Melissa Lucarelli, MD, knows what it’s like to run a practice that’s short-staffed.
The family physician in Randolph, Wis., has 12 employees in her office. In the past year, four have gone on maternity leave, including the clinic manager and the claims manager.
“We had to be very creative in how we compensated in order to stay open and keep seeing patients,” says Lucarelli, a member of the Medical Economics editorial advisory board.
It’s a problem most small- to medium-sized practices face at some point: A staff member quits unexpectedly or goes on leave for a long period of time because of pregnancy, illness, accident, or emergency. How the practice compensates for that staffing shortage can affect its revenues, workloads, staff morale, and even the quality of care patients receive.
Cross-training to the rescue
In many practices, existing staff must pick up the slack when there is a vacancy.
That requires cross-training in various jobs, says Melissa White, practice administrator at Newton Family Physicians in Newton, N.C. The practice has six physicians and four nurse practitioners supported by a non-clinical staff of 12. “Everyone is cross-trained in at least one job and many in two,” White says. “All of us can do something else or everything else. It’s a condition of being in private practice.”
For example, the practice typically has two people working the front desk, but three others can step in as needed. The single checkout employee has two backups, and so on.
All employees must embrace cross-training as a condition of employment, White says. “We make it very clear that it’s a team effort and if you aren’t willing to be part of the greater good, maybe it’s not a good fit for you,” she says, adding that she once fired a staffer who was good at her primary job, but who wouldn’t train up to the required level in a secondary role.
It’s a similar story at Associated Physicians, a 20-doctor independent practice in Madison, Wis. Job applicants are informed they’ll be cross-trained and the training begins immediately when the person is hired, says Executive Director Terri Carufel-Wert, RN, MHA.
The practice sends new employees to its EHR provider for training and pairs new workers with veteran employees. Staff members also have monthly online training in their own specialty and others, and employees are asked to share their knowledge with each other.
The practice also solicits employee input on such things as the best ways to learn and what skills are required, says Business Operations Manager Margaret Wilkinson, CMC.
Detailed written descriptions of office procedures and policies are invaluable for training new staff members and getting temps up to speed quickly, adds Lucarelli.
Many practices turn to staffing agencies to fill vacancies. This can be a fast and easy way to find a credentialed temp, but has drawbacks, such as the expense and work restrictions.
Lucarelli has hired temporary workers from agencies to fill vacancies, but prefers not to. Her quarrel is not with the quality of their work, but the extra cost and the restrictions on their duties. Office temps cost 50 percent more than regular staff once the agency fee is included, which is more expensive than paying overtime to an existing employee, she says.
She also doesn’t like that temps work under a contract that can limit their hours and duties. While an employee might stay late to get a job done or help out, temps tend to stop working as soon as their shift ends, she says. And she once had a temp skip a day because her contract did not require her to come to work if it was snowing. “And this is in Wisconsin,” she says.
“They’re not beholden to your employee handbook; they’re beholden to their employer’s contract,” she says.