Potential TPS rollbacks threaten physician practice stability

John Dorer, CEO, eb3.work

As if we needed another factor to weigh down physician practices in the U.S., another big shift in immigration policy could do just that. Temporary Protected Status (TPS) was recently stripped for several groups who had previously been shielded from deportation. This gave them the authorization to work here in the United States legally.

While there is some uncertainty about these recent TPS orders as they’re being contested in court, in the end, if they’re allowed to proceed, the disruption would put more than 1 million workers at risk of losing their jobs.

The number of workers who could be affected is worrisome, to say the least. The initial order cleared the way for nearly 350,000 Venezuelans to be denied TPS, as well as 500,000 Haitians, 160,000 Ukrainians, and tens of thousands more from various other countries like Afghanistan and Cameroon. These are not undocumented workers. They are vetted, work-authorized employees who make meaningful contributions to the U.S. economy. Many hold essential, entry-level positions in health care and other industries, where employers already struggle mightily to fill vacant positions.

For physician practices, particularly those small independent practices that are beyond stretched thin, the rollback of TPS protections would introduce new vulnerabilities not only in staffing but also in the world of compliance and even patient care.

Why physicians should care

Worker shortages have plagued numerous industries for several years, and physician practices have shouldered the brunt. Critical staff like medical assistants, billing personnel, front desk receptionists, custodial staff and clinical support roles are the backbone of the practice and, unfortunately, among the most difficult roles to fill and keep.

It is roles like these that tend to be occupied by TPS workers. Losing even a handful of them can present some major challenges for physicians and their practices. Recruiting and training new staff is a costly endeavor. The Society for Human Resource Management estimates that the average cost per hire exceeds $4,000, which doesn’t even account for lost productivity during training. When a front desk coordinator or medical assistant, for example, suddenly leaves, scheduling is disrupted, along with patient flow and documentation. Compliance risks start to grow too, as employers must ensure all staff remain legally authorized to work. If TPS status lapses and practices fail to take a proactive approach, they could unintentionally violate employment law.

For independent physician practices especially, those who manage both clinical duties and business operations, these kinds of disruptions can have devastating effects. Not only is the bottom line put in jeopardy, but so are patient satisfaction and the continuity of patient care.

A shallow labor pool

The possibility of shrinking the pool of workers that relies on TPS would be like throwing gasoline on a raging fire. The labor pool in the U.S. is already contracting precipitously, creating historic shortages of labor across industries, and the reasons are many. The birth rate in the U.S. has been on the decline for decades, while the population is aging. Overall, more workers are exiting the workforce than are joining it. At the same time, the Bureau of Labor Statistics estimates that health care occupations will grow by 13% over the next six years. That’s a faster rate than the average for all other occupational areas.

For physician practices, many of these are entry-level or support roles that the practice cannot do without. And the persistent shortages are already hard to ignore. The Chamber of Commerce reports that industries like health care, hospitality and manufacturing are in the midst of a constant struggle with hundreds of thousands of unfilled jobs. Disappearing more than 1 million legally authorized workers from this already shallow labor pool could make this situation far worse, leaving practices competing for an even smaller share of available workers.

How employers are preparing

It’s easier for larger health systems to absorb at least some of the shocks by redistributing staff or contracting with staffing agencies. These are luxuries, however, for the independent practices, which are often operating with much leaner margins and fewer layers of redundancy.

The possibility of losing more staff, this time tied to TPS rollbacks, means employers in health care need to be extremely focused on cross-training staff so they are able to cover various roles in the practice. Partnering with a staffing agency can help provide short-term coverage, albeit at a higher cost. Review employment records now and conduct compliance audits to ensure that all records are up to date. It’s even a good idea to consider introducing modest retention incentives like flexible scheduling, tuition reimbursement or transportation support to entice existing staff to stay.

At a time like this, these shouldn’t be viewed as luxuries, but as necessary measures to keep practices running smoothly in an increasingly unpredictable labor market.

Exploring lawful, long-term solutions

While near-term solutions are critical to the overall labor shortage, the uncertainty surrounding TPS protections highlights a longer-term challenge. U.S. employers need to create more reliable, lawful pipelines to supply reliable entry-level staff.

In the health care sector, visa pathways such as those offered through the EB-3 category enable employers to sponsor foreign nationals for roles that are difficult to fill at the local level. While the time it takes to process visas can be lengthy, they provide a stable labor source that is also highly compliant. Workforce development is another critical tool, like apprenticeships. On-the-job training and partnerships with local community colleges and trade schools can help build a solid and consistent pipeline of U.S.-based talent. Nontraditional perks, such as day care support for workers’ children, can improve retention even when wages cannot be significantly increased.

The most important point above all else is for physicians to begin planning now. Waiting for the court process to play out and possibly wider TPS rollbacks being allowed to remain in place could cause sudden gaps that may leave practices scrambling.

Preparing for uncertainty

Unfortunately, as is the case with so many things, for physician practices where the challenges of running a small business already include regulatory complexity, financial pressure and workforce instability, not being ready for what could happen with TPS would be a mistake.

This is not merely an immigration issue. For those who rely on these workers, it is a business continuity problem. Those who get ready now, by reviewing compliance, diversifying staffing strategies and exploring lawful workforce solutions, will put themselves in a stronger position for tomorrow.

The health care labor market isn’t going to improve anytime soon. For physicians and practice managers, the question is not whether shortages will persist, but how to adapt.

John Dorer is CEO of eb3.work, a workforce solutions company that helps U.S. employers address labor shortages through lawful and compliant staffing strategies.