In my clinic of three physicians, we have three front desk personnel (one handles check in, one check out, and one posts charges), three medical assistants, a referral coordinator, and an office manager.
You may remember the fact that in November the front desk staff was discovered refusing to schedule patients on the Wednesday before Thanksgiving. Instead of firing them as I was encouraged to do, I authorized a final warning which is the step just before firing. It was nearing Christmas, after all…
Within a few weeks, all three resigned. In some ways this was good. It saved us from having to go through HR crap and unemployment filings.
Interestingly, though, as soon as they were gone our schedules exploded. My partners, who had been struggling to get their numbers up? Yeah, not really a problem anymore.
Following that, one of the other physician’s medical assistants resigned.
Then my medical assistant resigned.
Then the third physician’s medical assistant resigned.
You can imagine that if even one of those people is gone, it puts tremendous stress on all of the other employees. It is rough for a week or two but drag that out into months, and the pressure is just too much. It creates a snowball effect. Staff members start dropping like flies.
Then add to that the exploding schedules. It is one thing if you grow/ease into it. To have it suddenly dumped on you? Beyond stressful.
While trying to restaff my clinic over the past six months, I have uncovered some mind boggling things:
First, we are required to use a “recruiter”. I have heard for over two years that there are “problems” and that the system is trying to make it better. It is just getting worse. Turns out the recruiting company is actually only two employees for our entire healthcare system. 85 openings currently. As it turns out, it does not matter if I give them resumes. Hell, it also does not matter if fully qualified people send their CVs in on the website. I have a position that we have been trying to fill for over five weeks now. After beating the bushes, applying pressure, we were finally given four “screened” applicants, of which two were woefully inadequate and one had already taken a job elsewhere. On a hunch, I had my office manager access the applicant pool for our position.
Over 180 CVs.
That we are not allowed to touch….
Second, while the tradition is a two week notice when leaving a job, at this pace it takes a couple of months to wait for a suitable applicant to be sent over. Once we offer the position to someone, it takes three weeks for them to clear employment screening. Then there is a full week of training with corporate before they ever end up in our office. Overlap these, and a small office simply cannot function. We are crippled.
Temp agencies? You are paying $23-25/hr for someone that would have been only $15/hr, someone who is most likely sub par anyway AND when you throw in our overly complicated, counterintuitive system (seriously, it is embarassing) without any formal training? It only makes things worse…
Third big revelation? If we are told the day before a new hire is supposed to start that they did not pass the pre-employment screening, we are screwed. We have to start the process all over again. The job has to be reposted. Have it happen a second time and we are now at four months looking for someone for this particular position. The system works somewhat for large clinics because they have more flexibility. The work of one person divided among seven is much easier to handle than if it is spread between two.
I have been begging, pleading for help from corporate and none has materialized.
And that, ladies and gentlemen, is only the tip of the iceberg….
Why am I still here?
I get this question a lot, and I have spent a lot of time thinking about this as I have watched the foundation of the clinic collapsing. It is the same everywhere in corporate medicine. I have seen it as I have interviewed for positions in clinics elsewhere.
You don’t know what kind of employee you are really getting from a 20 minute interview. Once you have them it is a hell of a time getting rid of the bad ones and retaining the good ones. Being a little clinic required to play by the rules of a giant, out of touch corporation is the way of things.
I am too old to go solo and insurance companies make it difficult to negotiate lucrative contracts as an individual in primary care. Even crappy EHRs are expensive. Malpractice insurance is expensive. All of the increasing government regulations and mandates and certifications are difficult to keep track of: PCM, meaningful use, PQRS, HIPAA, “shared savings”, CLIA, radiology regulations, Medicare guidelines, Medicaid guidelines, ICD-10, OSHA… I know I must be missing some.
What I want to do is just see patients. Patients are what keep me coming back every single day. All of this other stuff, these roadblocks to good care? I don’t want to even have to think about them. But I do. I have to. They make me stew and boil and….