How to Adapt as Healthcare Workforce Management Shifts

January 23, 2024 - There’s a significant workforce crisis in healthcare right now, according to Sarah Nosal, MD, FAAFP, a family physician and a member of the board of directors at the American Academy of Family Physicians (AAFP).

Nosal, who also serves as the vice president for innovation and optimization, as well as chief medical officer at The Institute for Family Health in the South Bronx, New York, has noticed a substantial decline in the number of candidates for open positions, especially in family medicine and primary care.

“We are not producing and recruiting enough individuals into all of these communities that have a real need for primary care, particularly our rural communities where doctors are aging out,” Nosal explains.

The height of this healthcare workforce crisis hit during the COVID-19 pandemic when troves of employees left their jobs and even the healthcare industry at large. However, the situation was dire even prior to the pandemic. The Association of American Medical Colleges (AAMC) estimated in 2019 a shortage of up to 121,900 physicians by 2032. Two years later, that number jumped to up to 124,000 physicians by 2034, with primary care slated to see a shortage of 17,800 to 48,000 physicians during the period.

The COVID-19 pandemic amplified ongoing workforce challenges, such as clinician burnout, which reached a record high during the pandemic despite years of decline. Organizations also continue to feel the pressure from workforce shortages, rising expenses, including labor costs, and patient demand for care.

“The situation has really shifted for individuals who are seeking employment and the people who are trying to hire people into the healthcare workforce,” Nosal says. “Most places have to change how they are offering compensation benefits and schedules to hire clinicians.”

What organizations need to do

Provider organizations need to understand that the market has changed, according to Nosal.

“Many times in the past, we could tell interested candidates to take our offer or leave it, and people would do just that,” Nosal explains. “There were enough candidates who were strong and available to make that offer.”

The clinician workforce, particularly for primary care, is no longer as strong or robust. Provider organizations need to understand that the talent pool they are recruiting from may be limited, and they are facing stiff competition for qualified clinicians. People looking to hire and retain staff must be more flexible in the current labor market.

“This generation of graduating family docs and staff members are looking for a different kind of flexibility,” Nosal adds. “And they are expecting you to accommodate individual needs.”

That means hiring teams need to think about who these candidates are, what they value, and what they are looking for during their career, and the team should know this before they make an offer. Otherwise, organizations are not setting their staff up to be productive, high-quality, and importantly, satisfied clinicians at their organization.

“If I push you into a position that you are not going to be happy in, then I’m not going to be able to keep you and there’s nothing worse than hiring someone who is a great family doc and losing them because we haven’t created the kind of positions that they were looking for. If they tell you upfront what they are looking for, we need to hear them.”

But listening does not negate the negotiation process, Nosal stresses.

“We aren’t going to be able to accommodate everything someone is asking for, but I am definitely going to think differently about the kinds of schedules that we give people,” she says. For example, many younger family physicians do not want to work in the office five days a week. Many organizations can optimize schedules to provide a full-time position across fewer in-office days thanks to evening and weekend hours. Organizations should also be open to whether

“That’s a huge quality of life value for young doctors,” Nosal says. “And I don’t think it’s unfair for them to say this is what’s going to make this a sustainable career for them.”

“When we don’t accommodate or listen to individual asks, we end up with clinicians who are dissatisfied and burnout, and we know those types of individuals provide poor care and make errors. That’s not what I want for my organization,” Nosal continues.

What aspiring employees should do

Physicians and other candidates also need to let hiring teams know what they want from their career, and there is no time better than now to do that, according to Nosal.

“There’s such a desire and need with healthcare organizations to have family docs and primary care docs employed within their organizations and to be providing for their communities, so they are really in an excellent position to negotiate,” she explains.

“There’s no harm in asking for exactly what you want and assume you’re going to negotiate from there,” she adds.

Negotiating employment, and specifically compensation, agreements can be daunting for young clinicians seeking employment. In the past, healthcare organizations had the upper hand with negotiations. State specialty societies and especially lawyers can help clinicians navigate the negotiation and employment process, Nosal suggests.

“Historically, there has been a lot of good faith with individuals looking to be hired, and I’ve heard horror stories about people who had good faith and didn’t get exactly what they wanted in writing,” she explains.

Lawyers can be especially helpful with understanding an employment contract. Some terms clinicians should look out for include restrictive covenants and non-compete clauses. These terms, which are very popular in healthcare, generally prohibit a clinician from competing against their former organization within a specific region for a specific amount of time after their relationship with the organization has ended.

Non-compete clauses can exacerbate burnout, Nosal argues. Unhappy clinicians can get locked into a position if they cannot afford to quit and find a new position beyond the clause’s radius. This can particularly be a problem for clinicians working in markets with a major health system that has many locations within the community.

“If that’s the largest organization providing care in the New York City area, for example, you may actually have to move to a different part of the state or country because of the physical structure of these clauses,” Nosal states. “A lawyer can help by making that your primary site or only within a certain number of minutes from your site of employment, and it’s rare organizations are not willing to make accommodations there.”

How to attract and retain staff

For both organizations and candidates, work culture is important. How organizations treat their staff could also be the key to overcoming the competition and attracting the high-quality candidates organizations want to treat their patients.

“The respect you build on your care teams and in your practice is a top priority,” Nosal says. “Those relationships are actually going to get you staffed. It’s not what you advertise on your website or what you put out and pay for on the different employment sites.”

Word of mouth can go a long way with healthcare workforce management. At Nosal’s practice, for example, almost every person she has hired had been someone who heard about the position from someone else. That’s why it is important to not only value staff and demonstrate their value but also leave on good terms when those clinicians find a new position.

“Make sure you value employees while they’re there and maintain those relationships when physicians leave because they were good staff and they might send people your way,” Nosal states.

Organizations can show they value their workforce through tuition reimbursement, for example. Staff are more likely to stay within an organization that supports their career as it advances through education. This signals to candidates that the organization is a place to grow. Companies can also save in the long run with a study finding a major payer saving $1.29 in talent management costs for every $1 it put into a tuition reimbursement program.

Team leaders should also be meeting with clinicians frequently to check in and hear from their staff. Nosal describes daily touches during which staff meet with the people they report to and discuss the day.

“Someone needs to actually listen and care about, say, a workflow that didn’t go well or the room that wasn’t stocked properly,” Nosal explains. “Take that feedback and improve the systems at your site. That completely changes their willingness to commit to your organization.”

Finally, technology can help to create a positive work experience for clinicians by streamlining workflows and making work one less stressor in their lives. For example, AI can help to alleviate overflowing in-baskets by helping to direct patient questions to the most appropriate staff member versus sending patient portal inquiries directly to the physician.

“Clinicians are going to be expecting that we use these tools to make their lives more reasonable and that some of this stuff can be and should be done by other types of technology and resources,” Nosal explains.