Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep119: The staffing squeeze, with Rihan Javid, D.O., J.D., of Edge
Transcript
- 0:00 The answer isn't always just increasing salaries, right? It's obviously you have to have a great work environment. You have to be employee friendly. And so really what you want to do is you want to have a core workforce, whether that's in person or remote that you know is going to be with you 0:22 do welcome to off the chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the associate editor of medical economics, and I'd like to thank you for joining us today before we get started, a quick note, physicians practice will be hosting a practice Academy event on March 19, offering practical guidance for physicians and practice leaders on a range of business and operational topics. More details will be available soon. In today's episode, I sat down with Dr Rihan Javid of psychiatrist and co founder and president of edge, the remote staffing organization, to talk about how rising minimum wage and labor competition are reshaping physician practices, and why staffing pressures aren't as easy as just pay increases. We talked about why small practices in rural hospitals are failing to squeeze first, which roles are hardest to replace, and how turnover quickly turns into operational strain for physicians. Dr job, it also shares some practical advice on retention, budgeting for the year ahead, and why flexibility, including remote staffing, is becoming essential. Dr javit, thank you so much for joining us. Let's get into the episode. 1:34 Dr javit, thank you so much for joining me today. 1:37 Oh no, thanks, Austin. Good to see you again. It's been a few months. 1:40 So I guess we'll just jump right into the questions here. Nearly 20 states have plans to raise their minimum wage in 2026 from what you're seeing, how does that actually landing inside of physician practices and healthcare organizations? 1:53 You know, a lot of physician practices and healthcare organizations, they run on very tight margins, but actually rural hospitals, small physician offices, and so if all of a sudden you're raising minimum wage by 1015, 20% which is, you like, the minimum right? Other states, they increase it by like $3 over a year or two, it's that could be like 25, 30% it can less. A practice is planning it out, and they've really thought about it can hit them pretty hard. So we've seen, like, you know, maybe about 50% of practices have thought about it and they're implementing it and they budget it, and then the other 50% including small rural hospitals, they just get hit really hard, and they're like, Man, this is destroying our budget. So it's an impact. Yeah, I think it's great for the workers, you know, the staff. They work really hard. You know, some staff will do the job of two people, three people, right? Like, people get sick, and there's no calling sick, right? You got 40 people, 30 people, patients coming in, and so you have to do that. So it's really great for them, but at the same time, unless the practice is really planning for it can be a big impact. 2:55 So I think, you know, probably the big question is, you know, when you think of healthcare, a lot of organizations already pay above minimum wage for most roles. So why are they still losing people as wages rise? 3:06 Yeah, minimum wage is not enough for for healthcare. I think a minimum wage, you know, I'm in California, minimum wage here is like a 16 and a half $17 range. Minimum wage for healthcare workers and organizations of I think it's 50 employees or more, is actually $25 an hour, and that's the bare minimum. But you know, if you're a small practice or a rural hospital, you're competing not just against other small practices and rural hospitals, but you're competing against here in California, University of California Health Systems. You're competing against the state in Texas, University of Texas, Baylor Rice, a lot of these places, they pay above minimum wage. So my maybe it's only two or $3 above, but on top of that, you get a pension, you get a 401, K contribution. And so all of a sudden that, in California, that $25 an hour minimum wage, yeah, maybe it's $30 plus all those benefits, that's another five or $10 an hour. And so all of a sudden you're competing against people who are paying 3540 $45 an hour. And so it can become pretty prohibitive for small practices and world health practices, absolutely 4:13 when staff leaves for relatively small pay increases elsewhere, what roles do you see the practices are having the hardest time replacing? And why is that? 4:21 Yeah, that's I don't know if it's just one role in particular, but I think there's definitely some roles that are more critical than others. So obviously we know that patient facing roles are really important. So if you don't have an MA to check somebody in, patients just get backlogged in the waiting room. They're not happy, and that leads just the downstream effects of that. You know, they're delayed. They become upset at the medical staff, then they become upset at the doctor, and the visit just doesn't go as planned, right? So those are critical, and they're not always the easiest to replace, but a lot of practices, they say that the billing rules can be the most critical, so you can still see the patients, but if you can't submit the bills at a time. Only manner you don't get reimbursed, and then you're having a hard time getting revenue to pay your staff and yourself. And so it's not really one role, but it's just it's a combination of pretty much everything, with some of the more specific ones, like a billing like a coder, claims, submission, prior authorization person, those can be even harder to fill. But yeah, there's not, I would say, not one role. It's just overall, the roles are tough to fill, 5:30 sure, so when practices might be having a hard time. You know, as far as with staffing shortages, finding staff, retaining staff, they might respond by bumping pay, only to find themselves back in the same spot just a few months down the road. Could you talk about kind of what's happening in that process all the time? 5:48 It's so, you know, you increase your salary by $2 an hour. The guy down the street loses the staff, then he increases it by $2 or $3 and you gotta increase it by another dollar. So it goes back and forth, right? So the answer isn't always just increasing salaries, right? So obviously, you have to have a great have to have a great work environment. You have to be employee friendly, but at the same time, you got to realize that you're probably going to lose people to whether it's an extra dollar, $2 an hour, $2 an hour is $4,000 a year. So that's pretty substantial. So you can lose it to that. You can lose it to a shorter commute. And so really, what you want to do is you want to have a core workforce, whether that's in person or remote, that you know is going to be with you, right? So say, if you're staff for 10 people, you want, like, a good four to six people, probably six, really, maybe seven, who you know are going to be with you for the next 357, years. And then if you have like, one or two or three that you transition out, that's okay. But if all of a sudden you're losing six people a year, seven people a year out of 10, then, I mean, practice is not going to succeed. They're not You're not going to do well. You're not going to, you know, it's not just you're not going to be able to implement your current workflow and your processes, but you're not going to grow and expand beyond that. So it's really important to have a solid workforce that you know is going to be with you over the long term. 7:15 Hey there, Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack, an employee engagement win or a lesson learned the hard way. I want to be true. Shoot me an email at K Reynolds at mjh life sciences.com with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. 8:05 What are the day to day operational problems that physicians are feeling first, when turnover becomes a problem, even if they don't immediately connect it to, you know, we're losing staff. 8:14 I think the physicians end up with more work on their plate, right? So that could be medication refills, where a lot of times that Mays do it. You know, all of a sudden they're sudden they're checking in more people. They're staffing more people each year their staff. And so that stuff goes to the doctor as a prior authorizations. Maybe the staff member was doing it, the billing, you're not getting reimbursed on time. So all that stuff gets pushed back. And a lot of times it falls on the doctor to take care of. And we've seen all of that, including billing, where the doctors are doing that sometimes. 8:42 So as practice leaders look ahead to the rest of 2026 what staffing or budgeting assumptions do you think they need to have a second look at? 8:52 I think you have to have a flexible budget, and that's the main thing. So you gotta be like, you gotta look at the minimum wage, you got to look at the market wage, and you got to look at the living wage. I think living wage, market wage, a lot of times, are the same thing in the medical field, so you got to see what that is for your area, and you got to budget that in. But I think you also have to be flexible and budget in pay increase for your staff, because if you don't do that, it's, you know, you go over budget. But B, if you can't offer people what they're worth or what they're earning other places that you're gonna you're gonna lose them, and then all of a sudden, you're gonna end up paying more, because, you know, it's a lot cheaper to retrain people that you currently have, rather than you have to go through 10 different interviews to hire one person. And so you don't want to fall into that trap either. 9:38 If you had to give physicians one piece of practical advice on retention right now. What would that be? 9:44 Yeah, I think you have to treat your employees well, and you have to pay them well. If you can do that, I think that that goes a long way. And also, you know, you have to be very clear with their what their job duties are, and that, you know, we need you to do this, this and this and that nothing really comes as. Surprise. But even if you do that, there's always gonna be surprises. But they could just try to try to minimize and limit those as much as possible. 10:07 Sure, I just want to go back to so we talked about, you know, bumping pay isn't always the answer there. If you're losing staff, I guess, what is the appropriate reaction there? What is the appropriate response if people are leaving for a pay increase? I mean, what should you be doing as a practice? 10:22 I think first of all, you gotta look internally to see why people are leaving. Is it just because of the pay raise? You know, that's one thing. I think that's fine. That's gonna happen anywhere. But if there's internal problems, you gotta look at that. And then I think you also gotta look at your community. Are there enough people to hire to do this? And a lot of times answers No. And so at that point you have to look externally like, what can you do to fill some of those roles? And a lot of times we're seeing practices are reaching out to remote employees, both in the US and as well as outside of the US, including, you know, with us, we provide remote employees in Pakistan, Peru, Costa Rica, and so people are like, oh, I need three Spanish speakers who can do building as well as scheduling and patient care, you know, so we're able to provide those and so I think if you're consistently losing employees or staff, that might actually be a good idea, is to get a core group that, you know is going to be there for the next three or five years. Maybe they're remote, but they're able to do all those tasks. And then you just hire people who do the tests, where they're patient facing, or they're touching patients doing vitals, checking heights, stuff like that. So you gotta be really flexible, and you gotta think outside of the box. It's not pre covid days, not 1990 it's not 2020 2520 26 and you have to really plan for that 11:39 great those are all the questions that I have prepared. Is there anything that we didn't talk about that you think I might have missed? 11:45 No, I think, you know, it's really important first for staff, or for for medical office, to realize that there's some some roles that are very specialized, you know, such as, like a billing coordinator or a billing person. And you got to really see which ones you can, you can handle remotely, versus, I think, in pay, in person. And once you get, you know, everyone's gonna get turned over, right? So as you get turned over, you want to be prepared that you know, can, can we move this one to more of a remote role and use some of the savings from that one to do this here? And so I think if you're flexible and you're able to move those, your funds around and your locations around, I think that tends to help quite a bit. 12:27 Great. Well, Dr javit, thank you so much for taking the time today. 12:30 Okay, thanks, Austin. 12:36 Once again, that was a conversation with Dr rihan javit, a psychiatrist, co founder and president of edge, the remote staffing organization. My name is Austin Latrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. And don't forget, physicians practice will be hosting a practice Academy event on March 19, offering practical guidance for physicians and practice leaders on a range of business and operational topics, and more details on that will be available soon. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicianspractice.com off the chart a business of medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the mjh Life Sciences family. Thank you.