The physical, economic and emotional toll of the COVID-19 pandemic has kept staffing issues top of mind for most medical practices. Amid worker quarantines, resignations and vaccine refusals, last week’s MGMA Stat poll found that nearly three in four medical practices rank staffing as their biggest challenge heading into 2022.
This phenomenon is nothing new. Our first COVID-19 MGMA Stat poll (on March 17, 2020) found that 40% of medical practices had experienced staff shortages at the time, through a combination of quarantines for potential exposures and workers who stayed home due to lack of childcare as schools and daycares closed.
Heading into the final months of 2021, the healthcare worker shortage is forcing some home health groups to turn patients away. At one hospital in eastern Washington State, counselors and social workers have been brought on for “employee well-being clinics” to allow workers to vent about what they’re dealing with as they’re asked to cover more shifts.
State governments also have started taking steps to address healthcare worker shortages:
- In New York, Gov. Kathy Hochul floated the potential of deploying medically trained National Guard members in partnership with disaster medical assistance teams to ensure enough qualified healthcare workers.
- Montana labor officials are reaching out to workers with expired medical licenses, encouraging them to renew, while some organizations follow emergency credentialing procedures to get licensed workers into the system as quickly as possible.
A Sept. 28 MGMA Stat poll reveals the impacts of those staffing issues on operations within medical practices: 76% of practices reported changing operations this year to handle staffing shortages, while 24% have not. The poll had 767 applicable responses.
Eight strategies for managing practice staffing shortages
- Getting more out of your remaining providers and staff. In some larger systems, the shortage of nurses is in the hundreds. That means more shifts, longer hours and the overtime pay that generally comes with it. Other respondents reported paying out “commitment bonuses” or “COVID-19 hazard pay” to keep existing employees from leaving.
- Adjust operating hours/patient access and provide cross-coverage when possible. Though not an ideal solution, reducing appointment availability was a frequently cited tactic among MGMA Stat poll respondents. But cutting back on hours across the board isn’t the only solution. Consider consolidating hours between locations to provide cross-coverage when possible. Some practices report reducing provider schedules to four days a week and rotating days off to accommodate staffing needs. When considering this option, look to your most marginally profitable locations and try to shift appointments, physicians and staff into other units.
- Consider staggering staff start times or instituting flex scheduling.
- Blocking schedules for advanced practice providers (APPs) to help with phone triage is another way to adjust to the need to do more with less.
- Reduce services. When necessary, it might be advantageous to limit or temporarily suspend walk-in appointments. Some practices found success limiting certain types of appointments to specific days. Some practices have reported suspending flu vaccine clinics or elective procedures temporarily to spread providers and staff across all locations.
- Cross-train, redesign jobs and reorganize departments. Centralize workflows wherever possible to pool resources. While some view cross-training of staff to cover shortages as “robbing Peter to pay Paul,” there are opportunities to re-envision your practice personnel, including:
- Combining front-desk duties and promoting those who have shown leadership potential
- Restructuring some jobs to accommodate less-experienced applicants
- Overstaffing in areas where you do have ample job candidates and eventually cross-training them into high-need areas
- Resetting organizational culture (As one practice leader noted, they no longer accept anyone saying, “That is not my job”).
- Outsource and automate. Several MGMA members reported finding automated systems for anything that would have involved calling a patient regarding appointments (e.g., reminders, rescheduling), or instituting patient self-service technologies for checking in. Other practices embraced part-time remote transcriptionists or virtual scribes to free clinicians up to focus on patient care. Areas such as chronic care management (CCM) and remote patient monitoring (RPM) services were key areas that practices sought to outsource, as well as billing functions.
- Redesign your services and centralize what you can. As more nurses get pulled to inpatient units and shortages in outpatient settings intensify, ensure your nurses focus solely on license work and push non-license tasks to others. Other tactics might include:
- Developing a call center to take pressure off your front-end staff
- Centralizing insurance verification/referral units.
- Embrace telehealth again. Increasing telehealth accessibility can aid in the lack of staff support for in-person care. Oftentimes, it’s possible for providers to work more from home doing an exclusive schedule of virtual visits to take some of the burden off the clinic staff.
- Broaden your recruitment and hiring. Several practices and health systems have turned to retired nurses and other staff to rejoin the team. With COVID-19 case numbers dropping and vaccinations increasing, many former clinical workers may feel comfortable coming back now versus the pre-vaccine pandemic waves in 2020. Creating more part-time positions to make up for full-time vacancies can also be a stopgap.
Understanding root causes of staff burnout
Since early 2020, the resulting stressors from the pandemic have spurred exceptional burnout, and vaccine hesitancy among some healthcare workers has prompted many to consider leaving jobs in which vaccine requirements have been introduced, voluntarily by the organization or mandated by a government body.
Jeff Comer, PhD, MHA, FACHE, who has spent more than 20 years as chief executive officer of an acute and behavioral care hospital, noted in his recent appearance on the MGMA Insights podcast that burnout is a major underlying cause of staffing issues today.
“I'd say 50% of my day is spent dealing with trying to hire various positions; it's a nationwide crisis,” Comer said. “We cannot get enough healthcare workers in any specialty,” and it’s a problem that goes beyond physicians and advanced practice providers. “The clinical folks get so much attention with burnout and stress, as they should,” but oftentimes administrators and business office staff also face incredible stress. “The challenges and the pressures for every single person have become so acute. ... A lot of this carries over to our home life, too.”
In Comer’s home state of Arizona, the lack of faculty now means there’s now a two-year wait to start nursing school despite there being a projected need to grow the number of nurses by 45% to meet increasing patient demand. Though working in a medical practice can be extremely rewarding in terms of helping others, Comer said that other industries that have boosted wages, benefits and working conditions are forcing healthcare leaders to reassess how all employees are treated despite the stressful environment of seeing patients in a pandemic.
“Your frontline workers, they're really at the heart and soul of your physician practice,” Comer noted. “That front desk person is the most important person for your customer service,” and it’s vital to ensure everyone is treated with respect and the stress doesn’t result in unacceptable behavior.
“How many times have we seen physicians treat our frontline employees inappropriately and be rude to them? … That really impacts them a lot,” Comer said. “They don't feel part of the tribe, they don't feel part of the clan,” and it can be a deciding factor as retail and food-service employers boost their recruitment efforts and sign-on bonuses. The answer, he notes, comes back to two simple rules: Treat others well, and if you face burnout yourself, seek help.
“We all get burned out; you’re not alone. … Burnout happens, but the key is not to let it become chronic burnout, that it starts to affect your performance and your overall life,” Comer said. “If you’re burned out, get some help, have somebody work through with you.”
- Comer will present “Beating Burnout for More Effective Leadership” at the 2021 Medical Practice Excellence: Leaders Conference, Oct. 24-27, in San Diego. Learn more.
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