Rising Ambulatory Volume Strains Understaffed Practices: Report

Steph Weber

February 22, 2022

Despite some optimistic signs, healthcare staffing shortages remain problematic as the nation heads into year three of the pandemic, says a new Medical Group Management Association (MGMA) report (registration required).

Following the "hemorrhaging" of 3100 healthcare jobs in December 2021, the sector added 18,000 jobs last month. More than 80% of new January jobs occurred in ambulatory care settings. Of those, nearly 7 of 10 were in physician offices.

While these numbers are encouraging for understaffed practices, seasonally adjusted Bureau of Labor Statistics data indicate a more dire labor situation. Over the last 5 months, the healthcare industry "showed sustained levels of quits...ranging from as low as 503,000 quits in December 2021 to a peak of 592,000 quits in November 2021, all of which are well above the quits level of 419,000 in December 2020," says MGMA.

By late 2021, 18% of all healthcare workers had quit a job since the start of the pandemic, and 31% of remaining workers had contemplated quitting. Compared to February 2020, healthcare employment has shrunk by 377,000 jobs.

As demand for staffing quickly outpaces supply, many practices are having "problems retaining staff, hiring staff, or both," Ron Holder, chief operating officer for MGMA, told Medscape Medical News. "Practice leaders are hungry for solutions," he says, which prompted MGMA to release the report and to establish a dedicated staffing resource center.

Better Pay, Benefits, and Burnout

Workforce shortages existed before the pandemic, but several factors spurred the more recent exodus as healthcare workers began to "rethink their work-life balance and career plans," according to the report. A December 2021 survey by the Mayo Clinic highlighted the breadth of potential staffing shortages and found that one third of physicians, advanced practice providers, and nurses plan to reduce their work hours. Twenty percent of physicians and 40% of nurses plan to leave their practice altogether.

As a result, 3 in 4 group practice leaders experienced worsening (41%) turnover rates in the last quarter, citing better pay and benefits as the top reason (59%) staff left in 2021.

Additional reasons for turnover were attributed to:

  • Burnout (21%);

  • Retired and/or left workforce (7%); and

  • "Other" (13%), which included temporary leave to care for family, relocation for a partner's job change, and a "desire for remote jobs."

To attract new hires in this "highly competitive labor market," says the report, employers are offering more lucrative compensation packages. Many practices will also need to be proactive in their recruitment and retention efforts and rethink incentives.

"One-size-fits-all employment may not be the way to go anymore," says Holder. "Practices may need to offer [part-time] positions to attract people who want a more flexible or better work-life schedule."

Although patient volume dropped substantially during the initial phase of the pandemic, it rebounded by the end of 2021. However, the workload is now spread across fewer healthcare workers. To ensure current staffing models match patient demand and have "the right staff performing the right tasks at the right time," says the report, practices can look to national benchmarks like the ones published by MGMA. But some practices may benefit from utilizing a staffing-to-demand (S2D) model to determine ideal full-time equivalent ratios.

An S2D analysis relies on in-clinic observations of staff members and tracks the time spent on each task. The assessment is "a highly specific ambulatory staffing model" applicable to any role in the practice, from medical assistants to physicians, says the report, and is designed to ensure each employee operates at the top of their license.

"When you have physicians doing work that a nurse or medical assistant can do or having a nurse do work that a medical assistant or clerical staff could do, your practice will have a higher cost ratio per patient, or relative value unit," says Holder, "and likely be contributing to burnout of the staff at the same time."

Since S2D models combine a task's actual duration with the practice's visit volume, the resulting staffing needs and full-time equivalent calculations are typically more accurate. Another benefit to this model is that the most efficient tasks at each clinic can be identified and then replicated across the group's locations and similar roles, improving patient care quality and, ideally, employee engagement.

Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.

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