UCSF recently partnered with Bay Area Medical Academy on a new training program for medical assistants, as the need for qualified and certified MAs continues to grow. The program is a first-step toward training to be an MA at UCSF.
We spoke with Michael Jones and Angel Barrios of UCSF about preparing Medical Assistants to work in the healthcare field. (This conversation has been edited for length).
How did COVID impact you and your organization?
Michael Jones: So from an organizational perspective, Covid had a significant impact similar to most organizations, where we had to take it into account continuously: How do we keep our doors open, but also, how do we keep them open safely? And how do we care for our current staff to ensure that they are safe, and that they have the proper tools and equipment to do their job; as well as how do we ensure that patients and their families also have the proper access and safety procedures in place?
With that came a lot of learning opportunities. For one, we really bolstered and built out a more functional way to enable people to, of course, be off, and also we thought about our backfilling strategies when someone is off. It was a challenge to be worked out in that we didn’t want any one team — even though there is still some burnout and over exhaustion — to be overburdened, or too many teams at once.
Secondly, it really pushed us to be much more agile in how we think about hiring, and one of the benefits of this was looking at, how quickly can we hire someone? What methods can we use to hire them that could streamline the process? Do all stages of the hiring process need to be in-person? And how do we do that while still maintaining a great experience, still maintaining confidentiality where needed? And we realized pretty quickly that we could. We had the infrastructure in place to do things like a virtual offer, a virtual interview. Your virtual orientation, when needed, and all those things were able to help us get the proper staff in place.
When you’re talking about our launch pad roles like medical assistants and other direct patient facing roles, we saw significant impact in those roles, not only because of just significant burnout and just the overburden that these teams faced, but also because they also were part of the population that could become ill and most people across the organization still were on the frontlines. And so in terms of the medical assistant staff, we saw some immediate declines, as with all other roles.
But I think what really stood out for us was the opportunity for us to grow, and that’s what we pivoted to is the opportunity to expand the number of MAs we had in the organization to expand the number of other direct patient facing support roles that we had in the organization, and so from that, the M. A. Program was born. We now have a partnership with Bay Area Medical Academy. And where there was a really tumultuous situation, and where there was a lot of heartache and difficulty, we saw an opportunity, and that opportunity was to train our own staff, who are already patient-facing in some capacity, and had a set of skills that we needed and which allowed them to quickly pivot into the roles that we needed to backfill. This was an opportunity for us to scale our services.
Why is the BAMA partnership important for UCSF staffing needs, and how much interest are you getting in the program, in terms of numbers?
Angel Barrios: I just know that there is a shortage (of MAs) and there is an interest from a lot of clinics to actually host BAMA students. And because they’re hoping that eventually, after the students get to be in the clinics, they will be interested in working for the clinics and go through the full training.
Michael Jones: In terms of numbers, in the coming months we’re going to take on dozens of medical assistant trainees, and every single department that we reached out to, almost every single one that could, said yes. And there wasn’t any pushback, which means, there’s an increased appetite, and an increased demand for us. And so what this tells me from a demand planning perspective is that we have a good number to start with with our partnership, and how we’re developing a couple of other things, but we may have room to scale much higher.
In terms of the number of open positions that we see each week, on average, we are seeing dozens of positions. Once we have filled those, sometimes we’re also starting to do backfills for those who received new jobs within UCSF or those who retired or those who are no longer employed with UCSF, and so those open positions plus then also backfills.
There is now a shortage to the point where we’ve expanded our recruitment team. About two to three years ago, the recruitment team was only about a third of the size it is today. So, we’re increasing the number of recruiters, and each of them is focused on very specific areas with a handful of those focused on the patient-facing roles such as MAs, PCAs, which are our patient care assistant roles, and other direct patient-facing roles.
In terms of numbers, it is a very dynamic number and part of what we’re seeing is our new opportunities are outpacing our backfill opportunities, which tells me there is an increased demand for more individuals, not just to replace individuals that may have retired or transitioned to new roles.
Who is eligible to attend the MA Academy at UCSF?
Angel Barrios: Everyone that is newly hired by UCSF, so it could be staff that just finished with the BAMA program or another program, or they could be MAs from other places. But UCSF wants to train them according to the standards and quality that we have. So then they’re ready to go to any clinics or the clinics that they were hired in.
How did you find the training partnership with BAMA?
Michael Jones: That’s a really good question. At UCSF, with anything that involves finances, and we generally do this as a good rule of thumb, we evaluate partners. We evaluate partners based on, of course, our organizational fit. Do you fit our mission and vision, and do you also have the capacity to scale and support in the way that we need you to support? And you don’t always have to have the capacity to scale, because that’s something we could build together as partners. If you have the right model, there may not be a shortage of opportunity for us to say, let’s infuse resources here, or let’s support you in this way for us to then help you scale.
In finding Bay Area Medical Academy, one of the things we did was we looked across the Bay Area landscape. We also looked at asynchronous opportunities, to figure out what can really be done to scale our staff. And what we realized quickly was that we didn’t actually have the full picture. So one of the things I did right away was I took a step back, and I said, before we start evaluating partners, let’s figure out what our staff needs. And before I go to that piece, Bay Area Medical Academy was actually on the radar of UCSF about 2 to 3 years ago back in 2019 or late 2018. Colleagues who had engaged with Bay Area Medical Academy, said, “Hey, we had a really great engagement opportunity with this organization. We don’t know if they’re still doing what they said they wanted to do with us. But let’s check with them and see what’s going on.” And so that’s part two of the story.
Part One is when we went back to our staff, and we asked, what are the barriers that are restricting you from advancing your career? We did that through our staff engagement survey, which we do each year, where we gather feedback on how people feel and whether they feel they belong in the organization, and how they engage in the organization.
We also gather feedback on whether managers are supportive of career development opportunities. We ask something along the lines of like, what does it look like for you if you want to grow your career, and for some it was: I simply want to be a manager. I think I have the skills to be a manager. I want to be a manager. I want to be a director. For others it was: I really don’t know. I’m really good at the role I do. I have really good skills, but I really don’t know what else is out there. And you have to remember, at UCSF, as most health systems are today, we’re like a small city. Every single job that you could think about in a big city, you could probably find a derivative of it here at UCSF. So starting off as a let’s say, a medical assistant, doesn’t mean you need to remain in the clinical track. You could go on to be a faculty member, and perhaps teach others. You could go on to do something in HR, you might go on to do something in labor / employee relations. You have a lot of really great opportunities. And so we started to ask people what’s stopping them from pursuing another career opportunity.
Three things came up: 1. Resources — “I don’t have the money to go to school. I can’t really pay for it.” 2.) Time — ”I don’t have the time to do a traditional training program. It’s going to take way too much out of my schedule.” and 3.) No managerial support. And these things are really important to us, because when you think about managerial support, that manager is going to say, in the middle of the pandemic mind you, I’m already short staffed, I already have a lot more work to do, and now you’re asking to be off for a number of days, number of weeks, whatever the case is, for training?
So in evaluating our partners, those are things we consider. Resources that were available to support students, the time that the courses were going to be offered, and of course the cost of the program. And finally, whether or not this was something that’s gonna be something our management team can support.
Bay Area Medical Academy was one of the groups that checked all the boxes for us. So, when we started to work much more closely with Bay Area Medical Academy and with our internal leadership, we were really happy to structure a program that was offered during the evenings, and also on weekends, a really big plus for our first shift and second shift staff.
It helped us to realize things that could be asynchronous. A student could go to classes on Zoom, and then on Saturdays, when not working. So that was how we started to work with BAMA because we first listen to our customers, which is our staff.
What are the deciding factors in the selection process for the program? What do you ask new medical assistants who are entering the program?
Angel Barrios: We look for somebody who is motivated, of course, and dedicated. Once they come to us, after the BAMA program, we like to see that the MA trainee knows the basics, we look at how they’re doing their vitals, their rooming, all the tasks and responsibilities expected of them. In the clinics, because the BAMA studentwill not go through the MA Academy just yet, they will be trained by MAs in the clinics. They will go through the UCSF learning modules. They will go through a basic one-day ambulatory, clinical orientation, with some basic skills covered. The rest of the training will then happen on the job. There will be an evaluation, but we encourage them as much as possible, in terms of evaluation, to be very objective in the training, to use careful language when providing feedback, such as “this medication process that you did is unsafe” and explain why. Now you’re putting the safety issue on the process or that action for that particular time — you are not telling the person that they’re being unsafe as if it’s a personality trait, because there’s a difference. So that’s one thing that we teach them.
It’s also very important that the MAs are very open to teaching BAMA students, or any other externs, because then we may want the BAMA student. Would the trainees like to work for UCSF if they did not have a good experience, if they were not given good training? So, it goes both ways. The expectation is yes, we expect the trainees to be good. We understand that they don’t know everything, but it’s important to be open to training, open to learning, and to exude what we say are “UCSF values.” There’s already an expectation from them because they are employees now, but it’s also very important that on UCSF’s part which we always always remind them, they should be open to teaching and open to understanding that these are new trainees. There should be patience and understanding. So we teach that in our preceptor workshop.
How is your training partnership with BAMA advancing economic equity in San Francisco?
Angel Barrios: Yes, advancing economic equity in San Francisco. If a lot of the students or the trainees are able to go further in their professional development that also allows them to be able to earn more. And then, of course, there’s more buying power in terms of the economy: what they give back, they will be able to afford more things for their families, and that’s just the process that advances equity.
What I like about this model and I found it very, very important, here at UCSF, even as a community, is it allows people or employees to move up the levels, up the career ladder. It allows them to provide for their own families, and it’s a process wherein that family who might not have been able to afford to send their kids to school, will be able to do that. So, their success is also success for their family. It’s like a domino effect in terms of that. Of course, in the community, at UCSF, it’s really fulfilling in terms of the mission and values.
That’s why I find this program that Michael has developed really, really heartwarming, and not just because it’s a partnership with you. But what you bring to the employee, what help you give to the employees, shows when we try to work together to get them the schedule that works for them. Many people do not have this opportunity where they work, it is not a possibility or a reality for a lot of people. There’s no opportunity. So, it’s great that UCSF has it, and that just makes me love UCSF more. Just meeting Michael and the work he does, I always tell him that because of this, it is not just the economy, it makes the world go round.
Michael Jones: That was beautiful. Thank you for sharing that. Well, I’ll just pick up on something you said, Angel. So each week we meet with Bay Area Medical Academy, and Hannah and the team, they go over the progress for the students. And sometimes it slips our mind, but when we’re talking about students who are getting A’s and B’s, and doing really well on exams, those are working parents, oftentimes. They are working full-time, they’re going to school full-time, they’re participating in raising their kids, and they’re doing an amazing job. And, they probably also have other social activities that they do to support their community. And all within all, they are achieving significant gains.
I asked one person: How did you picture yourself 8 months ago or 9 months ago? And I could tell there was an emotional filled email when they responded because they said “I didn’t see this. I didn’t see myself having a phlebotomy certification. I didn’t see myself potentially now becoming a medical assistant” Their child is going off to college, and the fact that they’re child’s going off to college and they felt they’ve set a really good example, it’s important to continue working hard and doing this.
And as a health institution, to what Angel said, we’re helping the community and we’re helping the world. I know that sounds like a grand ideal. But here’s why, and our data shows this, from a health equity perspective, the more you’re able to earn, you’re able to earn a good living wage, or even above a living wage, your access to healthcare becomes better, your access to preventative care becomes better. So when we create pathways for people it’s truly impacting communities, impacting their health, and extending life expectancy. From a health perspective, that’s really the end goal: to ensure that we’re impacting the community by extending life expectancy through doing some of these things.
Michael, I understand that you’re involved with UCSF’s Anchor Institution. Could you tell us more about the initiative and what some of its goals are?
Michael Jones: I could certainly tell you. I will tell you that the goals are evolving as we uncover more societal inequities. Anchor was started at UCSF in 2017 as a response to the Michael Brown murder in St. Louis. Quickly, it led us to see that we cannot impact societal change without actually thinking about how we go back out into society because we are a part of those communities. We are the ones that shop at the grocery stores, we are the ones that utilize those services. And so we looked at our first community, which is UCSF staff, and how we invested in our people, which is the workforce, so we figured out, we probably need to do a better job of helping people move up or move across the organization, and also helping to move into it.
Secondly, we needed to look at our procurement strategy: How do we attack addressable spend and by addressable spend, I’m simplifying here, it’s really saying, how do we look at supporting a local small business for a contract or for our needs; how could we infuse capital into a business that also supports community, and could also drive potential employment opportunities for that community. And so we looked at procurement in terms of how do we move our spend into the community? So that’s our second pillar.
The third pillar, which we’re working on right now, is our investment strategy. Not something you often hear from a hospital system, but we’ve taken 5 million dollars of our own money from our Treasury Department, and we put it into what is considered a CDFI. A CDFI is a community development investment fund, basically an investment manager of community projects. And so with that $5M investment, we are looking for organizations that are working on addressing recidivism work. So, we want people who come out of prisons and not go back in and this is how we’re gonna do it. We’re going to support training, jobs, and invest in this. Then, let’s look at housing. Housing is a huge issue. Let’s figure out how we keep people in their homes. We may invest there and look at these things on both sides of the Bay, East Bay and San Francisco, West Bay as well. It’s an investment, but it’s not like 10% or 40% return or something like that, it’s more like 1 to 2%. We’re not gonna get rich doing this. We’re not going to be able to open up a new hospital because of this money. It’s basically a social investment for social return.
We’ve done these three things, we’ve invested in our workforce. We’ve invested in our procurement strategy. And, we’ve also invested in our investment strategy. And there are other strategies, that we’re thinking about, but the core of all of this is how do we identify disinvested communities and invest in them strategically, so that we’re not just doing it for headlines. But really doing it, so that five years from now we’ve made substantial changes. Ten years from now, we’ve made substantial changes in the way things are done in the city and the Bay Area.
Angel Barrios: That’s beautiful Michael.
Bay Area Medical Academy: We agree. Thank you both so much for sharing your thoughts with us, and being such great partners. We look forward to our continued work.