Medical support staff is leaving in droves and leaving patients’ health at greater risk. Calls and messages to doctors’ offices have surged as patients try to access care. Wait times skyrocket to book visits.

News stories about the current state of the health care system typically focus on the plight of doctors and nurses. Studies detail the “Great Resignation” impairing the health care industry–a new report published last month estimates that since 2020, one in five health care workers (including physicians, NPs/PAs, physical therapists, and social workers) have quit their jobs, and altogether 47 percent plan to leave their positions by 2025.

According to the Bureau of Labor Statistics, 500,000 nurses will leave the workforce in 2022, bringing the overall deficit to 1.1 million nurses. These staffing shortages are hurting patients—e.g., contributing to the current pediatric bed shortage in the midst of a surge in respiratory infections.

However, these reports (and the alarming headlines) fail to include another critical labor force in health care: medical support staff. Medical support staff includes many positions: reception, nursing aids, medical assistants, and referral support. Protecting them is critical to prevent the further crumbling of our health care system.

But we don’t even know the number of these crucial staff who keep the system running. The U.S. estimate is around 6,603,680 workers in this position. This total also includes veterinary medicine and dental hygiene positions but doesn’t include medical receptionists/front desk staff, who answer phone calls. At our institution, there’s an ongoing attempt to register the support staff in each department. Such imprecise data of this population contributes to their invisibility.

Anecdotally, we know that many medical support staff, including front desk staff, medical assistants, and nurses aides, are quitting. Headlines talk about doctors and nurses leaving, but the staff exodus is probably more extreme. The only published study of its kind found a turnover rate for medical assistants of 59 percent in one year in one large primary care practice. A 2022 MGMA Stat poll asked medical practices what staff role was most difficult to recruit: the majority of respondents (44 percent) said medical assistants (MAs), followed by nurses (27 percent), administrative/billing staff (18 percent), and other clinical staff (10 percent). In the primary care clinic where we work, 11 support staff out of 30– more than one-third–have left their positions in the past two years.

Many reasons for leaving include low wages and lack of perceived respect. The official living wage in Massachusetts for an individual with no children is $21 per hour, yet the average medical assistant salary in Massachusetts is only $16 per hour. Given the high cost of living near many city-based medical centers, the support staff has to live far from their jobs without the option of working remotely.

And it’s not just low wages and lengthy commutes. Medical support staff on the job endure constant demands from angry patients (via phone, email, and patient portal) and burned-out medical providers. Staff is the flashpoint between patients and clinicians. They bear the brunt of patient frustration with the system and, remarkably, are more likely to experience workplace violence than employees in all other industries.

So when other industries beckon — the restaurant industry has recently increased wages to over $15 per hour for non-supervisory staff, and companies like Amazon, Starbucks, and Target are all offering a starting wage of $15 per hour or higher — it’s not a difficult decision to leave.

The frequent turnover in these roles contributes to the invisibility and low wages. If employees stayed in their positions, both would likely improve. All industries are having trouble retaining workers, with expenses and inflation increasing (particularly in health care). Hospital systems may believe they can’t afford increased wages or improving work environments for medical support staff, but the gaps in staffing and continued high rates of turnover only increase costs further.

Medicine needs a team approach to provide good care and reduce burnout. If discontented or temporary support staff are unreliable team members, the whole environment becomes less stable, and resignations snowball, including doctors and nurses. Patients will get fragmented, rushed, and substandard care. Dedicated, consistent medical support staff saves lives–building important relationships with patients, navigating insurance requirements, scheduling critical imaging tests and appointments, and collecting key clinical information.

Our failure even to quantify medical support staff speaks to how this group of employees is neglected, disrespected, and mistreated. We need to recognize, count and support these key health care team members before it is too late.

Leah Wilson is a nurse practitioner. Diana Lemly is an internal medicine-pediatrics physician.

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