?


  39. - Recent retiree - Monday, May 20, 24 @ 1:32 pm:

    The understaffing of the agencies certainly contributes to issues serving the public, but you’ll find some of the employees at these agencies don’t want additional staffing. They will even resist efforts to alleviate the problem. The use of “unlimited” overtime is/was rampant in some of these agencies. My former agency (IGB) brought in retired employees as contractual workers to shore up the workforce. The overtime lovers saw their hours begin to decrease. I’m talking about employees who were accumulating upwards of 80-100 hours of overtime per month. These employees filed a grievance with AFSCME, and the contractual employees were removed. The employees are back to earning obscene amounts of overtime and the agency is still understaffed.


  40. - Honeybear - Monday, May 20, 24 @ 1:50 pm:

    Nothing- thank the Republican Governor Edgar and his pension ramp for why pensions eat up so much.

    Recent retiree- yes, many employees love all the overtime. A problem solved if CMS management did a better job hiring.
    Again I ask if money is being budgeted for positions which aren’t being filled
    Where does that money go?


  41. - SWSider - Monday, May 20, 24 @ 1:53 pm:

    ==Sadly this team would rather focus on lining the Gov up for a presidential run than run state government. ==

    Well said. JPB has been an extraordinarily successful politician with absolutely no interest in doing anything but caretaking.


  42. - Nothing - Monday, May 20, 24 @ 1:54 pm:

    “thank the Republican Governor Edgar and his pension ramp for why pensions eat up so much” And thank all the Dems that passed it and still support it now.


  43. - winslowwilly - Monday, May 20, 24 @ 3:19 pm:

    Many have said it well. Counselors pay 2 to 3 times other mental health professions. Way beyond the cost of the license. Millions in IDFPR profit funding something else in IL. 33 states have passed a license Compact but not IL. Yes, these delays have been a problem for many years. Who in IL will provide a solution. IDFPR Director at recent hearing refused to answer the simplest questions about the status of a new computer system. When is this problem big enough for something serious to get done?


  44. - Appears - Monday, May 20, 24 @ 4:52 pm:

    “Nothing”…..and thank all those politicians from years past that used the pension system like a credit card to fund everything but what was supposed to be funded. Also, thank all the current and past state employees and teachers who worked and continue to work i sprite of the mess. Many took a salary far less than the private sector to teach, to build, to try to keep things running.
    If you don’t like the pensions, then pay the state workers a compatible salary to the public sector.


  45. - JB13 - Monday, May 20, 24 @ 5:22 pm:

    Any chance the problems with licensing nurses could in any way lead to decreased availability of abortion services?
    Because *that* would certainly get the governor’s attention


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