From cost to care: Why the front desk burns people out

Asked whether the staffing shortages of a few years ago had eased, the panel answered immediately and unanimously. Mehta put it most plainly. Staffing is "the thing that retires me," she said, the biggest issue she has faced as a practice owner and the one that keeps her up at night and stresses her out all day long.

Gordon located part of the cause inside the industry's own habits. She stopped short of calling it gatekeeping, but said the industry puts a fence around itself, screening out candidates who have never worked in a practice, which leaves no route by which anyone could acquire the experience being demanded of them. Then, having finally hired someone who fits the culture, practices put that person at the front desk, "which is a combat position," and burn them out before they have seen enough of the operation to understand why the work matters.

The economics compound it. By Gordon's estimate, a medical assistant can earn comparable pay at a quick-service or retail job, somewhere around $20 to $22 an hour, without getting screamed at about Medicare by a patient who does not understand it any better than they do. Mehta named a structural disadvantage on top of that: much of practice work has to happen in person, in a labor market where a great deal of comparable work no longer does. She has moved what she can to virtual assistants, but some of it cannot leave the building.

What has actually kept people

The retention tactics they offered were specific and mostly inexpensive.

Mehta ordered lunch for her staff every day through COVID-19 and has kept up dinners, birthdays, baby showers and holiday gifts since. Her more interesting move is a stack of $5 to $10 coffee gift cards in each staff member's hands, to be used without asking her first. When the waiting room backs up, they can send a patient across the street for coffee on the practice. It defuses the patient, and it lets the staff member be the one who fixed it.

Gordon treats incentives individually, because people are motivated differently. One employee wants a financial bonus and nothing else. Another wants a certification course paid for. A third would rather have half a day off. She also teaches the front desk at every clinic she works with exactly how the practice gets paid, so the people at the entrance understand their part in whether it does.

Her broader argument is that the industry has to hold itself together deliberately. If she walks past a billing employee having a bad day, she wants to lift that person's head back up, and she said the same obligation runs in every direction, from the front desk to the clinicians and back. Teams that feel invested in as people, she said, are less likely to leave over a small raise elsewhere.

Jacobs argued for protecting time. Shutting the practice down for a staff meeting or an education event costs revenue in the obvious way, and that is precisely the point, because it is legible to a team in a way a memo is not. "Education is a huge, huge cornerstone pillar," she said. She also noted that recognition is not one-size-fits-all: some people want the bonus, others want to be told specifically what they did well and how it landed with a patient.

Lafko's recommendation was the most structural of the four. She makes the case for quarterly one-on-ones with every direct report, a discipline she maintained across 55 people. When her organization asked staff what needed to stay in place for their satisfaction to hold, the quarterlies came back first, because it was "the leader's time to listen to them." Done properly, she said, they also repair the annual review, turning it into five minutes of history and 30 minutes of goal setting for the year ahead.

Her other prompt is simpler and costs nothing. Ask each person how their role connects to the practice's mission, and what part they play in making it happen. That question, she said, is where the answer to a quick-service wage actually lives.

Meet the panelists

Pamela Mehta, M.D., is a board-certified orthopedic surgeon in California's Bay Area who has practiced for more than 15 years and owned her practice for about 10 of them. Resilience Orthopedics is completely out of network, so every cost discussion in her practice happens out loud and up front, before anyone is treated. She also co-founded Learn at Pinnacle, which delivers education to women in medicine.

Shawntea "Taya" Gordon, MBA, FACMPE, is CEO of Atlas & Perpetua Healthcare Consulting. She has co-authored two revenue cycle books for MGMA and sits on the association's Government Affairs Council, which means she moves between the granular work of repairing a practice's collections and the policy fights that reshape them.

Carrie Jacobs, COE, is Executive Vice President of Operations at Chu Vision Institute in Bloomington, Minnesota, and runs the practice's ambulatory surgery center. She has spent nearly 25 years in practice leadership, in a specialty where insurance-covered and elective self-pay work sit side by side on the same schedule, and serves on the board of the American Society of Ophthalmic Administrators.

Amy Lafko, MSPT, MBA, spent two decades in health care leadership across acute care rehabilitation, home care, urgent care and medical group practices before concluding that most operational problems were people problems underneath. She founded Cairn Consulting Solutions and wrote "People First: A Proven Method for an Exceptional Healthcare Practice."

The discussion was moderated by Jean Moody, CHPC, Vice President of Specialty and Wellness Solutions at Synchrony, which owns CareCredit. Moody has spent nearly 20 years with the company and ran a LASIK ophthalmology practice before that.

This roundtable was recorded in October 2025.