The Medical Management Podcast_Taking Action in this Staffing Crisis: Audio automatically transcribed by Sonix

The Medical Management Podcast_Taking Action in this Staffing Crisis: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Jay Holmes:
Welcome to the Medical Management Podcast. A podcast focused on helping you level up your practice. Through interviews with some of the most successful leaders in the industry, we help uncover resources, tools, and ideas to help you level up your practice. Thanks for tuning in and we hope you enjoy today's program.

Jay Holmes:
Welcome back to the Medical Management podcast. This is Jay. Your host bringing you yet another informative episode. Today we get to spend a lot of time with Jesse Arnoldson, a co-host here and have a deep dive into one of the most pressing issues that all of our clinics are experiencing right now, which is recruiting and retaining employees and good employees at that. Jesse, welcome back!

Jesse Arnoldson:
Hey, everybody!

Jay Holmes:
Man, let's kick this off! You know, the place to start is what are we hearing about? And let's get a deeper dive into that. What are we hearing about with recruitment?

Jesse Arnoldson:
Yeah. You know, I think using the Boise area, the Treasure Valley as a way of painting the picture we are, I think that we've been struggling for a little while on finding good people. You know, not as many applicants, not as many qualified applicants. The applicants that we are getting are converting into interviews or getting very far down the road before we, you know, they either ghost us or they take another job or we just, you know, they're just not the quality that we're looking for.

Jay Holmes:
Yeah, they, they schedule them.

Jesse Arnoldson:
Yeah, yeah.

Jay Holmes:
But half of them don't show. It's a universal thing.

Jesse Arnoldson:
It's a universal thing. And we've talked in other episodes how to avoid that. But you know, it's even worse now. I think that for our current employees and for ourselves as well, we all have been running this COVID marathon and we thought we were at, you know, at the end over the summer, it was feeling really good. And we're turning the corner thinking we'd see the finish line and we realized we had, you know, another 100 miles to go. And I think a lot of us are hitting the wall. That's what a lot of our MAs and nurses and receptionists and providers, and administrators are, their resiliency canteen is empty and we're hitting, you know, some troubled areas there. And so people are leaving thinking that maybe a change in scenery is going to help them. Some of them are just going to take some time off. Some of them are reducing hours or going back to school. But whatever it is that they're doing, the end result is that our clinics are being left understaffed. And then to add on top of that, everybody's feeling the pinch at the same time, including these big hospitals and the hospitals, not only are they feeling the pinch, but, you know, agree or disagree with why they're doing vaccine mandates, and a lot of staff are leaving the hospital systems for that. And, you know, in a crisis, especially with increased COVID admissions and ICU bed occupancy, there is no, not staffing. And so they're offering huge dollars for anybody to come and work. And so, you know, the competition has just become cutthroat. And I think that we're about to see it be even worse. That's what we're facing in the Boise area. But as I've reached out and as other people in our MedMan team have reached out to those in surrounding states and across the country, it's the same in each community. You know, maybe the variables change a little bit, but we're all facing this dumpster fire in a crap tornado situation with recruiting and retaining good people.

Jay Holmes:
Jesse, absolutely, you know, and we've been feeling this pain. It's, you know, I think it really started 12, 13, 14 months ago, but it's just progressively gotten worse. We're all exhausted. We're tired. Let's jump into some actionable items that some of our listeners can take away. And what can we do? Is there anything we can do rather than just try to make it in the week, grab a bigger, you know, instead of grabbing your pint of beer, you're going to get a growler, take it home? What's what's? What is really What can we do besides just, you know?

Jesse Arnoldson:
Besides just becoming alcoholic, all of those...?

Jay Holmes:
Yeah. You know, just increase the vice. And certainly, that has been a method. It's shorter-term than longer-term, I hope.

Jesse Arnoldson:
Hmm. Mm-hmm. Yeah, so what do we do? I think that there are several options for us. And you know, as I've been asking the same question of, you know, H.R. directors, and the bigger systems, and small clinics just asking, what, if anything, are you doing that's helping? And here are a few things that have come out of it. One is that in the interview process, you know, I've, you and I have gone into length about what good interviewing processes look like, and they're extended. They're a little bit lengthier than the average and for good reason. But in this point in time, we, one of the things that is an absolute necessity is to be fast. You know, where I dipped into an interview process for a receptionist just recently for one of our clinics, and I got scooped unlike eight applicants in a row because they already took another job. And so I don't want to recommend decreasing the quality of your interview process, but you've got to be doing something to quicken it up. So whether that's, you know, I used to message people on, indeed, and have them respond to me, maybe I'm calling them right away to set a phone interview. Maybe I waited until after the in-person interview to check references. Not anymore. If I can get references in hand right after the phone interview, I'm working on them. I used to break up a working interview in a one-on-one interview. Now, I just extend the in-person interview by half an hour or an hour, now it's a two-hour interview. But we're getting all of those things done so that by the time we're done with that in-person interview, we have all the information we need and we're offer-ready so that when that person, you know when we're done, I know that everybody on the team is has checked in. I've done my reference checks, I've checked online, I've done these things. I've had my questions answered, ..... I have an offer letter ready to go if this is the right person. Well, that means it's doing a lot more work than I ever did before because I would never lift a finger on it on half these things until I was sure this is the right person, or that I was at least 90, you know, 75 percent confident. And so it's a lot of work beforehand, but you've got to be offer-ready. That's the competitive edge right now because too many people are calling during a phone interview and saying, OK, you want to work tomorrow and we're just getting scooped.

Jay Holmes:
Work tomorrow, get paid more.

Jesse Arnoldson:
Yeah!

Jay Holmes:
And here take home two weeks worth of pay.

Jesse Arnoldson:
Yes. Yes.

Jay Holmes:
As a bonus.

Jesse Arnoldson:
Exactly.

Jay Holmes:
And what we're saying, let's be clear here, we're not saying, take any shortcuts.

Jesse Arnoldson:
No!

Jay Holmes:
What we're saying is that.

Jesse Arnoldson:
Rearrange your process.

Jay Holmes:
Exactly! And condense the work instead of, you know, where the risk is lying today is that we're losing clients because we're too slow. Before it was, we don't want to waste our time doing all this extra work for candidates that we don't feel as good, they are good enough. You know the sad, sad thing, sad reality is that the bar is set so much lower right now. And so because there's just a smaller pool so we can be a little bit, we've got to take the risk of doing more work upfront because then we know just like in your case, you know, there's seven or eight candidates that you would have hired.

Jesse Arnoldson:
Yeah.

Jay Holmes:
But they already took a job.

Jesse Arnoldson:
Yeah, I love it.

Jay Holmes:
And that's a lot of wasted energy, right? So we're trading off. Where do we want to waste energy? Let's do it upfront because we think that's actually in the whole that's going to be a lot less wasted energy than going through the process, calling up, and saying, you're great. And they're like, yeah, you're coming at my new employer, at my new job. You know, I'll call you back if it doesn't work out.

Jesse Arnoldson:
Yeah, yeah, no, I love your thinking. It makes me feel better about putting that work upfront, that it's just compensating for wasted energy in another area. So it's unnecessarily extra work. It's just trading where you want to spend your time.

Jay Holmes:
Yeah, absolutely. I mean, totally, and it's just, in time, hopefully, it's going to shift and we're going to reassess and say, hey, you know, we've spent too much time pre-qualifying.

Jesse Arnoldson:
Yeah.

Jay Holmes:
Because most of them aren't going to work out. We're just in a different phase.

Jesse Arnoldson:
Yeah.

Jay Holmes:
And we really need employees,

Jesse Arnoldson:
We do.

Jay Holmes:
So, let's adjust, right? We're always trying to learn. Anything else, any other thoughts, tactics?

Jesse Arnoldson:
Well, other things to think about. We talked a little bit earlier about how people's canteens are empty, right? You know, whatever metaphor you want to use, that, our resiliency is not there. We're tired, we're burned out, we don't see the light at the end of the tunnel anymore. And so people need something. They need some sort of pick me up, whether that's fun at work or, you know, maybe something deeper in the form of employer-paid counseling, the taco, you know, bringing a taco truck over to the clinic on Fridays. I don't know what it is, but people need something extra at this point to help them cope with the day-to-day. That's huge. I don't know what the answer is, and I think this is an area where it's fine to let everybody kind of think for themselves on what that might look like. But whether it's, you know, purchasing swag for your team or sending them on little trips or gift cards or bringing in a drink order, I don't know what it is, but people need a pick me up, that's for sure.

Jay Holmes:
You know, I might get some heat for saying this, that, a silver lining here, I think, is highlighting this notion that we can be a lot better to our people, especially those people that interact with our patients the most. You know, we see that providers interact with patients a lot. But if you look at it, it's really, you know, it's the front office and the maids that are doing most of that connection. And, man, how can we elevate them? How can we empower them? How can we, they feel through actions? And this is very much an experimentation, we don't have it. This is New Frontier. We can do better. And now we have some time to go through those experiments to say, you know what sticks and what doesn't. And ultimately, every clinic's gonna be different. Everyone, everyone has a different culture. But you know, this is more of a call to action. Let's experiment, let's find things, let's keep pushing and keep saying that, you know what, we should appreciate our people more. We should have them saying, there's no way I'm going to leave this place. What we do and how we do it and how I feel doing it is so important to me, that I'm going to stick this out. And we have a lot to work too to get to that point.

Jesse Arnoldson:
Absolutely.

Jay Holmes:
But that should be that you know, the thought process here.

Jesse Arnoldson:
I want to share an example of a physician I saw this last week. I won't name him because he'd be embarrassed that he did this for all the right reasons not to be highlighted at all. But he showed up at the clinic on his day off and grabbed a couple of people's cars and took them and got them detailed and cleaned out while, you know, it was just the sweetest little thing. He didn't make a big, loud proclamation about it, but he went and took care of his people. That kind of stuff, you know, really lifts people up. And I think that we all need to be able to see the good in one another a little bit more. And yeah, you know what a neat guy that would take it time on his day off to go do that.

Jay Holmes:
Absolutely. I love it. Absolutely. You know, I think this idea of it's hard in my heart is harder than your heart. It's something that we really need to resist because it's hard for everybody, right? And everyone has things that are hard that they're doing with. It's a tough time. And I think we can't say, well, pity me because my life's hard, is the person you're sitting next to is going through the same thing, the same. It's a different thing, but it's still hard, right? And so how can we put push that aside and say, you know, if we give more than we get, we're going to be so much better. And this is a great time to really push that culture, you know, and try to live by it. And then hopefully, you know, by the leadership you get more by. And.

Jesse Arnoldson:
Yeah.

Jay Holmes:
Yeah, it's a, in doing so, you know, it's like the fourth quarter, thirty seconds left, but it's really not. It's like we're on Groundhogs Day of the fourth quarter, thirty seconds left of just doing it, you know, exhausted.

Jesse Arnoldson:
That's exactly how it feels. Oh, I love that.

Jay Holmes:
Yeah.

Jesse Arnoldson:
Let me, let me take that point and move it in a different direction. I, recently, you know, been thinking a lot about the idea that if you assume that somebody is going through a hard time, you're probably right and trying to help find resources for that. I think that now more than ever, mental health care, mental health care is top of the list, and making sure that your employees know that, you know, first, removing the stigma for them to reach out and use that resource because we all need it, two, removing the obstacles to get there. You know, quite often the employee assistance program that you're, you know, your business has is on a waiting list or it can't get accepted anywhere. And so, you know, people stop seeking help because financially they don't know how to access mental health care. I think that that's probably one of the key things in the retention area that is a much more profound benefit than taco truck on Fridays. It's, you know, creating an accessible path for them to get to the right help that they need. I have found myself being more of a counselor lately, and I'm not equipped to do that, and these people are. So how do I get the person in front of me to go to the professional that can truly help them? I think that that's, we have to be doing that, and doing it proactively. We need to be checking in on our people, seeing how they're doing, and getting them to the right resources.

Jay Holmes:
Hundred percent. What do you think about, you know, just with shortages, certainly in our market, markets that we serve with MAs, what do you think about this notion of, you know, how can we pull from other industries and train our, is that a viable path? Is that something that we can actually do in the clinic?

Jesse Arnoldson:
I think so. This is new to me. This is something I learned about this week, actually, Jay, I'm glad you asked about it. There are a number of organizations that are using apprenticeship programs, and most of them are local to the, like, we have a local Idaho version and there's a few in Washington where they're bringing on good people who do not have any experience or certification as a medical assistant, and they're using this apprenticeship thing and the in-clinic training to grow their own people. For far too long, it's been hard to get an MA, Jay, that's probably one of the hardest positions, at least in our area to fill. It was always interesting that I would post an MA position and a nurse position, and I would have 20 nurse applicants and 3 MA applicants. It never made sense to me.

Jay Holmes:
Right?

Jesse Arnoldson:
Yeah. But this is, I think, a path and hopefully a viable one. It's new to me, and so I don't have experience in it, but it's worth investigating.

Jay Holmes:
Yeah, you think about it, you think about the mechanics, the economics of it, where you've got, you know, you look online, you can have an MA, kind of in one of these trade schools, MA certification, which is really just a prep, right? What they do is they prep you to take the test, accredited national test, but essentially you're going to pay eight to ten thousand dollars to go through this eight-month course to then have to go and get 160 hours of on-the-job training.

Jesse Arnoldson:
Yeah.

Jay Holmes:
And the funny thing there is that could we do it in a clinic and could we say you're going to work for free for three months as a tradeoff? And in three months, you're going to be an MA. I don't know the logistics there, right?

Jesse Arnoldson:
Yeah, yeah.

Jay Holmes:
There still needs to be a test and we still need to supplement that education. But in my mind, we're going to have real-world, on-the-job training. And it's not going to cost the student anything, you know, comparison to having to spend 10 grand for not being able to work. Here, you're actually getting your hours, plus you're getting training, plus you're working in a real-life thing and it doesn't cost you anything. Sure, you're not getting paid, but you're not getting paid necessarily while you're going to school, right?

Jesse Arnoldson:
Yeah. And you're putting money in, it's a negative.

Jay Holmes:
Absolutely. So can you shift that? And so can then you think about your clinic as this, you know, you're basically this engine of initially, you know, you're winning, the student's winning, and at the end of the day, the end of the three months or six months or whatever it's going to be, you've got this opportunity where that, you know, that student becomes a full-time employee. I wonder, I wonder if that can work.

Jesse Arnoldson:
It's possible. It's very possible. Let me, you know, Jay, let me shift you a bit because I love this idea. I think that there's just shifting gears a little bit. We have to address pay at this point.

Jay Holmes:
Hundred percent.

Jesse Arnoldson:
You know, we're, I am not anti-hospital. And I want to just put that up front, but I am pro-Independent Medical Group. And so sometimes that puts me at odds with the hospital's actions, right?

Jay Holmes:
You know what?

Jesse Arnoldson:
Knowing that a hospital.

Jay Holmes:
That makes only one of us.

Jesse Arnoldson:
That makes one of us. Only one of us is anti, you know, not anti-hospitals. That's for another day.

Jay Holmes:
Sure it is!

Jesse Arnoldson:
And, you know, they have deep pockets and they are adjusting their pay scales and they're providing retention bonuses and they're providing sign-up bonuses and they are kicking our butts. You know you can go and get to two to four differentials at the hospital and be making, you know, two to three times as much as what I can pay you in this clinic. Obviously, we can't adjust that high, but we've got to do something to be more competitive. I know that one of the local hospitals just adjusted their pay scales to where the bare minimum is much higher than it was. And so we have to look at our pay scales and most likely make a bump up and then we have to find ways, I have never been a fan of sign-on and retention bonuses. I just am not a fan. However, my opinion doesn't mean squat in this moment because that's what the competition is doing. And so.

Jay Holmes:
Yeah, that's our landscape right there.

Jesse Arnoldson:
It is. It is. And so you really have to get either bite the bullet and do it, or find some creative way of getting additional dollars to do it. And we were fortunate enough to see a grant come through Idaho to help supplement pay increases and sign-on bonuses and stuff like that to help make independent clinics competitive when it came to retaining and recruiting good people, but that's not everywhere, and that's not, you know, that's only happening right now. It's a one-time thing. So, oh, what else do you do other ideas, Jay, in watching one of our administrators, she has adjusted her staffing model and has, you know, removed one of the positions that supported all of the different MAs. You know, we'd have three providers going, each of them would have their own medical assistant and then we'd have a runner that would help support all of them and take care of all the things that would distract from rooming, vaccines, blood drops, that position probably isn't going to be in place. You know, everybody's going to have to do their own thing. It's, you know, do we hold off on expanding to weekends and night hours? Do we maybe ask a provider for the time being? Do we pull back on provider hours or have providers maybe do more of the clinical operations than they have been to help support the holes that we're experiencing in our schedules? So that's another option is looking at your workflows and seeing where you can shift and shift work to compensate for the holes in your schedule.

Jay Holmes:
Yeah, I'll throw in another one. Just just as a, an interesting idea. I think that, you know, the industry, certainly smaller medical practices, you know, have entertained this idea of some sort of self-check-in, you know, reimagine the smaller clinic. And imagine if there was just an iPad sitting on a chair. And I think that's met with significant resistance because one, it really relies on the tech-savviness of the patients, and, man, that might work 50 percent of the people, but what about the other 50 percent? Sometimes it's a lot more, sometimes it's less right, it's a give-and-take there. But there was this, something I heard that kind of re-engaged that mindset, or that thought, that idea, which is what if there was a more of a remote front desk person where it wasn't just an iPad sitting on a chair that you'd pick up and fill out all your stuff and check-in, but what if it was the actual computer monitor with a little camera and there was someone sitting in another room in a different time zone even that basically greeted you, walked through the process, hey, you know, pick that thing up right there, I'm going to talk you through how to, how to do it, you're going to click this, you're going to click that. Ok, everything is looking good. Ok, well, wait a minute. You know I need your insurance card. I need your updated thing. So let me get that information. Awesome. You know, the MA or the nurse is going to come right and get you, just want you to sit down and hang out. And then that person then shifts over to maybe another clinic, and checks in someone else, right, in maybe another clinic. And so, you know, depending on the volume, maybe this person could be more dedicated. You can go outside of your, you know, your local region to hire someone. I just wonder if we can get to a stage there where, one, we save a decent amount of space. We don't have to have the like multitasker on steroids of the front desk that does everything and too much and doesn't have that one-on-one really, really dedicated time. I wonder if we could start thinking about that, and there's a little room to grow and experiment. It doesn't mean that this is the right way, this is the only way, but it is intriguing.

Jesse Arnoldson:
Yeah.

Jay Holmes:
How do we leverage? How do we leverage remote, more specific, more specialized, more patient-engaged interactions there?

Jesse Arnoldson:
Mm-hmm.

Jay Holmes:
You know what I've always loved with a lot of the dental practices that I go into is that they are very, very keen on saying, hey, Jay, you know, good to see you, why don't you sit down? We're going to be right with you. They know me, and I don't get that with most medical practices. I don't, you know, the schedule is there. Sure. Maybe it's and I don't know why, but we just don't see that same kind of, you know, really patient-appreciation connection. They know me, they know who's coming up. Make sure we do all that stuff. So maybe that's a way to not only really, you know, grow the pool of candidates that you could maybe look nationwide or even bigger, but also make it a better experience for the patient where the patient's like, man, you know, I loved whoever was sitting up here before, but this experience was ten times better.

Jesse Arnoldson:
Yeah, I think what it does is it opens the doors to, you know, what can we automate? What technology can we use? What was it our former mentor and CEO Jim Trounson used to say, you know, never, never waste a crisis, right? Like, maybe this is the time to make some much-needed adjustments that we wouldn't have done without being pushed. You know, like how we're being pushed now? I.

Jay Holmes:
Yeah, absolutely. Some of the greatest outcomes come from restraints that are forced upon that make you think differently. And oftentimes, we go.

Jesse Arnoldson:
Think about telehealth, Jay! Telehealth was always the thing, like, oh yeah, you know, telehealth is the future. But nobody did it like very few clinics did it. And then all of a sudden, within 15 days of COVID, you know, we're April 1st and everybody has telehealth going.

Jay Holmes:
Yeah, that was amazing. You know, it was a, obviously, you know, there is technology enabling, right, but it was, you know, at the very least, we're going to have Zoom and that can, you know, that's low buried and we're understanding it. Boom, we can do it right. You just kind of like the, you know, the iPhone, the smartphone, that idea was around for a long time. Technology just had to catch up to it.

Jesse Arnoldson:
Yeah.

Jay Holmes:
And I think that's kind of also help, but certainly the crisis of just the in-person patient visits. Just, yeah, just feeling risky.

Jesse Arnoldson:
Yeah.

Jay Holmes:
And technology was there.

Jesse Arnoldson:
Where's the crisis.

Jay Holmes:
Boom. Yeah, you know it.

Jesse Arnoldson:
Jay,, one more thing before we.

Jay Holmes:
Yeah, let's do it.

Jesse Arnoldson:
You know, I think that what this moment is calling most leaders to do is to also check in on themselves and make sure that they are creating the kind of culture and using the kind of leadership that helps people feel trusted, valued, and appreciated. You know, people are tired, but they recognize when they're in a good place for most of the time. And I think that it's incumbent upon leaders to double-check themselves right now and make sure that they're providing that kind of place for people. That goes a long ways, hopefully for the right kind of people.

Jay Holmes:
I'm glad you said that. Absolutely. We can't just, you know, take care of others, we need to make sure we're taking care of ourselves, too. So that's a great place to end. Good stuff, Jesse. You know, and listeners out there, we don't have it figured out, we're in the same boat here. We're doing the best we can. These are some ideas. These are things that are top of mind and are hopefully, you know, there's a takeaway or two, that you can take back to your clinic, you can take back, you know, on your commute and start thinking about stuff, and maybe it'll turn into some positive action, more staffing, better staffing, and all that stuff. And so again, you know, thank you for tuning in today. I really hope you enjoyed our conversation with Jesse talking about retention, recruitment in these tough times. You know, for the show notes, transcripts, and all this material and all the other stuff that MedMan does, head over to our website at MedMan.com, if you're interested and look out for episodes every week because they continue to come. Thanks again for joining us.

Jay Holmes:
Thanks for tuning in to the Medical Management Podcast. We hope you enjoyed today's featured guest. For the show notes, transcripts, resources, and everything else MedMan does to help you level up be sure to visit us at MedMan.com.

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