Practice Tips and Efficacy
Surgical Staffing Solutions
By Mariam Mafee, MD, FACMS
Covid and the Great Resignation have created many challenges in our profession. With openings in several job markets, people are shuffling or swapping careers for higher paying jobs, which makes recruiting, hiring, and retaining staff especially difficult. We have all felt this blow, and now employers must be more creative and competitive than ever to avoid losing employees to big companies like Amazon. During the annual Association of Professors of Dermatology (APD) meeting in September, four Mohs surgeons discussed staffing solutions to understand practice patterns around the country and to share their experiences. Highlights from this panel are included here for ACMS members.
Panelists:
- Dr. Christopher Bichakjian – Professor and Chair of Dermatology at the University of Michigan
- Dr. Elise Ng – Assistant Professor at Johns Hopkins
- Dr. Yaohui (Gloria) Xu – Professor at the University of Wisconsin-Madison
- Dr. Matthew Fox – Associate Professor and Chief of Dermatology at University of Texas at Austin
What are some non-traditional avenues that you have explored to recruit and hire staff?
Dr. Bichakjian: We have hired pre-medical students in our general dermatology clinics. Although there is an understanding that they will not be there long-term, they are motivated and effective members of the team. This arrangement has worked well for us. In desperate times, we have partnered with temp agencies to bring in an extra set of hands. On occasion, such temp employees were outstanding and were later recruited to full-time positions.
Dr. Fox: We have pursued some avenues outside of our internal recruiters over the years. We have posted jobs on internet recruiting sites such as Indeed, which led to some hires. We have even a few times handed our card to friendly employees at Chick Fil-A, but have yet to successfully recruit someone from there!
Dr. Xu: We have used a travel MA company to find MAs in our clinic. They have a 13-week contract. We had one MA that everyone felt was very strong, and she is returning for another 13-week contract. Unfortunately, she is not looking to relocate permanently to our city, otherwise we would offer her a full-time position. We also have worked with travel Mohs techs from time to time.
What is the process for finding and hiring at your practice, and how has that changed over time?
Dr. Bichakjian: In our academic medical center we are unable to directly recruit staff. Applicants to an MA position at our institution are reviewed by the Talent Acquisition group in HR, which subsequently triages to the various needs in the medical center. While this makes sense for more generic MA openings, this process makes it challenging to recruit to more niche positions such as a Mohs practice.
Dr. Fox: I have been at my institution for over 10 years, and we started from scratch. At first, I was the person looking at resumes and interviewing candidates. Our practice has grown significantly, and we now have a practice manager who screens all applications and performs initial interviews before presenting candidates to the rest of the team. We try to include clinical staff in the process of recruiting as much as possible.
Dr. Xu: Finding and hiring staff at our practice are done by our hospital administrative team separately from the physicians.
What training opportunities have you created for staff to increase retention and remain competitive with other practices?
Dr. Bichakjian: We spend several months training new MAs. This training provides the staff with a sense of ownership and pride. Unfortunately, we are (as of yet) unable to let this additional training translate into a new (i.e. higher) job title or pay scale, but we are working to make this happen. In that scenario, the intent is to train MAs on the job while they work toward a more specialized position.
Dr. Ng: Our department created a Certified Derm Tech program in an effort to help improve staff retention. The program offered a means for our dermatology medical assistants to gain increased training to justify a salary adjustment. The program has several components, including a set of online modules covering dermatology fundamentals, which is available through the Certified Derm Tech Association. These were then supplemented by lectures given by our dermatology faculty, which were more practical and clinically oriented, such as optimizing use of the EMR, how to understand pathology reports and common diagnoses, and how to discuss and document results. All these modules and lectures were then followed by a post-assessment exam, which they were required to pass to demonstrate mastery of the material. The last component of the program included hands-on training for lidocaine administration. Certification was obtained through a case log and demonstration of competency as determined by a dermatologic surgery attending. The program has overall been a successful one and has helped empower our medical assistants and give them a sense of accomplishment and ability that has contributed to retention. It also allowed our MAs to be cross-trained by gaining skills in different domains within dermatology, which has helped us with cross-coverage.
Dr. Xu: In order to retain one of our fantastic senior Mohs techs, we created a “Lead Mohs Tech” position to officially recognize her contribution and leadership role. We also worked with the medical school HR to create an hourly position which allows her to help me with some of my research projects such as entering data into a research database. Both ways have justified a pay increase for her, even though the increase is small.
What is the make-up of your clinical staff as far as RNs vs MAs? What has worked best for your practice over the years and why?
Dr. Bichakjian: Over the past decade, we have transitioned from all RNs to mostly MAs for a variety of reasons. From a job classification perspective, the procedural portion of work is well suited for an MA with specialty training. We still have RNs who handle all telephone triage. As long as we can recruit sufficient MAs, the model works well for our practice.
Dr. Fox: We have a near equal balance of nurses and medical assistants in our practice. Our nurses end up staying more long-term and we see more turnover with medical assistants who pursue other clinical jobs, further education, or other career paths altogether. That said, staffing trends have tended to ebb and flow over the years.
What are some things you do for your staff personally to maintain morale?
Dr. Bichakjian: While we have social gatherings and wellness activities, the most important morale boost is the establishment of true teamwork, i.e. the notion that all members of the team, staff, physicians and learners, are working together toward the same goal, with every team member prepared to do what is necessary to provide optimal patient care. This cohesiveness helps develop ownership and pride in everyone’s contribution to the teamwork.
Dr. Xu: We have bought lunch for staff and eventually started a monthly potluck lunch. These lunches typically are for special events such as staff birthdays or a celebration, and I find that staff get excited about them. All Mohs surgeons in our practice had canceled clinics a day or two during the holiday season or spring break to accommodate staff’s vacation plans, which was greatly appreciated by the staff. We have created a program called “What’s in a Name?” before each Grand Rounds, where one clinical staff is featured and shares fun facts with the entire dermatology department so we can get to know them personally.
How does your practice promote a culture of inclusion and teamwork?
Dr. Bichakjian: It is important to actively be a part of the team and ready to do any task, even those that are more menial. I help clean rooms, bring patients in, and set up when needed.
Dr. Fox: Dr. Hollmig, our director of dermatologic surgery, goes above and beyond to create a family environment where every voice and perspective is valued and respected. This is particularly evident in our monthly staff meetings.
Dr. Xu: One of our senior MAs is very crafty and a great host. She hosts parties in her backyard, coordinates birthday celebrations, and makes personal birthday cards. We call her our “Mohs Mom.” Given her strengths, she has happily fallen into this role. Social gatherings outside of work can be really fun and have strengthened relationships if organized well. Our Mohs staff had a “Halloween tradition” to take a trip to a haunted house/forest for two years in a row, and we are now looking forward to a snow tubing gathering.
What is the most valuable piece of advice you were given regarding keeping your team happy and the clinic adequately staffed?
Dr. Bichakjian: The team, the team, the team!
Dr. Fox: I learned from my mentors the precept that every staff member has strengths and weaknesses, as we all do. Our job as leaders is to maximize strengths, minimize weaknesses and place people in positions where they are primed to succeed. This part of the job may be the hardest, and also the most rewarding in the end.