This is a great topic, as I always strive to optimize my practice.
I’m an early-career employed attending. Some of my colleagues have a team composed of a couple of RNs and MAs, which seems to work very well (though this team setup is more of an outlier), while others prefer a bare-bones team structure by choice.
In my current setting, I work with an RN and MA for clinic visits, along with another RN primarily handling triage and related tasks behind the desk. However, in this setup, patients are seen first by the MA, then by the RN (who functions more as a note forwarder than a scribe), and finally by the MD. This process often feels unnecessarily slow.
I work in an area of the country where RNs are paid
very well. This 2 RN/1MA setup, if I had to pay for it out of my pocket, would cost me almost 50% of my base salary...and I'm paid slightly above 50th %ile. So this just seems insane to me. So do nursing salaries around here, but that's a whole different issue.
I’ve been tracking my time in EPIC, and the time it takes for patients to see the provider is longer than I would expect. I believe streamlining this process could save time and potentially reduce the total clinic duration by about an hour.
How is the normal flow of your clinic structured after the patient checks in?
Does the MA take care of vitals and medication reconciliation, potentially eliminating the need for the RN in this step and allowing the RN to focus on a more impactful role before the MD sees the patient?
We have some very competent and efficient MAs. So for non-treatment patients, the RN never even sees them. MAs do labs, VS, Med Rec and rooming. Whole thing takes 5-15 minutes depending on whether or not they need labs and how chatty they are (it's a small town, everybody knows everybody, there's a lot of chatting).
For treatment patients, the RNs get them first, do the Med Rec, IV/Port, labs and then MAs come get them and room them and do vitals. No duplication of Med Rec here. Again, the rate limiting factor most of the time is socializing.
How is your clinic support staff structured?
High staff turnover is an ongoing challenge, and the quality of support staff leaves room for improvement. How do you address these issues in your practice to maintain efficiency and provide excellent patient care?
The importance of great staff can not be underestimated and is generally underappreciated. As mentioned, RNs are expensive here, so we tend to use them for things that we need an RN to do, most of which is treatment and advice/triage related. Our setup is somewhat unique because, as a Rural CAH, our infusion RNs are managed (and paid for) by the hospital. We have one RN coordinator shared between myself and my NP (and soon a 2nd physician). She does all the care coordination, incoming referral review and outgoing referral tracking. We have 2 pharmacists who manage all the oral chemo PAs in addition to managing infusional drugs (but not PAs, the hospital does that). They also do a lot of chemo plan management and will even build a new plan from scratch, or adjust existing plans to fit my needs. We have 2 MAs (again, only 1 MD/1NP right now, will increase MA staffing next year with a new doc coming onboard) who do everything I mentioned above. They also do all of the normal result calls. I typically do my own abnormal result calls because it's just less work for me to do it than having to answer a hundred questions about it afterwards.
I have been fortunate in this job that the only real staff turnover that we've seen is for people making geographic or career moves (2 RNs moved for family reasons, one became an NP, one MA left healthcare entirely to work in law enforcement, former clinic manager retired) but not for reasons related to the job or performance.
Good hiring and training is the best way to keep things moving smoothly in this scenario. But that can be easier said than done.
