Medical Assistants in Community Clinics: An Evolving Role
AcademyHealth
June 27, 2010
Susan A. Chapman, PhD, RN
Associate Professor, UCSF School of Nursing
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Department of Social & Behavioral Sciences
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Senior Research Faculty, Center for the Health Professions
Why Focus on Medical Assistants?
• MAs have become the predominant non‐licensed staff in ambulatory care practices
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• Growing in numbers, particularly in primary care
Expanding role in team models, medical homes
• Expanding role in team models, medical homes
– Traditional role expanded clinically and administratively
• Few
Few limitations in expanding supply of MAs
limitations in expanding supply of MAs
• Affordable way to provide chronic disease care management
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• Concerns about whether MAs are prepared for expansion and innovations in practice June 2010
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Who are Medical Assistants?
• Nearly
Nearly 500,000 employed in U.S.
500 000 employed in U S
• 89% female; diverse in race/ethnicity
– Being bilingual is often a job requirement
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• Projected 34 % growth rate in next decade
• Trained on the job or short‐term training
– 3 to 10 month programs up to 2 year degree • Little regulation of practice
• Primarily a delegation model
• Professional certification available, usually not required by employers
• Wages: $28,300 median annual ($13.60/hr)
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Studies of MAs Role Development
• CHCF/Bodenheimer
CHCF/Bodenheimer‐ Case Studies of Building Teams Case Studies of Building Teams
in Primary Care 2007
• Bodenheimer‐
Bodenheimer teamlet model
teamlet model
– MAs retrained to be health coaches
– Other non‐physician staff may be health coach
Other non ph sician staff ma be health coach
– Concept of “the huddle”
– MA makes connection with patient and family
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• Health Affairs‐ primary care teams
• UCSF Center for Health Professions‐ 3 issue briefs on MAs
• Hitachi –
Hi hi interested in career path of entry level i
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workers
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Study Objectives
Study Objectives
• Highlight the major roles of
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Medical Assistants in community clinics
• Identify expanded/innovative roles, how they Identify expanded/innovative roles how they
were developed, and how MAs are prepared for these roles
for these roles
• Determine major workforce policy issues from the perspective of clinic administrators
from the perspective of clinic administrators, medical directors, and medical assistants
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Study Methods
Study Methods
• Targeted
Targeted clinics; primary care community clinics; primary care community
clinics
– Self‐nomination
Self nomination
– List from California HealthCare Foundation
– List from California Primary Care Association
List from California Primary Care Association
– List from experts
• Telephone interviews of key informants
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• UCSF CHR approval
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Participants
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• Selected 15 clinics, 10 agreed to participate
• Represented most CA regions/counties
– Alameda, Imperial Valley, Los Angeles, Madera, Merced, Napa, San Diego, Santa Clara, Sonoma • Interviewed 3 participants at each clinic – 27 completed
– Medical Director
– CEO/Clinic Manager
– Medical Assistant
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Findings/Key Themes
• All interviewees stated that MAs are crucial to the operation of the clinic
– “The
The MA can make or break the provider
MA can make or break the provider’ss day.
day.”
• All interviewees were generally knowledgeable about the MA scope of practice
• Medical Directors and Managers noted the lack of M di l Di t
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skills in new MA hires
– Basic clinical skills, customer service skills, independent decision‐
making, computer skills
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• Major role assisting primary care providers varies little among clinics
• Salary range is similar between clinics
– Between $9 ‐ $12 for entry‐level positions
– $
$16 ‐ $
$20 for expanded roles
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Findings/Key Themes
• Expanded/Innovative roles/titles:
– Immunization specialist/vaccine coordinator
– Health educator (off‐site projects, health fairs)
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– Chronic disease manager
• Follow‐up calls, order labs, patient education – Diabetes case manager
– Referral coordinator
• MA career options include:
– Supervisory positions
– Expanded roles
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– Career advancement to another profession. Many are taking classes toward becoming an RN, LVN, or PA
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Findings/Key Themes
• Difference in opinion regarding opportunities for advancement
– MAs generally believe there are many opportunities and ll b l
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advancement depends on the individual
• “Sky’s the limit.”
– Several clinic administrators and MDs have mixed views
• CEO: “They are high school grads, and they work their way up to level 3 or 4. But it’s hard to move them up the ladder if we can’t move them into a community college or into a BA…”
• EHR provides opportunities for role expansion
– MA has
has access to data for better patient management
access to data for better patient management
• Diabetes registries, protocols for care
– Additional training on the medical records system to p
become the clinic “expert”
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Further Development of MA Role
Further Development of MA Role
• Respondents “wish list” to further develop p
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role of the MA
– More training in‐house
• Funding support for training
• MA to “take ownership” in expanded healthcare team
healthcare team
• Push the model further
– As far as scope of practice allows
As far as scope of practice allows
– More protocols for making patient care decisions
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Challenges in Expanding the MA Role
Challenges in Expanding the MA Role
• Disconnect
Disconnect in job expectations and training in job expectations and training
for new roles
– No standard curricula or time to train
No standard curricula or time to train
• Training in team models for all members of the team
the team
– Respect for MA as a team member
– MA confidence to actively participate
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Policy Implications
• Will health reform keep pushing this expansion as clinic practice grows
clinic practice grows
• Reimbursement model needs to support this practice who pays for care management services
practice‐
who pays for care management services
• Is expanded scope of practice needed?
• Formal certification/training for expanded Formal certification/training for expanded
roles/funding for training
• How do MAs interact with other licensed personnel How do MAs interact with other licensed personnel
given lack of regulatory authority
• Patient expectations/satisfaction Patient expectations/satisfaction
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Suggested Next Steps
Suggested Next Steps
• More studies comparing outcomes of various models
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– We don’t have much outcome data yet
– No case controls studies specific to MA role
• Assess Replicability – Other primary care sites
– Patient populations
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– Beyond chronic illness management
– Within other fee structures Within other fee structures
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Acknowledgements
• The California HealthCare Foundation
The California HealthCare Foundation
• The California Endowment
• The California Wellness Foundation
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