All medical groups have faced the herculean task of addressing staffing issues amid the COVID-19 pandemic, as the availability of key clinical and administrative workers has ebbed and flowed through labor market changes and waves of coronavirus variants.
An April 5, 2022, MGMA Stat poll asked medical practices what staff role was most difficult to recruit. The majority (44%) said medical assistants (MAs), followed by nurses (27%), administrative/billing staff (18%) and other clinical staff (10%). The poll had 675 applicable responses.
While COVID-19 case numbers have dwindled in recent months, the ability to fully staff medical practices has been a major limiting factor for providers: A Nov. 16, 2021, MGMA Stat poll found that 30% of medical groups were below their productivity goals for 2021, with many citing a lack of staffing keeping them from attaining higher productivity.
Medical assistants (MAs)
A May 4, 2021, MGMA Stat poll found that nearly 9 in 10 healthcare leaders (88%) reported difficulty recruiting MAs, largely on account of many MAs who left the profession, often as a result of rising levels of competitive pay in non-healthcare professions.
In the April 5 poll, medical group practice leaders told MGMA:
- That failure to hire enough MAs has pushed work onto other staff, prompting more overtime pay, higher rates of stress and burnout among the staff taking on extra work, and a vicious cycle of turnover among employees leaving due to longer hours and more work.
- The variability of staffing often causes medical groups to shift operational hours, which can be confusing to staff and aggravating for patients.
- The limits on patient volume cause patients to be unhappy with wait times and potentially impacts care outcomes due to care delays.
The latest U.S. Bureau of Labor Statistics (BLS) Occupational Outlook Handbook projects 18% growth in MA jobs from 2020 (720,900) to 2030 (853,500), outpacing the 16% projection for other healthcare support occupations and 8% estimated growth across all occupations. This decade is expected to see 104,400 openings for MAs each year, on average.
One strategy for bringing more MAs into the industry has been the creation of accelerated MA training programs. A recent collaboration between the State of Nevada and Goodwill of Southern Nevada touts a “90-day MA” training program leading to full-time, paid apprenticeships with Intermountain Healthcare.
Common themes emerged from practice leaders who responded to the April 5 poll:
- A lack of nurses decreases staff morale and causes dissatisfaction among patients who are used to higher staffing levels during a visit in terms of processing medications, setting up referrals and scheduling.
- Vacancies have pushed wages much higher, as well as very high rates for temp agency placements and travel nurse contracts.
- Some groups will close practices one day a week more than normal to spread staff across their locations to avoid cutting hours.
- Time spent recruiting and interviewing candidates has been much higher than in pre-pandemic times.
According to the 2020 National Nursing Workforce Survey, conducted by the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers, the median ages of RNs and licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) were 52 and 53, respectively. Additionally, nearly 1 in 5 nurses (19%) are age 65 or older, fueling a significant number of retirements in the coming months and years.
The strain on RNs before and during the COVID-19 pandemic has also given many pause to consider leaving the profession. A November 2021 Hospital IQ survey points to 90% of nurses considering leaving the profession in the next year.
Complicating the matter further is the recent RaDonda Vaught verdict in Tennessee, wherein the former nurse was convicted of two felonies for a fatal medication mistake. The news has led several professional groups representing nurses to decry the verdict as a dangerous precedent and potentially pushing more nurses toward exiting the profession.
These trends point to a worsening of existing provider availability gaps nationwide and in areas with the highest care-demand projections:
- A recent Mercer report points to a potential gap between lower-wage healthcare occupations (MAs, home health aides, nursing assistants) of 3.2 million by 2026, as more than 6 million of these workers permanently leave their healthcare jobs and a mere 1.9 million join the workforce.
- The same report pointed to an uneven distribution of registered nurses (RNs) based on care needs, with some southern states (Georgia, Texas and South Carolina, among others) projected to have a surplus of RNs compared to projected care demand, whereas states such as Pennsylvania, North Carolina and Colorado are estimated to be more than 10,000 RNs behind projected care needs by 2026.
Other clinical staff
Many practice leaders told MGMA that the lack of technicians and other clinical workers have caused limits on how much diagnostic testing and lab work can be done, leading to increased use of contract labor or outsourcing to major laboratory service providers (e.g., LabCorp).
In some cases, this has led to “constantly changing office hours based on how much help” is available in these areas, increased call frequency from patients and an increase in appointment cancellations due to increasing wait times for access.
One practice leader pointed to updating operations to a four-day, 10-hour work schedule and pursuing more self-check-in options for patients to free staff for other areas of the practice.
Dozens of practice leaders told MGMA that overtime costs have increased for administrative staff, and managers are picking up lower-level tasks more often due to higher competition for frontline clerical roles.
However, the most common concern with recruiting in this area were billing staff, as several practice leaders pointed to difficulties processing claims and working A/R in a timely fashion due to staffing shortages. “Getting qualified billing personnel has caused major issues in reimbursement,” one respondent told MGMA.
As a solution, many said they have outsourced coding and billing to revenue cycle management (RCM) vendors when they were unable to find a qualified person. These responses echo those of a Feb. 22, 2022, MGMA Stat poll that found that 40% of medical practices did not hit their revenue goals in 2021, many of which cited staffing issues holding back their ability to work claims.
Did you know?
MGMA DataDive Management and Staff Compensation provides key compensation benchmarks for job titles throughout a medical group practice, from the C-suite to the front desk. Last year’s national survey included total compensation responses for more than 23,360 MA positions nationwide, as well as hourly rate data from 33,923 respondents. Learn more about this industry-leading data set.
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- MGMA Staffing Resource Center — The latest updates, tools and resources to help your practice navigate through the tight labor market.
- MGMA Stat: Measuring the Impact of the COVID-19 Pandemic — Find all our COVID-19 data stories going back to the start of the pandemic.