It Figures Podcast: S4:E17 – Medical Staffing Crisis

Speaker 1:

From Carr, Riggs and Ingram, this is, It Figures the CRI podcast, an accounting advisory and industry focused podcast for business and organization leaders, entrepreneurs, and anyone who is looking to go beyond the status quo.

Bryan Hall:

Well, thanks everyone for joining another one of CRIs It Figures podcast. I am Bryan Hall, I’m a partner with CRI and also the healthcare industry line leader for the firm. Today, I have Georgina Perry with me. Georgina, would you like to introduce yourself?

Georgina Perry:

Sure. Hello everyone. I’m Georgina Perry. I’m the director of Physician Services with CRI.

Bryan Hall:

Georgina today, we want to talk a little bit about a topic that I know is very near and dear to you. At this point we’ve been through the pandemic. We’ve seen how a lot of things are changing or have changed and we’re just getting our arms around what this new world looks like in healthcare. Your practice specialty is physicians and physician groups and clinics. Tell me a little bit about the challenges that they are seeing post pandemic.

Georgina Perry:

I think the most talked about area within the clinics these days after the pandemic is staffing. Staffing is at an all time, I guess low. There is a high need for staff, whichever way you want to think about it. I know that that’s been a hot topic. Where can we find staff? How can we fill these positions? What can we do to reduce our patient waits?

Bryan Hall:

Sure. That doesn’t seem too much different than accounting firms.

Georgina Perry:

Right.

Bryan Hall:

That’s the name of the game. But with regards to physicians, physician practices, clinics, what are you seeing them try to do to rectify this issue?

Georgina Perry:

Well, I think everyone’s initial gut reaction is to just make do with what we have. I think we all did that during the pandemic and maybe a little bit after. It wasn’t really until we started realizing that people are not coming back to their original jobs. Especially in healthcare, there were a lot of people who left healthcare during the pandemic and are not coming back. I think that is something that’s unique to the healthcare industry.

Where I know a lot of industries are struggling with staffing, that’s specific to a worldwide pandemic with the healthcare industry. A lot of folks were just trying to make do with what they had. Stretch their staff for just a little bit longer just until that person comes along. The other thing that we saw a lot of over the last couple of years was really high wages. People were paying twice what they would have five years ago for say a medical receptionist or a medical assistant or a billing clerk. Those prices I think were pandemic induced, panic induced. They are not sustainable though for most small clinics and medical practices. I think neither of those have proved to be long-term answers to the problem.

Bryan Hall:

Sure. In your opinion, why should we as a country, as an economy be focusing on this specifically for healthcare? We hear all the stories or read all the reports, this staffing crisis, record low unemployment, that’s affecting everything, every industry. But why should we be focusing on healthcare specifically in your opinion?

Georgina Perry:

I think healthcare affects everyone. Healthcare has to work because people are going to get sick and we have to make sure that everyone has access to healthcare. I think hospitals and clinics of any size, any location, whether they are serving wealthy or indigent populations, they have to be able to provide care. I think really that’s why everyone needs to be talking about this and paying special attention to it, especially if this is your industry where you work.

Bryan Hall:

Sure. I guess we had probably layer on to that, the continuous aging of the US population and our demographics and obviously the health results that we have currently. This is definitely a bit of a crisis situation and could get worse if we don’t rectify these issues like you mentioned. Just give us a couple points that you think that physicians, physician groups, clinics, et cetera should be doing now to solve this issue. Then maybe we can talk about later on the long term after this.

Georgina Perry:

Sure. I think the first thing we have to think about is holding onto the staff that stuck out the pandemic with you. What can you do to make sure that they have a rewarding career and not just a job to show up to? I think there were some bridges burned and hurt feelings when staff caught wind of the much higher wages new staff were getting paid. Signing bonuses that went to newer staff. I think looking at what you’re paying everyone, make sure that there is some parody there between staff who have been there for a long time versus staff who just got there. I think also making sure that they feel like they’re part of the whole. That they understand how their piece fits into the bigger picture. I think…

Bryan Hall:

What about technology? Is there a technology solution to any of this?

Georgina Perry:

Definitely, definitely. I think that’s the newest part where people are actually starting to pay attention to, maybe consider and utilize some of this new technology that’s been around for the last few years. I think prior to the pandemic, people maybe were not so interested in a virtual scribe or a virtual scheduler. Or an automated appointment system. But I think now with the staffing shortage, people are starting to look at these new technologies as viable sources to fill these holes where humans just are not available. I definitely think looking at technology, looking to automate any processes that you can, will definitely help fill those holes.

Bryan Hall:

Sure. You mentioned getting more out of your current staff is always the gut reaction. But is there any way that practices can create more efficiencies with what the people that they have and what they do?

Georgina Perry:

Sure. I think now is a great time to take a step back and look at all of the processes that are in place. Whether they are formal or informal processes. Look at how information is passed through your office. Look at how the patient goes through the patient visit through your office. Look for areas that have maybe inconsistent outcomes that should be more consistent, more predictable outcomes, and look at ways that you can make that process more finely tuned so that it is a predictable outcome every single time.

I think also you can look to see where is your most experienced and quote, unquote “best employee” getting pulled. That maybe he or she doesn’t necessarily need to be pulled. If you find that someone is constantly being pulled from their current process or their daily routine to help someone else or to help another department, there’s a deficiency somewhere else that’s keeping that first person from working at their highest use, their highest level of what they’re trained and allowed to do by license.

Also, maybe it’s just not efficient for a person from maybe a clinical lab to walk all the way over to a triage nurse to come get help with something. That might physically not be efficient to spend that time walking around and grabbing somebody else. We assess that there’s a problem there. There’s some sort of breakdown in one of the processes that needs to be addressed.

Bryan Hall:

Sure. You work with a lot of physicians, physician groups. I understand you have, your whole career. We know that what physicians want to do is they want to treat patients. That’s what they’ve been trained to do and in a lot of cases they have not been trained. They don’t have the skillset or they shouldn’t expect it. Should be expected to have it to analyze, to understand this data, to look at actual process engineering of their offices and gain efficiencies. What would you advise a physician or a physician group to do to make their practice a little more streamlined and get the most out of what they have?

Georgina Perry:

I think that’s where the physician needs to lean on their administrative support, whether that’s their practice administrator or reaching out to consultants. You really do need someone who’s on the outside. That’s definitely not a skill that they teach in medical school. It’s not something that most physicians or practice leaders are going to be skilled with. You are going to have a skill set that’s able to assess those types of improvements that are needed.

They are the ones who can identify that the process is not working. Everyone is stressed out. Everyone is pressed for time. Things are not getting completed in an appropriate fashion. That’s what your physician leaders are going to notice. Reaching out to groups such as CRI with our consulting services, this is something that we do day in and day out. Like you mentioned, I’ve been doing this for almost 20 years, working with medical practices, looking for inefficiencies and looking at ways to improve the either patient experience, the workflow or the staff experience.

Bryan Hall:

Sure. Just to summarize what I think I’ve been hearing here is that at least in the near term, there’s no magical solution that’s going to come that’s going to provide a lot more staffing. It sounds like that the physicians and physician groups do need to get more out of current staffing or the staffing that’s available. However, it sounds like you’re advising them to do it in a more thoughtful and scientific way using automation, using available softwares. Really taking a look at the process of treating the patients in their office and making sure that all the pieces fit and that everybody’s doing the highest and best use of their work. Did I understand that correctly or did I miss anything?

Georgina Perry:

Yes. No, I think that was a great summary. I think just to rephrase, you can’t just put more work into the same process and expect it to work. A lot of these processes only work for an old-fashioned run clinic or maybe a paper chart clinic. There’s so much new technology and there’s so many new innovative ways to do things. I think now is the great time to really see where you can make changes in your practice.

Bryan Hall:

Georgina, you’ve been talking a lot about staffing and physicians and group practices and clinics getting the most out of what they have or the folks that they have the ability to attract and hire. But what about the physicians themselves? Especially in maybe a smaller practice or even in a larger practice, how would a physician or a practice leader understand if a physician is getting the most out of their day in terms of what their patients they’re seeing and also are they seeing the right types of patients? Is there a capacity or efficiencies that can be gained by moving patients between physicians? What data is there to look at that?

Georgina Perry:

Sure. I think that’s a great point that we’re not just talking about the staff needs to be as efficient as possible and work to their highest level. This is everybody, all providers. This is physicians, this is nurse practitioners. Everyone who’s in your clinic. I think there’s room to assess each of their processes and technology that’s used. We haven’t even talked about the EMRs. I know a lot of providers complain so much about having to click so many times to get to this page to write the one note or to send the prescription.

This is a perfect time to look and see are you getting the most out of your EMR that you could? There are a lot of times other updates that come out or new programs that come out through your EMR technology that need to be implemented in order to take advantage of them. There are also national benchmarks that we could look at to see if your physician or nurse practitioner is hitting the mark with their volume. I think even though we talk a lot about value-based payments and quality over quantity, fee for service is still the way most practices are making their money and volume matters.

That’s the name of the game. We’re trying to get the receptionist to check in as many patients as she can, as fast as she can so the medical assistant triage nurse can get those patients back to the exam room so the provider can see as many people as possible. Again, just opening up the availability for access to healthcare to everyone who needs it.

Bryan Hall:

I think you touched on a little bit of this. If you’re a physician or a practice leader in a practice, that practice has been wide open busy since the pandemic began and we’re wide open busy today, other than our staff walking out the door or the owners of physicians pay going down, what other red flags are there that perhaps the practice is not operating as optimally as it could?

Georgina Perry:

I think you’re going to see patient complaints. You’re going to see staffing complaints. You’re going to see a backup of work. You’ll see a slowdown of payments. It’s going to eventually be the domino effect of just every process in your practice not working as well as it should be or maybe as well as it used to. I think the hardest hit practices are probably the ones that were really killing it six or seven years ago. Everything was fine, but then all of a sudden the game changes. They don’t have as many people. They now have to rely on new technology maybe that they were ignoring and they have to change the processes that were working for the last 15 years.

Bryan Hall:

That’s got to be hard.

Georgina Perry:

Right. It’s a lot of change and change is hard.

Bryan Hall:

Thanks everybody for your time today. Please like, follow and subscribe to the It Figures podcast on your favorite social media platform. We update that weekly so you can find earlier versions and future versions as well. If you have any questions, please reach out to your local CRI advisor or you can reach out to Georgina or myself.

Speaker 1:

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