Using Pre-Health Professionals as Practice Support Staff
Is there a role for premed students in your retina practice?
Retina practices face an ever-changing health care landscape. To employ physicians’ time more efficiently, the use of ophthalmic technicians as medical scribes or assistants has grown significantly along with the increased use of electronic health records.1,2 The regulations and certification requirements for hiring medical scribes in retina practices vary by state. For example, Colorado, where our practice is located, does not require medical assistants or scribes to be licensed or certified. Still, many employers prefer hiring medical assistants who are certified or who have graduated from a credentialed medical assisting program.3
AT A GLANCE
• Depending on state regulations, using premedical students or pre-health professionals as medical assistants, billers, technicians, or scribes could be beneficial for retina practices and the individuals filling those roles.
• Notorious for job-hopping, the millennial generation has affected the hiring practices of medical organizations. Taking on and training students for short periods of time during their education may be an attractive option.
• Retina practices should weigh the pros and cons of hiring uncertified pre-health professionals.
It can be advantageous, however, for private practices to look to the growing pool of pre-health professionals in these roles for a multitude of reasons. Pre-health is a term analogous to premedical but is more general, describing those who intend to pursue a career in medicine or related fields. These professionals may include college students or recent college graduates interested in gaining experience and patient care hours in the medical field before applying to medical school, physician assistant (PA) school, or nursing programs. These individuals are highly motivated and interested in the medical field. Although they might seem like less attractive candidates because they intend to pursue further schooling, it is worth comparing the pros and cons of hiring pre-health professionals rather than certified medical assistants in your private retina practice.
FACTS TO CONSIDER
The largest single cost of operating an ophthalmologic practice is the support staff, including medical assistants, billers, technicians, and scribes.4 Minimizing staff turnover and employing the highest quality and most efficient staff is important in creating an effectively functioning retina practice. Turnover rates for medical assistants can be as high as 20% a year, whether due to a perceived lack of potential career advancement or to small competitive wage increases offered by other practices.5
Further complicating this situation are the work habits of the millennial generation. Millennials tend to change employers more readily than their older counterparts.6 As millennials comprise an ever-growing portion of the workforce, employee retention rates are a concern for private practices attempting to minimize hiring and training costs. A certified medical assistant stays in a position for an average of 4.2 years, according to the US Bureau of Labor Statistics,7 only slightly longer than the 1 to 3 years that a pre-health professional might stay.
Training time for a new medical assistant or scribe should be taken into account. Pre-health individuals, although not formally trained in medical assisting, generally have at least some experience volunteering or working with patients in a medical setting. Instituting a formal ophthalmic training program for your employees increases the likelihood that individuals without previous ophthalmology experience will be successful in your organization. This may make the investment in training an uncertified scribe or assistant less risky and more advantageous. The practice may be able to pay an uncertified individual less, due to his or her lack of experience, than someone certified and with 3 or 4 years of experience in retina. And with a training program in place, the time it takes to get both individuals up to speed may be comparable.
A large portion of the Association of American Medical Colleges’ application is focused on the clinical experiences of the applicant. Any student applying to medical or PA school must have a minimum number of patient care or clinical hours. The Association of American Medical Colleges recommends that medical school applicants have at least 100 hours of clinical exposure, and most PA programs require 500 to 2,000 hours of clinical experience.8 Those pursuing a career in medicine or a related field will have at least a college degree, typically in the sciences, and will be looking for positions in clinical settings such as retina practices.
There are other opportunities in retina for pre-health professionals beyond work as medical scribes or technicians. Large retina practices often provide opportunities for clinical research. Research assistant or clinical coordinator positions might be filled by premedical students with undergraduate research experience. Many premedical students work in research to improve their curriculum vitae for medical school. In a retina practice, such an individual might work in clinical research and have the added benefit of patient contact through the practice’s participation in clinical trials.
MUTUALLY BENEFICIAL ARRANGEMENT
Andi Chernau is a technician at Colorado Retina Associates who plans to start medical school this fall. Her experience working at Colorado Retina Associates not only enhanced her application to medical school, but it also provided her with valuable exposure and experience in a subspecialty, which otherwise would not be possible until the elective rotations in her third and fourth years of medical school.
“Working as a technician/scribe in retina has provided me with exposure to a specialty I am potentially interested in, allowed me to gain valuable patient care hours that boosted my medical school application, and also gave me the opportunity to work with patients and physicians on a daily basis,” Ms. Chernau told us.
She is an example of an uncertified but capable medical scribe who can be employed very effectively in private practices in states such as Colorado, where the scope-of-practice law allows the hiring of uncertified medical assistants and scribes. For a private practice, individuals such as these, although lacking formal certification, can be easier to train and bring up to speed due to their biomedical background and high level of motivation.
Colorado Retina Associates has shifted its hiring style to target individuals with a strong science background who are interested in gaining additional medical experience in retina. These individuals are enthusiastic about the opportunity to work in retina because they have a future goal of attending medical, PA, or nursing school. Often, the type of experience they can gain with us is a requirement for application.
Our practice embraces the opportunity to work with these talented individuals, and we appreciate their commitment to us, even if it is for only 1 to 2 years. Many times, duration of employment is discussed with these individuals during the interview process, so that the expectations of both parties are mutually agreed upon. We have designed a specific training program for individuals with this background, and we often start them in pairs so that they have a partner who is on a similar professional path.
PLUSES AND MINUSES
There is an obvious benefit for pre-health professionals who work as medical assistants or scribes. They gain the clinical experience necessary for their next steps in schooling. They can acquire exposure to fields they may ultimately be interested in exploring after medical or PA school.
For the practice, this offers the opportunity to build relationships with future PAs or doctors who may want to return to work in retina.
Private practices can build relationships with their medical scribes and technicians and support them in their professional endeavors, with the possibility that they may return to work for the practice after their training. The prospect of a medical scribe going through medical school, residency, and fellowship and then finally returning to the same practice may be unlikely, but it is a possibility, especially if his or her experience included an important mentorship or meaningful relationships. The return of PAs may be more likely, due to their shorter schooling requirements.
There are drawbacks of hiring uncertified pre-health students. One of the negatives, as mentioned above, is that these pre-health professionals will eventually leave for school. One way to offset this drawback is to balance the hiring of medical assistants within the practice so that there is a mix of certified, experienced scribes and technicians along with uncertified pre-health students.
Recognizing pre-health students as an attractive hiring pool is a first step. In order to hire these individuals, retina practices should form relationships with local premedical associations for colleges and universities. For instance, one of the authors (JL) graduated from a post-baccalaureate program that required all master’s degree students to complete 100 hours of internship in the medical field. This could be satisfied with bench research, clinical research, patient care hours such as working as a scribe, or even shadowing a physician. Thus, such associations can serve as valuable resources to retina practices looking to hire support staff.
Most graduate students see internship requirements as a way to build relationships with potential future employers during the application process for additional schooling. From the student’s perspective, working as a scribe allows one to work with patients in a clinical setting, gain exposure to a specific specialty, and form relationships with physicians who might further support their education and career with a letter or recommendation.
Another positive to hiring pre-health professionals is that they can be less expensive employees due to staying shorter periods and having less experience. Statistically, a certified medical assistant with 5 years of experience will work at a higher salary or hourly rate than a recent college graduate with no specific medical assistant experience but with a background in premedical education.
AN OPTION NOT TO BE OVERLOOKED
The benefits of hiring motivated, interested, but uncertified premedical individuals into medical assistant or scribe roles in retina practices outweigh the negatives. This demographic should be considered as a viable alternative hiring pool for practices looking for the most competent and efficient staff.
1. Pinto, JB. The variations of private practice models, part 1. Ocular Surgery News. June 5, 2005.
2. Eldridge CW. Expanding roles of medical assistants in the patient centered medical home. Muskie School Capstones, Paper 19. June 1, 2013. http://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1019&context=muskie_capstones. Accessed April 18, 2017.
3. Pinto JB. Is my practice overstaffed? Part 1. Ocular Surgery News. July 1, 2005.
4. Taché S, Chapman S. What a medical assistant can do for your practice. Fam Pract Manag. 2005;12(4):51-54.
5. Economic Tenure Summary [news release]. Washington DC. Bureau of Labor Statistics. September 22, 2016. www.bls.gov/news.release/tenure.nr0.htm. Accessed April 18, 2017.
6. Adkins A. Millennials: the job-hopping generation. Gallup. May 12, 2016. http://www.gallup.com/businessjournal/191459/millennials-job-hopping-generation.aspx. Accessed April 18, 2017.
7. Pasquini S. Healthcare experience required for PA school: the ultimate guide. The Physician Assistant Life. www.thepalife.com/hce-paschool/. Accessed April 18, 2017.
8. Medical Assistants. Data USA. https://datausa.io/profile/soc/319092/. Accessed April 18, 2017.
Jackie Bayne, COA
• clinical manager for Colorado Retina Associates in Denver, Colo.
Brian C. Joondeph, MD, MPS
• partner at Colorado Retina Associates and a clinical professor of ophthalmology at Rocky Vista University College of Osteopathic Medicine in Parker, Colo.
• firstname.lastname@example.org; @retinaldoctor
Jessica Leonard, BS, MS
• ophthalmology technician at Colorado Retina Associates in Denver, Colo.
The authors report no financial disclosures relevant to the content of the article.