Top challenge: Hiring and keeping the very best

"There are already fewer physical therapists than we have needs for," said Eileen Bove, vice president of human resources at Jefferson Health System, which employs nearly 30,000 at more than a dozen hospitals in the region. "Occupational therapists are hard to find."

With the competition so intense, pay becomes an issue, and that is what worries Hartnett at Temple, which must rely on appropriations from the state and tuition to fund its payroll.

"There's only so much money, and it can only go around so many ways," she said. That is where, she said, concerns about health insurance come in. "It's not just an HR issue, it's a financial issue."

But, nearly all the human resources executives said, being in the college-rich Philadelphia area gives them a leg up in recruiting.

"I think Philadelphia is a remarkable place for college talent," said Kathy Gubanich, managing director of human resources, in her office at Vanguard's campus in Malvern. "We have some of the finest colleges here, and there are so many."

Local companies are not confining their efforts to four-year college campuses and universities. Some are plumbing trade schools, community colleges and high schools. (See related story.)

And AstraZeneca milks another source of local talent: hiring experienced manufacturing workers from among the ranks of employees laid off from the nearby Chrysler plant.

What area companies cannot find in the local labor market, they grow in-house.

Jefferson, for example, is pursuing a grant to help some of its least-skilled employees move into more skilled jobs.

"We're going to take a certain number of employees and train them with in-house schooling," Bove said. "To go into the lab, or to go into technician jobs, they are going to need some help with basic skills."

Eighteen months ago, Acme reinstituted a long-defunct union-management two-year apprentice program to train store associates to become butchers and meat managers. The idea was to give younger associates an opportunity, while beefing up skills and building bench strength behind the meat counter as the baby boomers retired.

While the rising cost of health insurance was never the top concern of the human resources executives interviewed last month, it often did crop up in the top three.

"Health care is an enormous issue. It's huge. But it is a cost of doing business," said Gubanich at Vanguard, and, she said, good benefits are key to attracting and retaining talent.

Jefferson Health Systems and Catholic Health East experience the issue both as employers and providers of health care.

So how changes in the health-care system play out during and after the election does concern Clayton Fitzhugh, vice president of human resources for Catholic Health East, based in Newtown Square.

"We just know there are going to be changes in the air. We need to wait and see how that may impact us in terms of reimbursement and regulations," he said. "We're watching it."