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    Christian Green
    Christian Green, MA

    Filling medical assistant (MA) roles has been an ongoing issue for medical group practices. In an April 5, 2022, MGMA Stat poll, 44% of practices noted that medical assistants (MAs) were the most difficult position for them to recruit. To fill this gap, practices needed to be resourceful.
    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “Have you hired alternative staff to cover open medical assistant positions?” A little more than half (52%) of respondents said “yes,” while 48% said “no.”

    MGMA Stat results: 52%25 of medical groups reported hiring alternative staff for open medical assistant positions, per a July 19, 2022, poll.
    The poll was conducted July 19, 2022, with 517 applicable responses. Those who responded “yes” were then asked the type of staff they’ve hired:

    • 32% said they hired non-clinical staff
    • 28% reported hiring certified nursing assistants (CNAs)
    • 23% noted they hired licensed practical nurses (LPNs)
    • 13% stated they hired registered nurses (RNs).*

    *Figures do not add up to 100 due to responses that don’t fall under any of these categories.
    Nearly four in 10 respondents noted that they hired some combination of LPNs, CNAs, RNs, non-clinical staff, and even EMTs and pre-med students to address staffing issues arising from the difficult-to-fill MA positions.

    The impact of a lack of qualified MAs

    Since the COVID-19 pandemic began, many practices have cited that they have had a difficult time finding qualified candidates to fill open MA positions. Whether candidates are demanding higher wages or don’t have the requisite experience, practices have had to be creative in addressing this issue.
    “We have had many MA candidates ask for up to $30 per hour with little to no experience in healthcare, much less our particular specialty,” noted a practice manager in Georgia. “In addition, we are discovering the interview process seems to have changed since 2019 with more than 70% of our candidates failing to keep their interview appointment or even failing to submit a professional resume.” When the organization is able to find qualified candidates, they oftentimes only want to work four days a week at a higher pay rate.
    Another manager with a healthcare system in Georgia said he’s noticed the interest in working in healthcare wane during the past few years. “I have seen a number of staff leave healthcare, the local schools that provide various support staff are experiencing smaller classes, and the potential pool of staff who are graduating are asking for higher wages, often more than we are currently paying or can pay to stay competitive in the current healthcare market,” he said.
    With fewer providers and staff, practices are often forced to cut back on scheduling patients. “Since the efficiency and productivity of our physicians is directly tied to MA support, this affects our ability to expand our clinic patient load,” said a chief operating officer for a practice in Missouri. “Our clinical manager and other support staff have to cover on many days.” 
    Shortages can also impact a practice’s hours of operation. “We were forced to change our clinic hours because we were finding it difficult to meet the need of extended hours and weekend hours … we just could not supply the staff operationally,” said the practice manager in Georgia. Another practice manager in Colorado added, “There have been days that we have had to close the office early or block out certain providers due to being short staffed.”
    This has led to burnout, as providers and staff attempt to fill the void. “It is difficult to schedule time off for them because everyone else then has to shift and accept more responsibilities for that period of time,” said a practice manager in Louisiana. “We have just started this week letting our phones go to the answering service for the lunch hour. That way everyone can get a few minutes to decompress and have lunch.”
    She added that in the coming weeks the clinic will close its doors a couple hours early on Fridays to lessen the strain on providers and staff. “These ladies are mentally and physically worn out and there is no light at the end of the tunnel,” she said. “It seems so inadequate to try to be their cheerleader when I have not produced any relief for them. Lunches being brought in, ice cream parties, gift cards only go so far. They need people to help with their workload, and right now I have nothing to give them.”

    Clinical training for MAs

    As highlighted in the July issue of MGMA Connection magazine, one solution to address MA shortages is creating an in-house MA training program. As Sally Hammond, assistant director, Cone Health Medical Group, noted in the article, her organization reduced its turnover rate from more than 20% to around 10%, thanks in part to its certified medical assistant (CMA) academy.
    “We were very blessed being in a health system. We probably had more of an opportunity to find folks who would like to do this kind of work,” she said of Cone Health’s ability to find providers to train its CMA candidates.
    One of the reasons Cone Health started its program was because the nearby community colleges and technical schools weren’t providing the clinical training CMAs need.
    This was also the case with the Louisiana practice. According to the practice manager, who used to serve on the board, the local community college was the “gold standard” for CMAs four years ago, producing top-level talent. “We always had students who would fulfill their externship hours in our clinic, which in turn gave us great employees,” she said of the mutually beneficial relationship.
    However, enrollment in the two-year program declined significantly, and the community college eventually lost its accreditation. As a result, it plans to reduce the length of the program to seven to nine months.
    “One of my colleagues … has gone back to [the college] with a suggestion of allowing students to not only do their externship in some of the local clinics, but to be paid by the clinics for that time,” the practice manager noted. “We can also contribute to the cost of students’ schooling with a time commitment to our facilities.”
    The community college has yet to respond, while temp agencies and other sources have not yielded qualified candidates. In fact, the practice manager noted that the practice has only been able to retain one new hire in the past 12 months, while another new hire failed to show on the first day and another quit after the first day. 
    “I felt that there must be a problem with our pay, our mission, our facilities, anything that would explain why we are no longer able to staff this clinic,” the practice manager said. “But what I found out from other colleagues was that they were facing the same dilemma.”

    Other MA staffing solutions

    Although Cone Health’s CMA academy has been successful, some smaller organizations might not have the wherewithal to create their own training program. Instead, they may be compelled to use other positions to fill MA roles.
    For example, to help fill gaps in care, the Georgia practice used other clinicians and staff. “In terms of providing vaccines and phlebotomy skills, our physicians and midlevels have had to fill this void, and even our front office receptionists have at times had to room patients. … Even I had to learn how to perform different laboratory tests to ease the stress,” the practice manager explained.
    Other practices have moved completely away from hiring MAs, shifting their responsibilities to nurse practitioners (NPs), for example. As Sally Jordan, chief executive officer, HealthPoint Family Care, conveyed, her group instituted a formal program in September 2021, providing an annual stipend for NPs as an incentive, while extending appointment times to account for the tasks MAs would have done. “NPs have the training and experience to do the work of MAs, such as administering immunizations and point of care testing,” she said of the seamless transition of NPs handling MA tasks.
    Jordan added that 80% of the group’s NPs are participating in the program, which went a long way in resolving HealthPoint Family Care’s staffing issues within a month of implementation. “When surveyed about going back to working with clinical support staff when the hiring challenges are gone, 100% of the integrated NPs said they would choose to continue to work without support staff,” she said. “Many state they are more efficient working alone and the benefit of the additional income as reasons.”
    Further, the organization started a hybrid NP position for recent graduates, which allows those individuals to practice as an NP three days a week and train with a physician in a support role the other two days. According to Jordan, the 10% of NPs involved in this program reported high levels of satisfaction with the additional training from working alongside a physician. Within a year of starting in the hybrid model, NPs are expected to be fully blended into the new NP program, with added MA-type responsibilities.
    Although there are available solutions, the fact remains that qualified, professional MAs have been hard to come by for many practices, which has taken a toll. It starts with reduced morale and burnout among providers and staff, which can impact revenue and eventually patient satisfaction.
    “We all feel that we are falling well short of the high level of patient care and service that we gave before COVID,” said the practice manager in Louisiana. “There simply is not enough support to perform at the standard that we have set for our clinic for years.”   


    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message. 
    Do you have any best practices or success stories to share on this topic? Please let us know by emailing us at  
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    Christian Green

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