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The health-care industry added jobs in 2008 despite a deepening recession.

But growth was sluggish — especially considering an industry still trying to catch up with population — and experts anticipate further struggles with the rippling effects of a feeble economy.

Jobless numbers have soared, crippling individuals' access to private health insurance and increasing reliance on state-funded health care, industry experts say. Hospitals have also seen the value of their investments plunge, diminishing their access to cash.

And the availability of nursing positions has dwindled, despite recent reports of an imminent shortage in the state.

Hospital officials said to control costs they've taken a hard look at staffing levels, but not at the expense of patient care.

"Hospitals are continuing to hire for those clinical positions where they're needed to take care of patients," said Adda Alexander, executive vice president of the Arizona Hospital and Healthcare Association. "But they've been conservative in other departments that don't directly affect the patient. We've been seeing some changes in that work force."

University Medical Center had 7.5 percent more full-time-equivalent employees at the end of 2008 compared with year-end 2007. In this year's Star 200 survey, UMC reported having 3,552 full-time-equivalent employees, up from 3,304 the previous year.

John Marques, UMC's vice president of human resources, attributed the increase to some acquisitions and expansions. As Southern Arizona's only Level 1 trauma center, UMC needs to maintain certain staffing levels to ensure it can treat critically injured patients.

But because of the money crunch, UMC is making careful considerations when it comes to adding employees who don't work directly with patients — such as administrative, financial or human resource positions — Marques said.

"We've put a tight emphasis on head count and taken a good, hard look at bringing on any new positions," Marques said.

Arizona Community Physicians — a primary-care medical group — grew from 685 full-time-equivalent employees in 2007 to 750 in 2008.

Executive Director Larry Levey said the increase doesn't mean there are more physicians in Southern Arizona. Rather, individual and small groups of primary-care doctors joined the health-care group to get the financial benefits of the larger organization, he said.

With the new physicians came the need for additional support staff, Levey said.

Northwest Medical Center, with 2,289 full-time-equivalent employees, saw an increase of 7.8 percent from the end of 2007. It also opened La Paloma Urgent Care, at 4001 E. Sunrise Drive, but Human Resources Director Veronica Leon said positions there were mostly transfers, as opposed to new hires.

"Because of the economy, our hiring has slowed, and another thing is our turnover has reduced," Leon said.

During tough economic times, more nurses who might have retired have stayed on the job, and many are taking on extra shifts. That means hospitals are relying less on hiring temporary nurses, officials said.

"We have moved toward putting people on as core staff members, and cutting back on having to hire agency nurses," said Michael Letson, a spokesman for Tucson Medical Center.

TMC had 3,134 full-time-equivalent employees at the end of 2008 compared with 3,038 at the end of 2007.

On the other hand, the Carondelet Health Network, which runs St. Mary's, St. Joseph's and Tucson Heart hospitals in Tucson and Holy Cross Hospital in Nogales, saw a decrease in its number of full-time-equivalent employees. At the end of 2008, the health network was down to 4,570 — a 4 percent decrease from the previous year.

Carondelet had ramped up hiring in the previous year as it expanded facilities, said Linda Werbylo, vice president of human resources. But the health network is not hiring like it once was, she said.

"We've not seen the increases in volume like we did last year," Werbylo said. "Our guess is that patients are delaying elective surgeries."