Aine Cryts

Low pay, no opportunities for advancement and feeling disrespected at work: Those are the three top reasons American workers said “I quit” as part of the “Great Resignation,” according to a Pew survey conducted in March 2022. Other experts have referred to this wave of resignations, which rose to a 20-year high in November 2021, as the “Great Reshuffling,” indicating that these workers simply chose better jobs.

While physicians and nurses are more likely to stick around, your front desk staffer may have one foot out the door. Experts provide a wealth of advice to hire and retain employees—including offering salaries that compete with local retailers, conducting “stay interviews” and offering four-day work weeks.

Chris Garofalo, M.D., a physician in North Attleboro, Massachusetts, agrees that this is one of the most challenging hiring environments his practice has faced. “There are people who are looking for more flexibility. I know when I talk to my patients. Most people don’t want to go back to the office full time, but they don’t necessarily want to stay home full time.”

Still, one of the issues with a medical practice is that it’s difficult to have people working from home. “We need to take care of our patients in the office setting,” said Garofalo.

He addresses employees’ need for flexibility by letting them take a half a day if they’re sick or want to go to their child’s soccer game. “Most of the time we can accommodate that. They don’t necessarily need to take it as sick time. If someone needs to go, we will deal with it later.”

Hiring strategies for front desk and medical assistant staff

Seeking candidates to fill front desk and medical assistant roles is never easy. According to Garofalo, online job boards can be hit or miss. “About 60% to 70% of the people who respond and make an appointment for an interview no-show the interview. Of the people who show up, 30% to 40% don’t have the medical assistant qualification, and we can’t train on the job,” he said.

Recently, Garofalo needed to hire a medical assistant at his practice so he posted the job opening on Everything North Attleboro, a community Facebook.

“My thought was this was more local,” he said. “It’s not just people who are going to apply generically to job postings. I put a more personal touch, and we got some really good responses. That’s how we hired our most recent medical assistant, who has 15 years of experience.”

Another option is to actively recruit employees who want to work as part-timers, according to Andy Swanson, CMPE, vice president of industry insights at Medical Group Management Association (MGMA). “Medical practices have gotten better at flexible staffing in the last 10 to 15 years,” he said.

Swanson expects that many of the people who recently left jobs will run out of money and need to pursue part-time work. At a medical practice, that could look like a 9 a.m.-to-2 p.m. shift three days a week for one front desk staffer, and another team member takes that shift the other two days.

“Not everyone wants full-time work.…Maybe they don’t want to stop driving for Uber or they want something while the kids are in preschool,” he said. Another benefit of this flexible staffing model: The practice can save money that it would have spent on health insurance and other benefits, added Swanson.

Hiring and retention strategies for administrative staff

The average hourly rate for a Target employee in Sunnyvale, California, is $21.80, while a Target employee in Washington, DC, earns $20.24 an hour, according to San Francisco-based Zippia, which tracks salary information for job seekers.

But understanding the local labor market is one area where medical practices fall short, said Swanson. “You’re competing with fast food services and retail. That means your pay has to be at or above [those workplaces], and you can’t pay the median rate of $18 an hour that MGMA says you should pay for your state or region. “

His advice to the practice’s human resources person: “You need to mind-shift and benchmark pay rates to your market, not just to the national average.”

Jennifer Brull, M.D., FAAFP, a family medicine physician in Plainville, Kansas, doesn’t have to compete with Target’s hourly rate because the retailer is a two-hour drive from her practice. But she can offer her front desk staff some lifestyle benefits that are tough to beat: Minimal physical labor is required and the outpatient practice doesn’t require staff to work evening or weekend hours.

It’s just as important to create a work environment where employees want to stay. Many among Brull’s team have remained at the practice for 10 to 25 years. “We have a reputation for being a culturally good place [to work] where people care about you….If you need to be out for a family event, you can do that. You have health care coverage as a benefit. That’s how we try to make ourselves attractive as an employer.”

Hiring and retention strategies for clinical staff

In addition to hiring and retaining administrative staff, physician practices have to recruit and retain physicians and nurses. Twenty-eight percent of health care leaders reported losing a physician to an unexpected retirement, according to a March 2021 poll by MGMA. Meanwhile, the U.S. Bureau of Labor Statistics projects 9% employment growth for RNs from 2020 to 2030; the fastest growth is expected for nurses in outpatient settings.

This is a real-world challenge for Brull, who has decided to leave her practice in November 2022 and hopes to hire two doctors before she leaves. She owns her practice and collaborates with a nearby practice; together they’re recruiting the new physicians.

In addition, a nurse practitioner is leaving the practice in June, so Brull needed to recruit another new clinician. In July, the practice will welcome a new physician assistant who is on course to graduate this spring.

Brull credits her practice’s work precepting physician assistants and nurse practitioners with creating “a pretty big pipeline” for the recent physician assistant hire. “They know who we are. They’re in our practice for a month or more, which is a great way to know if they like us and vice versa. That’s much better than an interview,” she said.

But the practices still need to recruit two physicians. Early on, she and her physician colleagues decided that one of the new physicians should specialize in family medicine with a focus on obstetrics. Besides that, one of the physicians — she’s “an amazing networker,” said Brull — is actively recruiting two new physicians.

She had to work with the nearby hospital to ensure an “income guarantee” for the new physicians and the recruitment process requires “getting us plugged into residency programs across the state,” said Brull.

There are two selling points she’s leaning into as her team recruits two new physicians: Plainville is a rural area with low crime and a good education system, and physicians who choose to practice in the area for four years can have their medical school tuition refunded.

“I grew up in this part of the state,” said Brull, who has practiced medicine in the Plainville area for 20 years. “I moved to the big city for 10 years for training and then I moved back. The only things I miss are the shopping and the food. Now there’s online shopping, which means I only miss the food. And my husband is a great cook.”

Tom Florence, executive vice president of recruiting at Merritt Hawkins, said the company’s physician recruiting business has seen “a tremendous uptick in demand.”

Typically, about 15% of physicians will move or change jobs each year, he explained, but that’s now “hovering in the 25% range.” Florence credits the pandemic with prompting physicians to reconsider what’s important to them. That could be a different location, a different practice setting, different work hours, or the need for flexibility, he said.

When Florence coaches hiring managers, he suggests that they start with a market analysis, much the same way a real estate agent does with a property that comes on the market.

“You want to make sure that the (physician) opportunity they’re providing is viable compared to other physician roles…which includes looking at compensation for a primary care doctor in Boston, for example. If we can’t find a candidate locally, that’s now a national search,” he said.

Beyond salary, flexibility for physicians is critical, according to Florence. “Anytime you can give them set hours or set schedules, they really appreciate that. Four-day work weeks—that’s an opportunity that stands out as well.”

Still, he encourages practices to retain physicians by consistently checking in to see how they’re doing. “Some companies do exit interviews. I encourage clients to do ‘stay interviews.’ ”

Stay interviews are meetings once or twice a quarter where physicians are engaged in a conversation with the lead physician who asks these questions:

Professional information services company Wolters Kluwer also offers advice on recruiting nurses, including the following tips:

Emphasize career advancement by offering new-graduate residency programs and transition-to-practice programs to attract new talent.

Focus on work-life balance, not just the job.

Compensate appropriately, realizing that tuition reimbursement and loan repayment programs are attractive perks.

Offer flexible schedules, which will may help with work-life balance.

Create “nurse ambassadors” who can connect emotionally with their peers in video testimonials.

Create a sense of community where nurses feel they have a voice.

Garofalo is candid about his practice’s inability to compete with larger practices or hospitals that can pay employees more. His strategy: Build and sustain a “kind culture.” For him that means letting an employee leave for the day if their child is sick and backing up an employee if a patient treats them rudely.

Building and sustaining a culture where employees want to work “starts at the top,” said Garofalo. “It starts with the physician-owner and our practice manager. I think we have to model that kind of behavior….We are very protective of our employees. We certainly have had episodes where patients were getting very upset (at employees). We as doctors aren’t afraid to step into that, rather than just delegating it to our employees.”

“It’s important for employees to know we have their backs and we’re there to support them,” added Garofalo.

Here’s some language he has used with a patient who had treated a staffer poorly: “You don’t get to treat employees one way and me another way. You can’t be all ‘nicey nice’ with me (and rude to staff).”

Getting the workplace culture right seems to work as a retention tool, he said. “Over the past four years, we have had three people leave who came back. They got more money elsewhere but they came back here to get paid less. But we provide a better atmosphere for people.”

Successfully navigating conflict among employees also helps, advised Garofalo. His approach to building a “family-type” atmosphere at the practice is twofold. The practice is very careful to ensure the people it hires are a good fit and, he says: “We really try to keep drama to a minimum. We address it. We have our HR person who has no problem addressing it. We make sure that people understand what behaviors will and won’t be tolerated.”

MGMA’s Swanson advises medical practices to think long and hard about the employee value proposition. “That outlines a handful of key drivers in which employees find value, for example, pay, benefits, and vacation, in addition to the career benefit, learning and development, and flexibility with the ability to work from home,” he said.

It can be as simple as practice leaders asking this question: “What are we going to offer on a spectrum of value creators?”

“We’re either going to pay you more…or offer flexibility or better hours. What can we do…to really stand out for the majority of candidates?” Those are the questions every practice leader should be asking, said Swanson.

This article was originally published by sister publication Medical Economics.

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Attracting staff during the great resignation

When a patient presents with oral pain, Jill Morgan’s advice is simple: Ask questions.

That’s because a patient may experience oral pain for various reasons from a canker sore to tooth pain, a wire sticking out of braces, or a burn on the roof of the mouth after eating a hot slice of pizza.

“It’s always the pharmacist’s responsibility to help our patients sort through when an OTC medication is appropriate and when they need to be seen by a health care provider,” said Morgan, PharmD, BCPS, professor and chair in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore.“There are so many [OTC] products that it’s overwhelming. No matter how much burnout there is or how overwhelmed we are with work, at the end of the day, patients are our main priority.”

If a patient arrives at the counter with a canker sore, an OTC treatment such as benzocaine may be appropriate because it will help protect the ulcer while the patient is eating, she explained. According to the Cleveland Clinic, canker sores—which can be painful—are found inside the mouth; they can be caused by stress, a minorinjury, or consuming acidic fruits and vegetables or hot, spicy foods.

With benzocaine, Morgan advised, it is important to tell patients that using too much can cause methemoglobinemia, a condition in which the amount of oxygen carried through the blood is greatly reduced. Patients should not swallow benzocaine because it can increase the likelihood of seizures; this is a greater concern for children and for adults who already have a seizure condition, she added. Because of the risk of methemoglobinemia, the FDA advises against the use of OTC oral drug products for teething infants and children 2 years or younger.

With tooth pain—especially pain associated with having wisdom teeth removed—Morgan explained that Motrin (ibuprofen) should help; still, the pain should not last long and can also be treated using a wet tea bag.

Patients wearing braces can experience pain due to wires poking the inside of their cheek, said Morgan. Wax products can help, along with mouth rinses, both of which are typically provided by orthodontists.

Although Motrin is also an option, patients should see their orthodontist if the pain persists because ongoing irritation from the wires could cause infection, Morgan said. It’s also important to ask patients whether they have a fever or if the cheek area is warm to the touch, recommended Morgan, noting that both symptoms are signs of an infection.

Treating burns inside the mouth can be a challenge. If a patient burns the roof of their mouth while eating pizza, there is not much a pharmacist can do to help. Morgan’s advice for patients experiencing minor pain is to recommend that they drink cool liquids or do a saltwater rinse. If the pain is particularly intense, the patient should see a physician, she said.

This article was originally published by sister publication Drug Topics.

Canker sores. Cleveland Clinic. Updated August 29, 2019. Accessed March 14, 2022. 

https://my.clevelandclinic.org/health/diseases/10945-canker-sores

Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the-counter benzocaine products used for teething and mouth pain and prescription local anesthetics. Updated May 31, 2018. Accessed March 14, 2022. 

https://www.fda.gov/drugs/drug-safety-and-availability/risk-serious-and-potentially-fatal-blood-disorder-prompts-fda-action-oral-over-counter-benzocaine

Mouth discomfort can be especially irritating, but there are some over-the-counter (OTC) products that might be useful.

Aine Cryts

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Attracting staff during the great resignation

Using OTC remedies to manage oral pain