Spectator

 old stadium stands 

“Hey, Doc, everyone here looks different again. What’d you do? Run ’em off?” He was laughing but I really just wanted to scream in frustration.

It is not funny.

One of the most upsetting things I have found blogging about the difficulties I have had with staff turnover is that invariably I get the insinuation or outright accusation that I am doing something wrong, that I must be the problem. 

The reality, as I have mentioned, is that I have very little control. Most days it feels that I am a mere observer, showing up to the clinic to see what new staffing drama unfolds.

Two weeks ago I was told by a VP that there is a 46% turnover for medical assistants and front office staff within the first 90 days of employment across our system. System wide? 

Those numbers make my own clinic problems look so much better.

Why is it so high for our system, though, I wonder? My theory is that corporate makes it very difficult to reward good employees and very difficult to get rid of the bad ones. That magnifies the stress experienced by every single member of the team. 

Here is a 2004 article that cites a 53% average staff turnover in 2 years for medical practices and it mentions that network affiliated practices experience higher turnover than independent physician offices. That was 12 years ago. I wonder what the numbers are like now?

I don’t have any published data as far as our specific organization is concerned. No proof. I just have to take this VP’s word for it. He quoted the same numbers again the other day so maybe it is real.

Sure made me feel a bit better, though, even if it does not really solve my problem. It isn’t really all my fault, after all. There is something wrong with the system….

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107 thoughts on “Spectator

  1. Staff turnover in doctors’ offices is constant. At least it is in my vast experience. Part of that, I’m guessing, is that the good ones, the smart ones grow in the job and want more responsibility than they can get in a physician’s office.

    Liked by 2 people

  2. It’s the Healthcare system over all. In 15 years of surfing as a CNA in long term Healthcare facilities, I have seen the best of the best and the worst of the worst. And the most horrible part is the worst employees are the ones that take the credit of the hard working ones, and the hardest working ones get the shit end of the stock, causing burnout and even termination did snapping at management for what management purposefully ignores.
    And in the end, it is the people we take care of who really suffer the most. You must only spend X amount post person each visit while I am only alotted X amount of time to each resident for care. We have to cut time corners and that makes us look uncaring because bottom line-it’s corporates bottom dollar that means the most. Not the floor staff or the doctor or the staff in other departments, and most of all NOT the ones receiving the care.

    Liked by 2 people

  3. The only thing I can say Dr. is; Years ago in my working years, people valued their jobs and those in charge valued their workers. I believe today’s generation wants the fast buck, I don’t think they value the job itself. Unfortunately it’s all about money.
    I was one of the last group of folks retiring from AT&T and I guess I was lucky. I remember hearing that the company now has a new motto, “turn em and burn em.” You have to work there 5 years to get vested, many today do not make it that far so their attitude is different. I am not saying that is the case in your clinic, but more the attitude of the working class folks now.
    Many companies have a big turnover and if someone snickers just ignore it. It is what it is and out of your control. But, keep venting it’s good for the psyche. :o)

    Liked by 1 person

  4. Hmmm, complex problem Victo. I would suggest that if you feel disconnected from your staff that they would definitely feel disconnected from you. Your company obviously differentiates between office staff and doctors. This happens a lot at universities too where administration staff are very separate from teaching staff. The problem that this creates is that admin is seen by ownership as being a cost center – they provide no billable service to the patients. The doctors, however do produce revenue by their interface with the patients and hence are viewed as revenue centers. Employees are super sensitive intuitively of their position in the workplace and I’ll be honest, if my work were seen as dispensable,I’d find another place to work too. And that is how your organization seems to view the administration. Cost centers are always tapped for reductions in costs and hence increases in profits. Revenue centers are given more to increase revenue and hence profits. See the difference? Here in Canada when our postal system was government mandated and funded, every stamp that was sold was seen as a cost and so the service to the customer was poor because that was the way to reduce costs. When they went private and were required to show profits, then the service and positive culture increased dramatically. Now selling an extra stamp to a customer is making moire money for the postal service. It had become positive instead of negative because of the switch from cost center to revenue center.

    Liked by 2 people

    • Example of frustrating things:
      Corporate says I have to give a 7 min grace period before counting someone as tardy. The only way to get everyone here to start on time is to make their start time 7 min prior to our actual start time. THAT, however, creates overtime issues which they don’t want. So then do you just not put a patient in the first AM slot and have 20 fewer patient encounters per month, which they also don’t like, or run perpetually late all the time which then affects patient satisfaction which they don’t like.

      Liked by 2 people

      • That’s a pretty typical problem with shortsighted management who try to increase profits by decreasing cost center spending. Cost are what is incurred in order to generate profit – they miss that sometimes. I use a handicap transportation service offered by the city. A while back I was still working and worked only 5 minutes from where I lived. This service is 95% taxpayer funded – which means the poorer service they give the less it costs. Anyway I had a 6:30 pickup time so i could be to work by 7 am. That was the earliest that the service would schedule a pick-up. They had a service guarantee of pick-up within 30 minutes of the appointment time. They would dispatch a driver from their shop – which was 20 minutes away – at 6:45 for my 6:30 p/u. The driver arrived 5 minutes after 7 every morning. When I called to complain they said that the service had a 30 minute window and 5 minutes over was not unacceptable. If this was a customer funded service, with competition, do you think they would say that? No chance. It was a cost center for the city – hence poor service. Your admin is perceived as a cost center by Head Office – therefore poor service and lousy culture and late.

        Liked by 3 people

  5. As soon as outsourcing and streamlining became the vogue, employees have responded by no longer showing one-sided loyalty. Most patients do not realize that their doctor doesn’t have more control over the situation.
    Of course, I also know some medical staff who are certain the doctor is very much part of the problem, so I would think it must vary depending on where you go.
    Many people still think private practices are run by the doctors who affiliate with a group but still control things, and that is rarely the case anymore.

    Liked by 1 person

  6. I heard that in orientation they are saying our hospital turnover rate is around 30%. While that doesn’t surprise me, because this place sucks, I don’t really think it’s a selling point to new hires. I have seen all sorts of bat shit crazy employees not get fired. And the best employees quit because of drama. I swear we work for the same corporation. 😉

    Liked by 2 people

  7. I’m sure there must be a lot of stress in those clerical jobs, Doc. They take some of the abuse of unhappy patients and are pretty much powerless to solve their problem. Maybe ? If you find the answer to the very complex issue, you’ll be lauded by HR personnel forever. ☺

    Liked by 1 person

  8. My daughter works for an OB/GYN in Colorado. Prior she worked for a GP in Florida for 8 yrs. She said the turn over is disturbing. It’s like a family and it’s hard to leave. I guess she’s the odd man out. But people seldom left because of being poor fit with the Dr. but a poor fit in the specific area field to newbies not sure where they belong yet or the field they want to be permanent in. I’d be offended if people assumed my staff left because I was the common denominator as well.

    Liked by 1 person

  9. If someone from HR did exit interviews on the people who left, they would probably gain a pretty good understanding of they’re leaving and hopefully correct the situation. Unless they don’t care enough to want to know. That’s always possible. Turnover statistics alone don’t give you reasons. They only complete reports.

    Liked by 1 person

  10. What I remember from my old management days is that turnover is incredibly expensive – all the down time and hiring time and retraining time, the stress. It makes so much more sense to address the core issues (job quality, time off, pay, etc.) than to perpetually rehire and rehire. Clearly it has nothing to do with you, but it sounds like you’ll have to continually deal with it. 😦

    Liked by 1 person

    • I tried to give a raise to one of our star employees, the only medical assistant to stay after the mass turnover last year, and was told we could not because she had received a raise earlier in the year and the raise could not exceed a certain percentage of their income per year. These sorts of policies get more and more restrictive each year.

      Liked by 1 person

  11. My husband has worked in hospitals, long-term care facilities, hospice, and MASH units while in the service. THE ONLY place he has ever felt as if he is a valuable member of staff (outside of his Army service) is with a small non-profit hospice. He worked at a major metropolitan hospital that put patient care first and loved it; turnover was minimal. When it was purchased by a large conglomerate the atmosphere changed to a money-oriented workplace and the change over of employees increased rather dramatically.

    Liked by 1 person

  12. I so get what you are saying. We have a new initiative to do something about retention. It is part of our Culture of Improvement which I am the Captain…. (“Eiy Matey”) We are employing Lean operatives to look at our employee turnover. (Don’t cha just love the Corporate Lingo…) The hardest area hit is our Home Health Aides. Turnover rate currently is about 27% but I think that is under inflated. We know we had 34% leave within the first six months. The finger pointing is interesting. One reason is that they say is that they are not getting trained correctly, which is not true. I fire back to HR you hire anyone who has a pulse. We all are trying to beat a numbers game. The bottom line is that it is a crappy job with crappy pay and crappy hours. If they go to a minimum wage of $15.00 an hour, we will have to close the program. We will not get candidates. There is no future either for an aide. Once an aide, unless they go back to school, they remain an aide. We do not offer tuition anymore as part of a success program. They would get their LPN and leave us after their required time was up.
    Our nurse retention is better but they want a 15% level. It’s all about numbers. It costs $54,500 to train a basic home care nurse and on-board them. It takes a long time for that deficit to become revenue. And it isn’t about the bucks either for the younger crowd. They want a decent wage with a level work/life balance. In Home Care, clinicians go home and often are doing documentation at 10PM after the kids are in bed and the dishes are done. The system has become so cumbersome that it is impossible to finish all the documentation at the time of the visit and still make productivity. Then they get hounded because if the documentation is bad, we get money taken away from us… which we could use to pay them better if we had it…. And the circle goes round and round. Health Care is tough.

    Liked by 1 person

  13. I’m not surprised network affiliated practices experience higher turnover than independent physician offices. I bet that trend continues, and it’s a key. The system is sick. It’s a bureaucratic illness.

    Liked by 2 people

  14. Do you think some of it is also students that are wanting to go to medical school and need experience until they are accepted? I know a bunch of people that have worked as a medical assistant, CNA, or front desk assistant for very short periods of time as resume builders.

    Liked by 1 person

  15. Most people dont know the history of HMOs and blame corporate greed for the problems.. Full circle..the blame..in America, lies squarely on our own shoulders..
    Our great/grandparents cleared the path by being led like sheep at the voting box..

    Our parents/grandparents made the decision in ’73 at the voting box to take the HMO pill for a cure-all to high health insurance premiums, created by the government.. Ted Kennedy and Nixon helped to father the ugly bureaucratic baby..

    When I began working as a young adult, my folks (along with many ppl) still balked hmos and the new ppos that came on the scene, and shelled out the extra premium costs for quality insurance.. I did too and also made the decision to retain my healthcare costs rather than fall into obamacare today.. Unfortunately, even though my company offers a few different options for health insurance, a ppo is the best for major coverages offered.. I’m grateful that the company I work for cares and works hard for us to have choices..

    Back in ’73 I remember a split between doctors.. The majority of GPs seemed onboard and would cram as many patients in thier schedules.. The patient sat for about 20 mins in the waiting room, then would sit in the office alone about 20 mins and the doctor would come in, give a quick exam, look at the chart and make a diagnosis or order tests, and whisk out, on to the next patient, in under 10 minutes.. That’s the majority, a few GPs would still give quality care by asking questions other than what was on the chart and actually listen to the patient.. Most doctors of specialized medicine disliked this system and now had to make a different type of relationship with GPs and the insurance companies..

    HMOs and PPOs came down hard on physicians for running too many tests and made the process harder for approval.. Greed again raised its ugly head and the majority of doctors just kept herding patients in and out the door, without regard for anything requiring more than a flu shot or antibiotic.. Thier salary of piece rate was now determined by the provider.. And continues today.. With government still complaining and claiming a healthcare crisis that needs addressed.. They (government) created the problem by demonizing the private healthcare insurance companies and the insurance companies went along.. Because they were smart enough to see how this would ultimately be good for them.. Gone is the free enterprise of dollars that can be controlled by the consumer.. Price today isn’t dictated by what you can afford or choose.. The government today will fine you for what they say you can afford, if you choose to have no coverage..

    Our crisis of healthcare is our own fault.. Then and now..

    Then we have Drs like Victo, who struggle in a system, seeing the problems and feeling helpless to address them.. I’m just glad Drs like Victo actually chose this profession.. Their’s is the best care, in a broken system.. And we all broke it..

    People often ask how to fix healthcare.. And they look to the entity that created the problem, to fix it.. Because of that thinking, the problem is fixed.. Just not in our best interests..

    Liked by 1 person

  16. Pingback: My Article Read (4-12-2016) – My Daily Musing

  17. I’ve been at my current pharmacy for over 6 years (4 of which have been full-time). When I talk to outside-of-work friends about the seemingly high turnover, they joke about how I must be the problem causing people to leave.
    But it’s definitely not fun having people come and go all the time. There are so many factors to be addressed though!

    Liked by 1 person

    • It’s the it interesting that we are the problem as we are perceived to be the constant in the revolving door. It is terribly stressful and disruptive when people leave. As you point out, there is not a simple answer.

      Liked by 1 person

  18. It is my observation that many jobs lack an essential human need, the need to feel useful and appreciated. I think this is more important than pay. Tardiness, for example, would diminish if people looked forward to coming to work. Supplying this element is, obviously, a great challenge. If a job is rote, routine, and boring, I don’t wonder that people would look further.

    Some organizations tackle this problem by job rotation. The wife and I regularly patronize a certain delicatessen where the staff regularly rotate jobs, register, kitchen, waiter, and it works. We are on a first-name basis with many of them so I know they are a stable cadre. Then too, they seem to have formed good social bonds with one another, something you can’t really force.

    Applying this to the medical situation is probably extra difficult because most authority is placed in the doctor. In your case, Victo, I might start by asking myself whether there any elements of my own work that I could delegate to my staff. It is just human nature to want to be in control of everything.

    Liked by 1 person

    • There is nothing else I can delegate. Believe me, I would love to get rid of so much! Rotation is also not possible. The front desk cannot work the back for instance. Healthcare is just a tough field, period, so the little things do matter for staff.

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  19. “There is something wrong with the system….”
    You are very right. Its not you. There is something very wrong with environment, with the training, with the pay, with direct supervisor… One or many of these things need to be changed.
    Turnover is very costly, I imagine they must be trying to fix it… surely?

    Liked by 1 person

  20. There is something wrong with the system. Do you remember the days when there was a doctor’s receptionist who was there forever and knew you? Or perhaps that didn’t happen in the States. I blame the Health Insurance companies who make life ridiculously difficult for frustrated patients and stressed medical receptionists and doctors.

    Liked by 1 person

  21. From someone who has felt like a “professional patient” these past few months, I personally believe the problem lies in the bureaucratic insurance machine from hell. But in your case, whatever the reason is, I’m positive it’s not you. I think I can say with 100% certainty that if you had a small, private practice, people would fight over who got to work for you.

    Liked by 1 person

  22. I worked in Heath Care for over 40years…I worked 21 years at one of my jobs, I have held several jobs down at the same time, but I saw so many people come and go in that span of time, the Director of Nurses was a position only held for a length of 3 years max by the same person….burn out, and lack of support from the other department heads was a big part of it….I was in the administration level at the end of my stay and could see up close and personal how insane and illogical they were….no surprise to me of the turn over….and what was even more crazy….I never through away anything, I hauled out surveys and papers from 20 years prior and showed them they were still fighting the same BS as they facility was 20 years ago…..no change = no movement forward…I got married and my husband suggested I give up one of my full time jobs…I flipped a coin and they lost….best decision of my life…..I know its not your fault for the fast turnover, its too bad that the administration level can’t give better incentives to stay….as with everything, it comes down to the dollar sign….I think that business have forgotten you have to give a little to get…..no doubt your an excellent doctor….caught up in the BS of the industry….of course this is just my opinion…..kat

    Liked by 1 person

  23. And turnover itself can be frustrating and stresful to deal with. Always working with new people. The orirntations, and guidance, the time it takes for the new person to fit in the team. All of that can be really frustrating.

    Liked by 1 person

  24. we are dealing with the same problem. My husband also feels like everyone is looking at him for doing something wrong and no being able to get good MA’s… I think it’s everywhere….. hate that part of the job. I expect we will be having another one walk out after I have HR talk to her tomorrow… several times she has a bad day and is rude to people. This time it happened to be to a retired physician from our group. sigh. feeling your pain.

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  25. My Husband is having the same problem staffing his clinic with staff who actually “work.” We talk all the time about the “entitled generation” and how difficult it is to find people who actually have good work ethic… And good work ethic is only the beginning – there are so many other factors that go into having a good fit.

    Liked by 1 person

  26. You have mentioned staff problems before.
    Let me say very clearly: I don’t believe one minute that you are the problem.
    You probably are a (very) demanding Boss, but (I am sure) fair. 🙂
    Turnover may be due to various factors: Job stress? Do you know if the staff changes profession?
    Simple wages issues? Are they paid enough?
    Generational tendencies: if they are young enough to be Millenials (born 1980-2000), those have almost zero job loyalty. There was a report by the Pew research center I read a few years ago.
    http://www.pewsocialtrends.org/2014/03/07/millennials-in-adulthood/
    That is not exactly the report I’d seen but it will give you an idea.
    (If you remind me, I will dig in my archives to see if I might have kept a copy)
    Cheers.

    Liked by 1 person

  27. PS. I’ve been running all week, between stupid things to fix and a couple of posts I wanted to be perfect. That’s it. Posted. And I was saving your weekly digest for last. But then I realize there were only two posts of yours. (And very good) You normally post almost daily. Everything all right? 🙂

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  28. Doc, no matter what business you’re in: if everything is hinged on one person, there’s a problem. I can’t imagine how it could ever be your fault, as nice as you are. Frankly, exiting staff may find that they’re expectations if glory and compensation don’t match up with reality, that there’s stressors they can’t cope with, that the grass is greener somewhere else, that they hate patients (and people, lol), ect. I mean, the random dude who jokes around with you is not clued in on how your industry works cuz as far as he knows you’re the star. Don’t take it personally. Hope this helps some😊

    Liked by 1 person

  29. I have learned from listening to my wife’s experiences in the health field that sometimes all it takes is one toxic employee with a bad attitude to poison the entire work environment making it uncomfortable for all. The worst is when the toxic individual is in a supervisory position leaving subordinates no real option to air grievances. It is unfortunate when employees with a poor work ethic cause the hardworking employees to be overburdened with the bulk of the work load, the unfortunate part being that it is usually the hard worker who quits while the shirker stays on, perpetuating the problem. It is as you said, the physicians have no control over any of this. That’s what HR is for.

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