The Executive Suite: Surviving medical staff shortages

Melissa Lucarelli, MD, knows what it’s like to run a practice that’s short-staffed.

The family physician in Randolph, Wis., has 12 employees in her office. In the past year, four have gone on maternity leave, including the clinic manager and the claims manager.

“We had to be very creative in how we compensated in order to stay open and keep seeing patients,” says Lucarelli, a member of the Medical Economics editorial advisory board.

It’s a problem most small- to medium-sized practices face at some point: A staff member quits unexpectedly or goes on leave for a long period of time because of pregnancy, illness, accident, or emergency. How the practice compensates for that staffing shortage can affect its revenues, workloads, staff morale, and even the quality of care patients receive.

Cross-training to the rescue

In many practices, existing staff must pick up the slack when there is a vacancy.

That requires cross-training in various jobs, says Melissa White, practice administrator at Newton Family Physicians in Newton, N.C. The practice has six physicians and four nurse practitioners supported by a non-clinical staff of 12. “Everyone is cross-trained in at least one job and many in two,” White says. “All of us can do something else or everything else. It’s a condition of being in private practice.”

For example, the practice typically has two people working the front desk, but three others can step in as needed. The single checkout employee has two backups, and so on.

All employees must embrace cross-training as a condition of employment, White says. “We make it very clear that it’s a team effort and if you aren’t willing to be part of the greater good, maybe it’s not a good fit for you,” she says, adding that she once fired a staffer who was good at her primary job, but who wouldn’t train up to the required level in a secondary role.

It’s a similar story at Associated Physicians, a 20-doctor independent practice in Madison, Wis. Job applicants are informed they’ll be cross-trained and the training begins immediately when the person is hired, says Executive Director Terri Carufel-Wert, RN, MHA.

The practice sends new employees to its EHR provider for training and pairs new workers with veteran employees. Staff members also have monthly online training in their own specialty and others, and employees are asked to share their knowledge with each other.

The practice also solicits employee input on such things as the best ways to learn and what skills are required, says Business Operations Manager Margaret Wilkinson, CMC.

Detailed written descriptions of office procedures and policies are invaluable for training new staff members and getting temps up to speed quickly, adds Lucarelli.

Hiring temps

Many practices turn to staffing agencies to fill vacancies. This can be a fast and easy way to find a credentialed temp, but has drawbacks, such as the expense and work restrictions.

Lucarelli has hired temporary workers from agencies to fill vacancies, but prefers not to. Her quarrel is not with the quality of their work, but the extra cost and the restrictions on their duties. Office temps cost 50 percent more than regular staff once the agency fee is included, which is more expensive than paying overtime to an existing employee, she says.

She also doesn’t like that temps work under a contract that can limit their hours and duties. While an employee might stay late to get a job done or help out, temps tend to stop working as soon as their shift ends, she says. And she once had a temp skip a day because her contract did not require her to come to work if it was snowing. “And this is in Wisconsin,” she says.

“They’re not beholden to your employee handbook; they’re beholden to their employer’s contract,” she says.

However, using temps can save staff from overwork and burnout while keeping the office functioning at a high level, says Nick Fabrizio, PhD, FACMPE, a principal with the Medical Group Management Association Health Care Consulting Group.

He recommends asking other practices for recommendations for reliable staffing agencies. When using an agency, be explicit about the work the temp will be expected to do and make sure the person they’re sending has the necessary credentials and experience for that job, he says.

It’s also a good idea to request that the temp be familiar with the EHR system the practice uses because training a temp on an unfamiliar system can be time consuming and place an additional burden on the staff.

If a practice has to repeatedly use an agency it should request the return of any previous temps who have performed well, proven a good fit with the practice culture and are already familiar with office operations, Fabrizio says. The less time spent bringing a temp up to speed with policies and procedures, the more time they can spend working and the more smoothly the office will run.

Temp agencies can be a good way to scout new employees, says Carufel-Wert, who has hired billers and coders from their ranks. “That’s been nice because you’ve been able to try them before you hire them,” she says.

Float pools

To avoid the extra expense and uncertainties of a temp agency, some practices rely on their own “float pools” of workers who can fill in for a single shift, a week, or even months. These people often have other jobs, but are looking to earn extra income.

Lucarelli says she is always on the lookout to add to her pool of former staff members, friends they’ve recommended and even
patients who can fill in short-term. It helps to stay on good terms with former employees so they’re willing to return, she says.

Avoiding staffing shortages

While some staffing shortages are unavoidable, many practices do what they can to reduce turnover and shortages.

A leave doesn’t always mean the employee can’t work at all. While she was on maternity leave, Lucarelli’s clinic manager still managed payroll and other business office functions on a part-time basis.

If a staffer gives notice at Associated Physicians, Carufel-Wert and Wilkinson will talk to the person about their reason for leaving and sometimes make changes to persuade them to stay, such as more flex time or even a raise. That’s easier and less expensive than hiring a replacement, they say. Of course, any accommodation must be reasonable and can’t have a negative effect on the rest of the staff.

“I’m not going to be held hostage by an employee’s demands,” Carufel-Wertz says.

Associated Physicians surveys salaries in its market to make sure its pay is competitive. It also pays for employees’ continuing education programs and sometimes gives raises if an employee acquires an additional skill.

Of course, staffing shortages can happen to the best-prepared practice. In that case, Wilkinson says, “You put your survival mode hat on and do what you can do.”