As Healthcare Innovation reported at the end of May, “Staffing shortages and staffing costs continue to dog the administrators of medical clinics nationwide, according to the just-published results of a nationwide survey conducted by the Alexandria, Va.-based AMGA (American Medical Group Association).” We noted that a press release published on May 30 began thus: “In AMGA’s new 2023 Clinic Staffing Survey, medical groups and health systems reported a median of 10-percent increase in staffing costs from 2022 to 2023 and that they continue to struggle with staffing levels. The survey revealed that medical groups are addressing clinic staffing shortages in a number of ways, namely through incentives, process improvement, and care model/staffing structure changes.”
“Overall, clinic staffing appears to be stabilizing after the past few years, but a few clinical support roles, such as RN/LPN/MA, remain in a downward trajectory,” said AMGA Consulting Director Elizabeth Siemsen,” in a statement contained in the press release.
The press release noted that “The comprehensive survey addresses both qualitative and quantitative aspects of clinic staffing, and reflects responses from medical groups, representing more than 6,100 clinics. The survey contains staffing benchmarks for typical clinic staff roles with data presented per physician, per provider, per 10,000 wRVU, and per 5,000 visits. It also contains APC per physician ratios. Responses indicate medical groups are looking at incentives to support recruitment and retention, with 88.2 percent of respondents offering referral bonuses, 77.6% offering sign-on bonuses, and 55.7 percent making benefits package changes. All percentages are increases from 2022.”
The senior leaders of clinics are doing what they can to change processes in order to become hyper-efficient, particularly through the leveraging of technology. “Medical groups are also looking at process changes, many with a technology focus,” the press release noted. “Most respondents are working on automation at the front end of the visit process; 90.9 percent reported using an online patient portal, and 65.8 percent reported using self-check-in/kiosks for office visits.”
Non-technological strategies are also being employed. “As they seek solutions to staffing shortages, respondents were also employing strategies beyond technological solutions,” the press release noted. “They shared they are making changes to the care model or staffing to deliver care with a different complement of staff. Data indicate that there was an increase in the number of medical groups making a change in clinical staff team structure, indicating they are taking a hard look at clinic roles and how to optimize them. Results reveal some indication that the tactics have had an impact. Medical groups shared that while staffing has gotten better at the start of 2023, challenges in staffing levels remain. Only 25% of respondents indicated clinical staffing was at 90% or better than optimal staffing, with only 39.5% indicating that administrative staffing was at that same level.”
The survey found that “Clinic staffing was up marginally overall, suggesting a stabilization from the past few years, with many metrics returning to pre-pandemic levels. The overall staffing trend is impacted by fluctuations in both provider levels and clinic staffing throughout the pandemic. The uptick in the data related to the 2023 median total clinic staff per provider may be attributed to an increase in other patient care roles.” Specifically, on a key measure—median total clinic staff per provider—staffing appears to have stabilized, with that figure at 2.13 in 2020, down to 1.83 in 2021, up to 2.03 in 2022, and 2.12 now in 2023.
Shortly after AMGA had released those survey results, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed three AMGA leaders in a group interview: Fred Horton, president of AMGA Consulting; Rose Wagner, R.N., chief operating officer, AMGA Consulting, and Elizabeth Siemsen, director, AMGA Consulting, regarding their perspectives on what was revealed in the survey results. Below are excerpts from that interview.
What was your initial reaction to the survey results?
Fred Horton: We’re really trying to understand where the pain points are, and the potential recovery in the marketplace, and also to see if there have been substantive changes for the medical groups that are relatively stable, for how they’ve addressed staffing shortages.
Rose Wagner, R.N.: I was most interested to see if and how the market was recovering. So I was interested in that.
Were you surprised by the results overall?
Wagner: Some yes and some no. We are seeing recovery, but not as much in some areas as others. Recovery is happening. Organizations are getting more creative in their tactics; but costs are also going up at the same time.
Liz: My initial surprise was that, in the qualitative section, I was actually surprised to hear that things are starting to improve. Hearing that some groups were starting to see the light at the end of the tunnel, that happened sooner than I thought it would.
Fred: I agree with Liz; I was somewhat surprised that some groups were recovering. It’s just so uneven across the country. In our consulting practice, we’re finding that when we’re in areas with a more robust economy, folks can go to newer organizations, or even to non-healthcare offerings, in locations where there’s a lot of technology, or they might work from home.
Elizabeth Siemsen: In the survey, we asked some tactical questions. And we heard repeatedly that some of these tactics were already in place, while others came out of the COVID-19 pandemic. Some of the organizations turning the corner had already been working forward in terms of staffing issues; they were working on those issues already.
Horton: During the COVID-19 pandemic, I had an annual visit, and I went to my provider. It’s a multispecialty group, and they had the queueing lines and registration, and you were given a slip and you handed it to them, and it was so smooth. That organization that I accessed for care, is doing the normal process again now. We had signed in on iPads, and when you were cleared, you got your pass, and you went up. It was very quick. And that queuing station down on the main floor was sized so that it could be efficient and handle the peaks and valleys. But in traditional healthcare, many times, we revert back to where we came from. Some organizations have integrated what they learned during the pandemic, but others haven’t.
That seems to be a distinction between different types of physician organizations right now, right?
Siemsen: And I would add onto that that those who handled those practices are in a better position to work through it a bit more easily.
Are there some specific clinician roles you’re most concerned about?
Wagner: That medical assistant role. Organizations have had to replace them with LPNs or RNs. So they’ve got a higher-paid person doing what a medical assistant could in the past. To be clear, a medical assistant in this context is not a PA [physician assistant: a licensed clinician who can deliver primary care].
Horton: Among the clinical providers, both physicians and advanced-practice providers, there is a shortage, and it’s pretty significant, and there’s a lot of burnout with physicians right now.
Siemsen: We asked people to rank the most disruptive problem, and the MA was ranked number one or two. Disruptions financially and operationally if you can’t have consistent staffing. And the second position was actually physicians, a concern for everyone.
Typically, what kind of background does that medical assistant have?
Wagner: Maybe nine months of training, and they’re certified. They can take blood pressure and vital signs and room the patients.
What will happen in this area over the next two or three years?
Horton: A lot of it depends on the sector, primarily care versus specialty care. Primary care, on the physician side and advanced practice provider side, is really under siege in terms of shortages and difficulties recruiting, and that’s been exacerbated by some of the consumer models that have evolved forward. We’ll continue to see a continued proliferation of those; they’ve hired a lot of physicians and have a lot of different models. And they’re leveraging technology well, and traditional healthcare will have to learn to do so.
And you see the disruption coming from disruptive new entrants into the market like Oak Street Health and so on, correct?
Yes. And telehealth: I have three sons: 26, 24, 22, and what they care about is now. If they can see their primary care physician, they’ll do that, but if that takes too long, they’ll go to urgent care or go to telehealth. So we need to embrace some of those elements, so the products and services…
There is a need to engage in responsiveness to the rapidly growing sense of empowerment among healthcare consumers, correct?
Wagner: There is an embrace of it, and it will continue to develop. You’re absolutely right: some organizations have really embraced it, consumerism, and others haven’t, and those will be negatively impacted as well. I wonder how many goods and services were purchased online pre-pandemic, compared to post-pandemic.
And leveraging consumer-facing technologies will relieve some stress on the staff in clinics and practices, correct?
Wagner: Yes, we’re finding that organizations have had the technology, but haven’t used all the available components, like electronic pre-registration and self-scheduling. And yes, that is the digital front door that everyone’s been talking about, and it’s also the solution, or how they’ll be able to compete with some of the newer entities.
Siemsen: We should also note that 91 percent of survey respondents told us that they were increasing the use of their online patient portals. They had made some initial investments, and consumers responded. And it ties into staffing, because if consumers can handle things on their own time, that will help.
What are the smartest organizations doing to address staffing issues?
Siemsen: Those able to lean into the technology investments they’ve made; the other piece is, what is the pipeline for getting people into the organization? Building relationships with local schools/universities, and focusing also on technology as well.
Wagner: It’s all about hiring all the right people who are a good fit for the organization, and moving towards good retention and employee satisfaction. Get the staff into the door and make sure you retain them.
Horton: And even though it’s not the pandemic anymore, they’re sticking with their plans to continuously improve efficiency, and they’re looking at other models and saying, how can we replicate that in our environment? They’re showing stick-to-it-ive-ness.
Where are you right now on the scale of optimism to pessimism?
Horton: Healthcare continues to be resilient, and organizations learn, and they have capital; I think the traditional environment is able to change and able to invest in the right areas to move forward. It’s just how quickly they can do so.