The news for staff members is slightly more positive when job retention is considered. Most practices simply can't afford to lose any staff members because they "got down to the skinny" on staffing a few years ago, says Whaley. In fact, 63 percent of our survey respondents said they have either reduced staff or kept the same number of staff in the past five years, while only 37 percent said they have added staff. "Unless you're a practice of a good size or a hospital-owned practice, there's no real extra there" when it comes to staffing, says Whaley.
Since practices are operating with fewer staff members, each employee has more responsibilities. "It's much, much leaner since reimbursements are down, and there's no leftover capacity to cover people who are sick," says family physician Robert Gwinn, who works with Meek at Coshocton Clinic. "There's very little capacity to start new programs, new things, new ideas, you're just so stuck trying to survive and there's no latitude for trying something different or trying something new."
Things get even more problematic for staff members when one of their colleagues decides to leave the practice, says Whaley. Most practices "try and limp along as they can until the staff really starts dropping in the halls before they refill a position."
But rising staff workloads are due to more than just downsizing. The amount of work practices need to accomplish each day has increased, says consultant Elizabeth Woodcock. "During this 24- to 36-month period, where we've seen this [downward] trend related to staff salaries, and in some markets longer than that, the amount of work that has to be done has gone up significantly, and I think that's where the real challenge for practices is."
Practices have to make up the revenue they're losing in reimbursement reductions by increasing volume. "In order to sustain the profitability of a practice, practices truly, just simply put, have to see more patients," Woodcock says.
Moreover, as many practices transition from paper to EHR systems, staffers face new tasks, says Whaley, pointing to medical assistants as an example. "In most places, physicians just cannot get through their day seeing all the patients that they want to see and get all the documentation done, and so it's not unusual for nurses and medical assistants to come into the exam rooms with [doctors] and do the documentation on the computer while the physician provides care," she says. "They're getting up to their armpits in the [EHR] and functioning much more on a documentation level."
Instead of increases
While employees are taking on more responsibilities, it's clear from our survey results that most are not receiving salary increases for that added work. As a result, it's crucial for practices to find new ways to reward them. Here are a few ideas:
1. Bonus right. If possible, provide small monetary awards to staff members who go above and beyond, says Bee — for example, if someone leads a successful EHR transition or picks up the slack while a colleague is on maternity leave.
Be sure to use bonuses to fuel positive change by being specific about what you'll pay for, says Whaley. Establish policies that say a bonus will be paid to employees if particular, measurable goals are met.
2. Provide PTO. As an alternative to a monetary bonus, reward exceptional staff members with paid time off — but do it on your own terms. Specify when they can use the PTO, such as when a doctor or nurse practitioner is out of the office and workload drops, says Bee. "It doesn't raise the bill and it doesn't hurt the production if you're careful about when you grant those days off."