r/Residency • u/JarJarAwakens • 16h ago
DISCUSSION Why do residency primary care clinics tend to have incompetent medical assistants and office staff?
What prevents them from hiring the same type of staff that an efficient private clinic has?
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u/Jemimas_witness PGY3 16h ago
Probably money. Doubt they pay well
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u/DonkeyKong694NE1 Attending 13h ago
I worked somewhere the MA’s were all hired as temps even if they were there long-term. This allowed the institution not to pay benefits. Who’s gonna bring their A-game to work in that situation?
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u/AneurysmClipper PGY5 15h ago
Ma's get paid the same amount as McDonald's workers and have about the same amount of experience no offense at all. So I try to be easy with them
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u/betahemolysis 6h ago
I get paid less than a McDonald’s worker and the hospital won’t let me work full time hours, even though they constantly complain about being short staffed
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u/Fluffy_Ad_6581 14h ago edited 8h ago
Attending here, its not just residency primary clinics. It's primary care clinics and there's several reasons for it.
- Underpaid
- Culture that tries to make up the underpaid part my continuously elevating the things they do as being better than what doctors do and refusing to give them feedback because they're so underpaid. .
- Refusal to give them assistant work because it's demeaning.
- Terrible office manager.
- Poor training in school.
- Poor training on job.
- The staff that remains is usually consistent of toxic staff that will perpetually bully new staff... Which leads to high turnover
- You have a few that do the work of the many. They get burnt out and leave. You get stuck with the many that don't really do much.
Our biggest asset has become our biggest burden. I've literally had some just sit out the way with me because I worked faster without them. This culture where they don't do assistant work but instead play doctor by taking a history and some even do a physical exam is preposterous but doctors refuse to change it.
It's exhausting and instead of blaming insurance (don't get me wrong they're a problem for different reason), we need to take a good look at the standard clinic workflow and staff tasks because it's the reason we run late and don't have time with pts.
I don't feel supported as an outpatient family medicine doctor. Just more warm bodies stealing my time with pts.
Now watch all the doctors coming out and talking about how staff is the best thing ever and are absolutely perfect and they have no idea why they run an hour late every day
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u/Ophthalmologist Attending 9h ago
Are you in private practice? Get rid of your toxic staff. It's absolutely necessary to keep any clinic functioning at a high level. Even if the toxic staff seem like they have irreplaceable skills, let them go. It isn't worth it.
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u/Fluffy_Ad_6581 8h ago
I've tried multiple clinics and I've left every single one because of toxic people. I've left rural, underserved areas because of it.
Unfortunately I have no power. They would rather keep the staff than make changes to keep a doctor. Female friends I've talked to have had very similar experiences. Male friends have reported some toxicity which is immediately addressed when they complain though.
This is unfortunately the overwhelming majority of clinics. This is the standard. I'm sure there are unicorn clinics out there but I have yet to see one.
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u/Round-Hawk9446 7h ago
Quit being an employee...
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u/Vivladi 6h ago
Just start a successful small business bro it’s so easy bro
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u/Shanlan 6h ago
Of all the specialties, FM is the easiest to hang your own shingle. If we aren't even willing to do that then the profession is truly lost.
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u/Fluffy_Ad_6581 6h ago
All the family medicine practices are being bought out by private equity in areas I've lived. Drug reps have even talked about it.
It looks like the only successful ones see 20+ pts, run a business AND hire a bunch of midlevels. I'm not interested in being a liability sponge for midlevels.
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u/Shanlan 6h ago
DPC seems like a good entry point and has a decent moat. It requires being in the right market.
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u/Fluffy_Ad_6581 6h ago
I tried dpc unfortunately I worked for another doctor. They weren't collecting money from pts and they lied to me about me being the only doctor taking new pts. The issues remained. Our MA did jack shit and had a major attitude problem but they refused to address the issues. I left ultimately. I was getting paid shit.
Gotta recover financially from that and may retry dpc in the future.
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u/Ophthalmologist Attending 5h ago
If they're all being bought out by private equity then again, start your own. If you're successful then great, or if they buy you out too then while being bad for our profession it's also great for you financially.
If you go to work for a PE owned practice they're going to work you like a dog and likely refuse to employ you unless you agree to supervise midlevels. If you don't want to have to supervise midlevels in that situation you're probably going to HAVE to start your own clinic.
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u/krnranger NP 10h ago
I'm especially impressed you noted #7. I thought it was just me that noticed this.
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u/Mercuryblade18 16h ago
Clinical/medical assistant is a lower skilled job with not great pay. It takes awhile to learn the ins and outs of a clinic and since you're just a resident you have zero bargaining power to get better help. At the end of the day you're still gonna see patients and they'll still bill.
Once you're an attending they actually have to give a shit but even then it can be hard to find a replacement CA/MA
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u/Apollo185185 Attending 15h ago
Because they’re employed by the hospital, not the physicians. The doctors have no hiring or firing power over them.
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u/__mollythedolly 10h ago
I've been with our program as a social worker for 10 months and watched the entire MA and office staff turnover twice already.
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u/tatumcakez Attending 9h ago
I personally think dealing with ALL the attending and residents has to do something with it too. A normal outpatient clinic, an MA may have to learn the style of 1-2 doctors and what they prefer? Resident clinic.. sooo many more to learn, different personality, less tolerable conditions
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u/Niscimble PGY3 15h ago
My institution trains every level of medical professional so we get a TON of trainees in all capacities. Generally what happens is one will work in our clinic for a year or two after graduating and then get use that experience to get a better paying job elsewhere.
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u/Adrestia Attending 9h ago
The support staff in residency clinics have to know more & work harder for the same pay that standard clinic support staff get.
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u/feline787 7h ago
Not just primary care - as a med student I’ve been to academic residency derm, ophtho, etc specialty clinics and their staff are also poop
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u/AncefAbuser Attending 6h ago
Resident clinics tend to get the sickest, lowest reimbursing patients. That means more volume per day. Means overworked staff. Means those who can, will leave.
Private practice is great. Higher pay. Selective panels. Better work environment. Higher pay. It matters. People will tolerate more BS when the paycheck actually matches.
Medical staff training has also dropped in the last decade or so, worsened by COVID.
You can rip my seasoned staff from my dead hands. I've seen the utter shit shows the newer grads are.
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u/MGS-1992 PGY4 7h ago
Because the relatively higher proportion of Medicare and Medicaid patients you see don’t bill high enough to afford more/better MAs 😂
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u/FarazR1 Attending 6h ago
Residency clinics in particular have a lot of unique hurdles that other offices don’t:
Residents rotate through so each one has a different process and style
Clinic is usually thought of as a side rotation so its not taken as seriously as a core rotation
Changes in clinic protocol often require months to implement because resident/attending schedule is so variable
In order to support residents, a lot of things have to be done that are not the case for regular clinics, including patient caps and rescheduling. This leads to bad continuity.
The whole supervision/staffing issue makes things inherently less efficient which means clinic is not making much revenue and residency clinics usually run at a deficit
Patients and staff do not understand that during residency, your schedule is made to service your career goals. If you want to do an away for example, you will need to be taken off the clinic and that means there needs to be redundancy for clinic.
MA and front desk jobs are often stepping stones so staff wont stay for a long time.
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u/VariousLet1327 4h ago
Where do you think the new grads from MA school go to get job experience? Anyone with talent, work ethic, competence eventually gets enough experience to move to a better paying job. This who are too inept or unmotivated never leave.
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u/HitboxOfASnail Attending 8h ago
The inconvinient truth is that in residency clinic, they already have a permanent workforce of able bodied and intelligent individuals capable of doing all the work, and without any risk of turnover due to poor conditions: the residents
so they literally don't need to hire capable MAs or office staff, they already have an abundant supply
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u/swollennode 3h ago
It’s not specific to pcp clinics. Every clinic is prone to this.
Mainly because they’re underpaid, under appreciated, and have to deal with the public.
In many clinics, even private practice ones, MAs are paid the same as McDonald’s or grocery store bagger. Even worse, they’re paid the same as a high schooler who has no experience. Why would a person with 10 years of experience want to be paid the same as a high schooler? So the clinics end up hiring a lot of temps and seasonal workers.
They’re vastly under appreciated because everyone sees them as low level staff. On top of that, there is a lot they can do to help a clinic running smooth, but if they’re not appreciated, why would they go the extra mile for the clinic?
On top of that, patients can be really abusive to the staff, and some places, the providers don’t stand up for them.
This all comes down to business management, which, a lot of doctors don’t know how to do. They don’t know what it takes to retain good employees.
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u/Big_Opportunity9795 3h ago
Because the people actually affected by their ineptitude have zero hiring or firing power.
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u/fuqthisshit543210 16h ago
High staff turnover, inefficient management, lack of resources, etc. Same shit as anywhere else