By Casey Korba, Director of Policy
The first national primary care scorecard recently came out from the National Academies of Sciences, Engineering, and Medicine (NASEM). Results showed a chronic lack of adequate support for the implementation of high-quality primary care in the United States across all measures, although performance varies across states. The metric around the primary care workforce found that the primary care physician workforce is shrinking, and gaps in access to care appear to be growing.
In the traditional fee-for-service model, the outlook for addressing the primary care workforce crisis is grim, but value-based care and accountable care models offer viable solutions that can address workforce challenges.
In January 2023, Aledade hosted our second workforce shortage webinar, “Primary Care in Crisis: How to Combat the Health Care Staffing Shortage,” to share best practices and lessons learned from our panel of experts. Sohail Khwaja, the Executive Director of the Columbia Medical Practice (CMP) in Columbia, Maryland, and Shantelle Simpson, the Chief Executive Officer of Appalachian Mountain Community Health Center (AMCHC) in western North Carolina, were joined by Beau Boyd, Aledade’s physician recruiter. The panelists shared the following creative solutions for recruiting and retaining clinicians and clinical support staff as we continue to recover from the pandemic’s devastating effect on the primary care workforce.
1. Leverage value-based care tools to address burnout.
The panelists agreed that value-based care is a critical tool to addressing burnout and solving some of the primary care workforce challenges. Khwaja said, “Practitioners and support staff have shied away from primary care in recent years because of the immense burden of documentation and all that primary care practitioners are expected to do. Value-based care is changing that. We have set expectations of how many patients we see daily and are able to meet that goal because our practitioners now have a lot of support.” He acknowledged that an interdisciplinary care team makes primary care easier, and that being able to take care of a limited number of patients, but take better care of them, should attract more primary care clinicians in the coming years.
Simpson concurred: “Before joining the ACO, I thought we were highly productive. But now that I’m working with Aledade, I realize how valuable the data we get is. We get more outcomes data, metrics on how we are performing, and information on care gaps. The App helps us prepare for upcoming appointments and get better information from hospitals, as patients are being admitted and discharged.” She noted that Aledade has provided training on various topics, which, in a time when staff have been overwhelmed, has been a helpful addition.
"Practitioners and support staff have shied away from primary care in recent years because of the immense burden of documentation and all that primary care practitioners are expected to do. Value-based care is changing that." – Sohail Khwaja, Executive Director, Columbia Medical Practice
Moderator Caroline Smith, Aledade’s senior policy specialist, also summarized findings from discussions with Aledade ACO members that have reported revenue earned through the Medicare Shared Savings Program and other value-based care programs can help with staffing. Dollars can be reinvested for staffing or community needs, and bonus programs for staff members, designed around hitting performance or quality measures, are popular retention tools.
2. Focus on building a diverse staff.
Khwaja spoke about Columbia Medical Practice’s impressive retention practices and successes. CMP is the largest physician-owned multispecialty primary care practice in Columbia, Maryland. Columbia's founders designed the town with the purpose of eliminating segregation by prioritizing mixed housing and diverse neighborhoods and schools. They envisioned equal access to resources for all residents regardless of socioeconomic status. Khwaja says the practice reflects the town. The staff at Columbia Medical Practice hail from more than a dozen countries, and the staff have long tenures; some have worked there since the early 1980s. He spoke about the importance of matching the community when it comes to care delivery and the importance of culturally competent care. He believes, “Diversity is our strength” when it comes to hiring and retaining staff.
3. Maintain an open-door policy where staff feel heard and respected.
Simpson joined the Appalachian Mountain Community Health Center last year, at the height of the pandemic. The federally-qualified health center has 7 locations across the state and each shares the goals of improving access to care and understanding the needs of the community. AMCHC serves children and adults, offers women’s health services and recently started offering dental care. Simpson is proud of the work they do to serve the homeless population and meet their complex behavioral health needs. When Simpson joined, staff turnover was high. She echoed Khwaja’s advice that creating an open-door policy where staff feel heard and respected was critical to increasing retention.
4. Empower team members to practice at the top of their license.
At AMCHC, team members understand their roles and the resources available to them. This helps with morale and understanding that every team member plays a part in patient care and the success of the practice. Says Simpson, “Staff are encouraged to practice at the top of their license. Each morning kicks off with the morning huddle so that all team members are familiar with the patients coming in that day.” AMCHC uses the Aledade App to power the huddle – the App pulls up all the patient information and helps the team prep and make decisions about the day.
The FQHC has also identified certain visits that the nurses can lead on their own. This makes the nurses feel valued and has helped with retention. Similarly, having a true interdisciplinary approach helps morale and ensures the team delivers optimal care. The medical assistants, nurses, clinical pharmacists, and physicians all work together to take care of the patient.
5. Provide flexibility and some autonomy over scheduling when possible.
AMCHC offers the choice of 8-hour or 10-hour shifts. Says Simpson, “The pandemic taught us we have to be flexible and not so rigid with people’s schedules.” AMCHC also implemented a same-day appointment system with dedicated staff to handle those appointments. Team members have clear expectations about their day, and staff not handling same-day appointments can focus on previously scheduled patients in the daily huddle.
Aledade’s physician recruiter Beau Boyd also discussed the importance of flexibility, which has taken on even more prominence since the pandemic. He noted, “You have to recognize the importance of being with family, addressing burnout, mental health needs, and the importance of being involved in your community.” He advised practices to walk clinicians and support staff through a week in the life and manage their expectations upfront about the nature of the day-to-day work in the practice.
6. Advocate for changes in programs and policies.
Advocating for impactful policies and strategies to address the primary care workforce shortage – for physicians, clinicians, and the office support staff – is critical. Aledade participates in initiatives at the state and federal level to promote awareness and advocate for solutions to policymakers. We also have initiatives in place (including Aledade FIRST) to educate medical students and residents about the possibilities – and rewards – of choosing independent primary care as a viable career path.
Aledade also continues to expand our Aledade FIRST program (Fostering Independence, Readiness, Sustainability and Togetherness). Current medical students and residents who are interested in getting exposure to value-based care and accountable care models in primary care can apply for the program. The first cohort of 11 residents in 5 states is underway, and we look forward to growing this program in the coming months. If you are interested in potentially recruiting a new physician or would like to learn more about Aledade FIRST, email firstname.lastname@example.org or visit aledade.com/residents. The FIRST program was also featured on a recent episode of the ACO Show found here.
Interested in learning more about how joining an Aledade ACO can support your staff and operations? Click here to connect with your local Aledade team.