The biggest “productivity roadblock” by far, for the leaders of the nation’s medical groups, is staffing, far outstripping other obstacles and concerns. That is the standout result from a poll conducted among members of the Englewood, Colorado-based MGMA (Medical Group Management Association).
MGMA released its latest “MGMAStat” on May 1, based on an online poll of 570 physician group executives conducted online in late April. In it, 56 percent of respondents cited “staffing” as their “biggest productivity roadblock,” followed by “administrative burdens” (23 percent), “patient scheduling” (13 percent), and “other” (8 percent).
As the “MGMAStat” report continued, “One practice leader summed up the challenge to MGMA: ‘There is a shortage in both provider and nonclinical positions. The shortage with providers creates access issues and limits the ability to answer the market's demand; the shortage with nonclinical staff affects the ability for the organization to efficiently move patients through the system and ensure timely reimbursement. With the challenge of increased market pressures of providing low-cost healthcare, raising salaries, and staff leaving the industry for alternative jobs, the acquisition of talented and professional staff is the largest roadblock to the success of productivity for the organization.’”
Further, the report noted, “Medical group leaders who were polled were asked to detail which areas of staffing issues had the biggest impact. Not surprisingly, several gave some iteration of “all of the above” and cited the restored patient demand for care as COVID-19 cases have eased and pre-pandemic normalcy has returned in many areas of society.
“[There’s] more clinical work than we have providers and staff to address,” one practice leader told MGMA. “It’s near impossible to recruit physicians and APPs — not enough to go around.”
As for who is being impacted by staffing shortages, MGMA wrote that, “When breaking down the specific roles within a medical group that are having the biggest impact on productivity, the much-discussed shortages of physicians, nurses and medical assistants (MAs) did not rise to the top. In fact, nonclinical roles (33 percent) were the top response among the leaders polled by MGMA, primarily staffers in clerical and front-desk positions, customer service representatives, and back-office roles in revenue cycle management. The next largest group of staffers whose absence was cited as a major hindrance to productivity were advanced practice providers (APPs) and nurses (30 percent), followed by MAs. These two sets of clinical team members represented more than 7 in 10 of the responses in an April 5, 2022, MGMA Stat poll of the most difficult roles to recruit in healthcare. ‘Finding and hiring good MAs’ remains a major challenge, according to one practice leader frustrated by ineffective recruiting efforts. “So many no call and no-show their interviews.’”
MGMA found that “Physicians were cited by 16 percent of respondents and were often the first role mentioned by leaders with challenges across the board. ‘[All of the above], but physicians lead it, especially in specialties,’ one respondent told us. Previous MGMA Stat polling from February 2023 found that more than half of medical groups expect to use the same level of contract and locum tenens workers in 2023 versus 2022. The rest of the responses focused on technician/technologist roles and therapists, especially licensed clinical social workers (LCSWs) and licensed professional counselors (LPCs).”
Administrative burdens
The MGMAStat report went on to note that respondents found that administrative burdens continue to hold their organizations back in terms of productivity.
“The list count and complexity of requirements is making it hard to accomplish our work and retain staff related to high-volume jobs,” one respondent told MGMA. Changes in payer billing rules also were frequently cited by medical group leaders as major hurdles to productivity, as well as finding the right team members to respond to a continuing flurry of new patient portal/MyChart patient messages after utilization expanded during COVID-19 lockdowns in recent years.”
Still, the report found, “[M]any healthcare leaders recognize that optimizing schedules and keeping their providers busy will inevitably result in rising needs in this area. ‘More productivity equals more administrative burden — increased lab work, test results to review, returned calls, returned emails — all increases with more productivity,’ one respondent told MGMA. ‘Technology to help streamline productivity requires additional expense for software, IT staff — sadly, most office staff aren't savvy enough to understand the software to use it to its highest level.’”
And, the report noted, “For many medical group leaders, the staffing issues have mushroomed into patient access and scheduling issues in recent years. There are not enough physicians or other providers to see the growing numbers of patients who delayed care in the pandemic, which pushed wait times for appointments further back. As a result, many patients abandoned their scheduled times while shopping for other doctors, causing no-show rates to spike and leaving practices with unfilled slots on their schedules. For others, the post-pandemic world has left them with unpredictable demand for sick visits in pediatrics and family medicine, as well as a new mix in terms of acuity. ‘Balancing appointment types to accommodate complicated patient visits with less complicated” has been a necessity, one respondent told MGMA, “so we can see both volume and provide quality care.’”
Other roadblocks cited by survey respondents included the following: “limited physical space in existing clinical facilities for medical groups that have rapidly added patients”; “higher-than-average training times for newly hired staff keeping them from fully taking on duties as quickly as more experienced employees”; “resistance to workflow changes prompted by staffing shortages” and “burnout among team members from years of pandemic and labor shortage stressors.”
