By LYNNE JETER

Cone Medical Group reduced its turnover rate from 20 to 10 percent by starting its own program for certified medical assistants (CMAs). HealthPoint Medical Care shifted their medical assistant (MA) responsibilities to nurse practitioners (NPs). 

Spurred by the COVID-19 pandemic, practices across the country are having to be resourceful to fill MA positions, with solutions varying from cutting clinic hours to building schools and focusing on other roles. Part of the problem: candidates are demanding higher wages or don’t have the requisite experience. 

“We’ve had many MA candidates ask for up to $30 per hour with little to no experience in healthcare, much less our particular specialty,” a practice manager in Georgia said. “Since 2019, more than 70 percent of our candidates are failing to keep their interview appointment or even failing to submit a resume. And when we find suitable candidates, they often want to work four days a week at a higher pay rate.”  

In a July poll by Medical Group Management Association, 44 percent of practices noted that MA positions were the most difficult to fill, while 52 percent of medical groups are hiring alternative staff to cover MA roles: namely non-clinical staff, certified nursing assistants (CNAs), licensed practical nurses (LPNs) and registered nurses (RNs). Nearly half of respondents hire a combination of the four designations, and even EMTs and pre-med students.

With fewer providers and staff, some practices are forced to cut back on scheduling patients, especially for extended hours and weekends. “There have been days that we’ve had to close the office early or block out certain providers due to being short-staffed,” said a Colorado practice manager. 

Burnout because of the problem has led practices to cut corners elsewhere. A practice manager in Louisiana just started letting the phone go to an answering service during the lunch hour. “That way, everyone can get a few minutes to decompress and have lunch,” she said. “We also started closing the doors a couple of hours early on Fridays to lessen the strain on providers and staff. Lunches being brought in, ice cream parties, and gift cards only go so far.” 

Cone Health Medical Group found a niche with its CMA academy, started in part because nearby community colleges and technical schools weren’t providing the clinical training CMAs require. “We were very blessed to be in a health system,” said Sally Hammond, assistant director of Cone Health Medical Group. “We probably had more of an opportunity to find folks who would like to do this kind of work.”

Meanwhile, a practice in Louisiana was experiencing something similar. The local community college was the gold standard for CMAs four years ago, producing top-level personnel. However, enrollment in the two-year program declined and the community college lost its accreditation. Now administrators of the community college are reducing the length of the program to seven to nine months. What’s more, the practice has only been able to retain one new hire in the last year. 

“I felt there must be a problem with our pay, our mission, our facilities, anything that would explain why we are no longer able to staff this clinic,” the practice manager said. “But what I found out other colleagues were facing the same dilemma.”

HealthPoint Family Care has moved completely away from hiring MAs, focusing instead on NPs. Last September, the group initiated a formal program, providing an annual stipend for NPs as an incentive, while also extending appointment times to account for tasks MAs would have done. 

“NPs have the training and experience to do the work of MAs, such as administering immunizations and point of care testing,” said practice CEO Sally Jordan, adding that 80 percent of the group’s NPs are participating in the program. “When surveyed about going back to working with clinical support staff when the hiring challenges are gone, 100 percent of the integrated NPs said they would choose to continue to work without support staff. Many state they are more efficient working alone and the benefit of the additional income as reasons.”

HealthPoint also started a hybrid NP position for recent graduates, allowing them to practice as an NP three days a week, while also training with a physician in a support role the other two days. The NPs involved in this program report high satisfaction rates. Within a year of starting in the hybrid model, NPs are expected to be fully blended into the new NP program, with added MA-type responsibilities, said Jordan. 

Regardless of various solutions, the problem still lies in the lack of professional MAs, which impacts the bottom line. 

“We all feel that we’re falling short of the high level of patient care and service that we had before COVID,” said the Louisiana practice manager. “There simply is not enough support to perform at the standard that we’ve set for our clinic for years.”