Seven healthcare providers recently joined Becker's to share how ongoing staffing shortages and layoffs have affected how they practice medicine.
Editor's note: Responses have been lightly edited for length and clarity.
Question: How have layoffs/staffing shortages changed the way you practice medicine?
Stephen Amann, MD. Digestive Health Specialists (Tupelo, Miss.): We have had to do our best to be forward thinking to maintain our staff and support. We have spent years working on our level of care that our patients expect we have desired to deliver. Fortunately, we have been able to do this and actually have growth as well.
For the past year or so, this has included pay improvements for all staff, multiple times, despite our overall decreases in revenue from Medicare. We have also tried to improve employee "team building" within the organization and open dialogue for ideas and improvements, which help with employee satisfaction. The lack of availability of healthcare personnel for hire has put a strain on our services, and fortunately our staff have always supported our mission. They have done a terrific job and are incredibly dedicated. We have adjusted our benefit structure to support staff and continue to look at this actively via our administrative team.
Long term, we are looking at ways to improve efficiencies and service with technology and try to lessen burdens on staff. We are looking at ways to help staff acquire practical knowledge, training and experience so that new opportunities for growth and advancement will be available to them in the practice. From the physician or provider perspective, these issues are also important, especially in GI with an aging physician force. We are developing options for providers to continue to work and enjoy their field but maybe in other capacities for the group. With that in mind, we may need to evolve with newer ways to provide care compared to the full-time traditional roles.
Patrick Botz, DO. Family Medicine Physician at Ascension St. Mary's (Frankenmuth, Mich.): Two years ago I had two medical assistants and a scribe. Because of staff changes and difficulty getting qualified MAs, I am down to one MA — my former scribe. She deals with everything, including preparing the chart, insurance issues including prior approvals and getting patients' in-room phone calls and everything in between. She's pretty amazing. After eight months with only the single MA, I may be getting a second MA. A scribe is too much to hope for at present. The whole clinic is short three MAs. In my particular instance, I see a few less patients a day. I want to avoid burning out my single MA. I also do more administrative tasks. It doesn't help that we are in our sixth week of converting to AthenaHealth EHR with inadequate support. With these issues, insurance prior approvals and other insurance hassles and medication cost and affordability issues and increasing administrative work and reporting, I will retire at the end of June 2024. It's all discouraging.
Michael Gomez, MD. Medical Director of Orlando (Fla.) Health Winnie Palmer Hospital NICU: I am fortunate to work with two great organizations (Orlando Health and Pediatrix Medical Group) in my current leadership position that understand that to do a great job taking care of patients, we need a fully staffed support team of nurses, respiratory therapists and all the other team members that keep a complex neonatal intensive care unit working. We are not currently laying off anyone; rather, staffing shortages that plagued us throughout COVID times have largely been overcome with aggressive hiring practices to get our staffing back to necessary levels.
When staffing shortages were present, we also had a huge number of complex patient issues and record patient volumes to deal with. I knew that the staff we had were extremely dedicated to the organization and very committed to getting the best results, so we cross-covered everywhere we had to, assumed new responsibilities, and found creative ways to get things done knowing we were growing a stronger, more dedicated team in the process. Tough times make you appreciate what you have even more, and teach you the great things you can do when you integrate roles and tasks which actually builds stronger teams when you overcome challenges by learning what you can accomplish when you work together.
Susan Lee, MD. Medical Director, Stony Brook Primary Care (East Setauket, N.Y.): Staffing shortages have been a challenge to those of us who practice ambulatory primary care. We have had to really look at our staffing ratios and cross-train staff to do more. For example, our medical assistants will not only be involved in performing usual floor responsibilities but also assist with previsit planning and chart documentation. I appreciate that despite our staff shortages we work more as a team now.
Taif Mukhdomi, MD. Comprehensive Interventional Pain Physician at Pain Zero (Columbus, Ohio): Fortunately for private practice, we haven't seen the same staffing challenges as hospital systems. With recent reports alluding to culture in the workplace affecting overall job satisfaction and patient outcomes, private practice is poised for growth. Our practice of medicine has only expanded to include more reliance on technology through remote patient and therapeutic monitoring, scheduling appointments and incorporating these advances into workflows.
It's no surprise that layoffs and staff turnover negatively affects patients and quality of care. I'd imagine with staffing shortages, employees would have increased workload for the same compensation that can lead to burnout and turnover. Turnover is a challenge in any business, but when companies have staffing shortages yet revenue has increased on balance sheets, it's hard for administration to make a change. As a physician, our priority is always the patient. It has been ingrained within our training for over a decade, and perhaps companies and employers know that.
Amee Patel, MD. Allergy and Clinical Immunologist and Assistant Professor, Department of Medicine, at Loyola Medical Center (Chicago): I think in today's world of a constant turnover of staff, I have learned (and am still trying to master) the art of fluidity and adaptability in my practice. In an ideal world, I would have ample (at least two) dedicated staff trained in my specific subspecialty, and this would allow more productivity and efficiency as well as a more individualized approach for each patient since there is enough personnel to cater to more requests of patients. Now, since there are shortages across the bar, I have learned to triage what is most necessary for staff to assist me with in terms of clinical patient care and then allow what is more of a luxury or nicety that is not an absolute must for patient care to be lesser on the priority list. For instance, when I had two dedicated nurses in the past, I could help patients schedule their imaging CT scans or discuss lab results through staff or myself via phone calls.
Currently, with a limited team, I can provide phone numbers for patients to schedule imaging on their own and I can securely message via EMR about results, but the personal touch is less due to the limitations of how much can be accomplished with the volume of patients and a bare-bones minimal team. I also use technology more by messaging via EMR, substituting laboratory evaluation in clinical scenarios where predictive values are comparable to in-person skin testing results, or using video visits where there is less ancillary staff requirement.
In a field such as allergy/immunology, however, having shortages can be quite arduous for a practice to recover from since staff is assisting in many procedures that are done concomitantly while the physician is evaluating patient consultations.
Hopefully, technology can help bridge some of this gap moving forward in new and unique ways since the shortages and mass exodus of staff (and physicians) from clinical practice does not appear to be slowing down anytime soon.
Virginia Schmidt, MD. Family Medicine Physician at AHS Family Health Center (Chicago): Staffing shortages make the work harder for those still on the job, especially people on salary who now have to work longer hours. Patients may not be able to see their own provider or may have to wait longer for an appointment. I've had colleagues tell me that they have seen situations where their support staff said they were told they cannot do overtime and had fallen behind on their inbox.
I think it contributes to provider burnout.