Search For the Holy Grail: Staffing in a Pandemic

“Talent wins games, but teamwork and intelligence win championships.”

—Michael Jordan

One of the things that attracted me to a career in medicine was the team approach: attendings, fellows, medical students, nurses, assistants, technicians, administrators, and others. We all had our jobs and worked together for the common goal of patient care. Yes, that’s an idealistic viewpoint, but it can still be a goal. As the popular quote goes, “teamwork makes the dream work.”

So how do we function without a full team? That’s a question a lot of us in healthcare have been asking since we returned from lockdown. How do we find staff for our offices? We are not alone, and the situation is getting worse. An April 2021 online survey of 230 HR executives primarily from large US companies by The Conference Board found that 80 percent of organizations report difficulty finding qualified workers, with 25 percent reporting it was very difficult. This compares to pre-pandemic rates of 74 percent and four percent, respectively. Meanwhile the ratio of job openings and hires continues to rise.

The reasons for this shift have been blamed on issues ranging from financial to emotional. Unfortunately, the end of federal unemployment benefits hasn’t increased job seekers as expected. Other factors like pandemic-triggered burnout, care responsibilities, persistent COVID and the desire to work from home (impossible for clinical staff) have been blamed. In addition, the US Census Bureau for the Bureau of Labor Statistics has reported an increase in retirement among adults 55 and older, being referred to as the “Great Resignation.”

This topic is very personal for me. Although, I’ve had some significant staff headaches, I’ve been blessed with little turnover for my entire career. Once here, people stayed, and those who left often returned. When new staff were hired, there were others with experience to train them and keep the practice going. After the COVID lockdown, I felt lucky everyone returned, and the office is busier than ever. But since then, I lost my full clinical staff of two: in April, an LPN of seven years to pandemic problems of child care and, in September, my head RN of 22 years to retirement. To extend the baseball metaphor: the stands are full, I’m standing on the mound, but there’s no one to catch the ball or watch the bases.

The search for clinical staff was rocky: few applicants, even fewer appropriate ones, and drama with brief new hires (one RN quit by not showing up). And it’s a job-seekers’ market. Calls to offer a second interview were met with being told they’d taken another position. I was left considering how to find candidates, evaluate them, train them, and manage my office in the meantime.

I have no great insights on advertising for candidates. I cast a wide net on major job recruitment sites and training programs. I did not use headhunters or advertise on social media, although I gather they are useful for some practices. Hiring college graduates planning to apply to medical, nursing, or physician assistant schools is popular: plentiful in university areas, smart and motivated to get a good recommendation, but success does mean they will leave in one to two years. I do think it’s important to have someone other than you, either in your office or outside, screen applicant resumes, do preliminary interviews (many don’t show), check references and confirm COVID vaccination status. It’s a valuable time saver. It may also be worthwhile to look at your current staff to see if there is cross-training potential.

How to figure out if the applicant will be a good fit? One option is to have the applicant return for follow up interviews or spend a day shadowing staff. Another is pre-employment testing using one of the variety available to assess skills, personality, aptitude, and potential. However, when the need is urgent and it’s a job seekers’ market, there’s a risk of losing someone good. I’ve stuck to the same interview script my office has always used—the same questions I prepared for my own medical school and residency interviews:

1. Why are you interested in this position? In this office? In aesthetics?

2. What makes you feel this would be a good fit?

3. What is your greatest strength?

4. What is your greatest weakness?

5. Where do you see yourself in five years? 10 years?

Depending on the response, I’ll sprinkle in some additional character questions paraphrased from former World Series-winning Major League Baseball executive, Theo Epstein’s scouting formula:

Give examples of how you handled adversity in training or at work.

1. How have you handled interpersonal issues at work?

2. How do you deal with situations in which you think you’ve been treated unfairly?

3. What would your friends say about you?

4. What would your coworkers say about you?

5. What motivates you?

Epstein’s list includes questions about home and family life, which legally we can’t broach, but it’s amazing what comes out with these questions—both positive and negative—especially when you provide sufficient silent pauses.

So, where do things stand in my office? I’ve restaffed with smart enthusiastic new hires and from within my existing office staff. It isn’t the same; you can’t replace people emotionally or professionally who have been with you as long or longer than many marriages, plus training and reorganizing responsibilities are exhausting. But I’m pleased to report that it is a positive work in progress. Ultimately, hiring and keeping good staff is luck and instinct and more luck.

PS: I’ve told my office manager of 23 years that she is just not allowed to retire until I do.