The Layoffs That Proved Our Workload Was Unsustainable

Written By Candice Elam

When I landed my job at a large primary care practice, I was excited. The interview process was thorough, with multiple rounds with their big decision-makers. I did everything I was supposed to do: I asked about workload, administrative time, and support staff. I even asked about the company’s financial health, and they pointed to their opening of a new site as a clear sign of growth and financial soundness.

What they told me was true, but it was far from the whole truth.

Just two months after my start date, the company announced the first round of layoffs. They had to have known this was on the horizon during my hiring process. What they didn't tell me was that the original sites, which included my site, were a sinking ship. Unbeknownst to me, I would become the 16th medical provider to quit that job in just 18 months. Many had resigned or retired before I ever set foot in the clinic. All of the sites were poorly staffed and poorly run, yet the company was still projecting an image of growth by opening a new site. This deceptive tactic, a perfect example of a bait-and-switch, couldn’t cover up the practice’s financial flaws forever.

Before I took the job, I didn’t know how many medical providers quit that company before me, but I quickly discovered the source of the mass exodus. In the few months of my employment, at least nine colleagues announced their resignation. Layoffs were supposed to the organization from the brink of bankruptcy. The leadership seemed to have a clear understanding of the business: they made it clear in the first round of layoffs that providers, nurses, and medical assistants would be safe. Their reasoning was simple: medical providers were the company’s income generators. And our clinical support staff was crucial because they made it possible for us to see more patients and generate more revenue.

But this revenue-focused mindset was deeply flawed. It failed to account for a massive, unbillable workload that would prove to be the real crisis. Their push to have us see more patients meant that we were providing so much service that we didn't have time to close the notes so that we could bill for all the work we were doing. As a result, the unbilled visits continued to pile up, without the money coming in.

I had never worked in an environment with such poor communication and siloed departments. It seemed everyone was an expert at saying, "That's not my job." A request that should have taken a minute would get shuffled between departments for days. Unfortunately, the patient care needs, and the legal vulnerability, fell squarely on the medical providers. An unlicensed assistive personnel saying they couldn't or wouldn't perform a necessary task meant it inevitably fell to medical proiders. We were spending our days doing countless administrative tasks that didn’t require our licenses, and none of which were billable.

This administrative burden was crushing. It was piled on top of patient visits and the after-visit work that came with every single encounter. Throughout the practice, medical providers were falling so far behind that there were thousands of unsigned visit notes, many from encounters more than 6 months prior.

This created a massive, un-billed backlog of services rendered, amounting to hundreds of thousands of dollars for each medical provider. The clinic was losing money every single day, but the leadership couldn't see the root cause: the system was broken, and the administrative burden on providers was impossible to bear.

In a medical provider meeting where the layoffs were announced, we were furious that our colleagues among the support staff were going to lose their jobs. We told our bosses that we, as the income-generating staff, had a deep understanding of what wasn't working and that they needed to take our advice seriously. We told them they didn't need to pay a consulting firm to tell them what we'd been telling them for free. We begged them to talk to us directly and let us be part of the solution so we could save our colleagues' jobs.

They ignored us. They hired a consulting firm who spoke to all the different classes of staff members separately (medical providers, nurses, medical assistants, receptionists, and so on) and then regurgitated what we already had been telling our bosses had they simply listened.

Under these circumstances, many of my colleagues quit due to overwork and a lack of support, which only increased the burden on those who stayed. Then, the layoffs took away more staff and destroyed morale. There was no plan to reassign the work of the laid-off staff, which caused the rest of the workload to fall squarely on the remaining employees. It was a vicious cycle that worsened the very financial issues the leadership had tried to fix with the layoffs.

The layoffs, which were framed as a necessary business decision, were, in fact, a failure of leadership. Had the organization invested in training and clear communication across departments, the administrative work would have been executed properly, and our visit notes would have been signed. The provider's workload would have been manageable, revenue would have been collected, and my talented colleagues and I might not have quit.

This experience taught me a profound lesson: a practice that fails to support its providers is a practice that will ultimately fail to support itself.

How to Spot a Flawed System Before It Fails You

This story is a powerful example of what can go wrong, but it doesn't have to be your story. After my short tenure at that job, I scoured the region for the right role and developed a new method for vetting a potential employer.

I always look at company reviews on Glassdoor and similar websites to get a sense of what the current and former employees have to say. I also look at the Google and Yelp reviews to see what the current and former patients have to say.

I was offered a position at another clinic with a tempting $20k salary increase and substantial bonuses, but a basic online search revealed a nightmare. The company's own recruiters downplayed the number of patients per day and assured me there was enough time for administrative tasks, so dedicated administrative time built into medical provider schedules was completely unnecessary. The Glassdoor reviews, however, suggested otherwise; medical providers spoke of a crushing workload and overbooked schedules. Patient reviews on Google and Yelp complained of long wait times, rushed visits, and staff not following through with requests for forms, appointments, medication refills, and explanations of lab results.

Taken together, I knew that the lack of administrative time, the overbooked schedules, and the patients’ legitimate grievances were two sides of the same coin: a systemic failure that would lead to hellish working conditions. The high salary and bonuses were not enough to retain staff, so I didn't take that job.

My blog series, The New NP Reality Check, is dedicated to helping you spot these red flags and avoid a first job that leads to burnout.

I also have free and paid resources designed to give you the tools you need to find a supportive practice and start your career with confidence.

Candice Elam
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