Article Figures & Data
Tables
Office 1: Mature practice, physician couple owned At this decade-old, 2-physician–owned office, the physicians personally hired all the MAs. Physicians and a senior MA who functions as a supervisor shared daily management. There was little socializing, but there were regular meetings held between the physicians and the MAs. No regular evaluations of the MAs were performed by the physician or the supervisor. There was low MA turnover. The physicians did not allow the MAs to answer patient questions without physician permission, but the MAs stated they performed this function independently. Follow-up: office has not applied for NCQA PCMH certification. Office 2: Mature practice, formerly physician owned, now health system owned This decade-old, 3-clinician (2-physician, 1-FNP) office was recently purchased from the physician owners by a nonprofit health system. The physicians initially hired the MAs, who were managed by the office manager; however, responsibility for these tasks was less clear under the new ownership. Frequent socializing occurred between clinicians and MAs within the office setting, and regular meetings were held between the staff and clinicians. The office manager has performed evaluations of the MAs with clinician input in the past, but not recently. There was low MA turnover. The clinicians felt they had adequately trained the MAs over the years and trusted their medical acumen to answer patient questions and provide patient education. Follow-up: office has NCQA PCMH certification. Office 3: Mature practice, physician owner retired, now health system owned This decades-old solo physician office was recently purchased by a nonprofit health system when the owner retired. A relatively new physician was hired for the office. The MAs included those who worked with the previous physician and new hires by the health system. The physician socialized and ate lunch with the MAs and held regular meetings with the staff. Neither the physician nor the MA supervisor performed regular evaluations of the MAs. There was MA turnover during the sale of the practice, but little since then. The clinician felt she knew the MAs from their meetings and frequent conversations and trusted their medical acumen to answer patient questions and provide patient education. Follow-up: office has NCQA PCMH certification. Office 4: New practice, health system owned This 2-year-old, 3-physician office was started by a nonprofit health system to build a practice that in the future might house a family medicine residency. The physicians were recent graduates. All the MAs were hired by the health system with no physician input. No physician had responsibility for training or overseeing the MAs; the MA supervisor and office manager for several primary care offices provided direct management to the MAs. There was minimal socializing at lunch or breaks between MAs and clinicians. The physicians and staff held regular meetings. There was no regular evaluation or feedback of MA performance. There was high MA turnover. The clinicians did not trust their MAs’ clinical acumen, but they did not train or oversee them. Follow up: major physician and staff personnel changes, office has NCQA PCMH certification. Office 5: Mature practice, physician owned At this decades-old, 2-clinician (physician, nurse practitioner), physician-owned office, the physician personally hired all the MAs and provided day-to-day management. MAs and clinicians frequently lunched on site together, there were regular meetings between staff and clinicians, and each year, the practice closed for several days and the physician took all the staff on a short vacation together. Although there was some business conducted, it was primarily a social event. The physician clearly defined both the clinical and clerical roles, but regular evaluation and feedback was inconsistent. Communication between MAs and between MAs and clinicians occasionally escalated to tears. There was little staff turnover. There were strict protocols for what clinical advice MAs could give to patients, and work was in a central area where physician was able to observe patient-MA interactions. Follow-up: office has not applied for NCQA PCMH certification. -
FNP = family nurse practitioner; MA = medical assistant; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home.
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Characteristic Office 1 Office 2 Office 3 Office 4 Office 5 Cliniciansa Number 2 3 1 3 2 Sex, % women 50 33 100 33 100 Age, mean, y 44 51 30 34 55 Race, % white 0 66 100 100 100 Mean years as clinician 13 27 2 7 13 Mean years at this office 12 19 1 2 9 MAs Number 5 4 5 2 3 Sex, % women 100 100 100 100 100 Age, mean, y 55 45 58 32 53 Race, % white 60 100 80 0 100 Certified (CMA or RMA), % 25 66 25 0 50 Mean years as MA 13 13 29 1 16 Mean years at this office 5 9 5 1 8 Offices Ownership of practice Physician Health system Health system Health system Physician Patient composition, % Medicare 16 25 55 15 15 Medicaid/uninsured 16 1 2 51 5 Private insurance 68 74 43 34 80 Office location Rural/suburban Urban Suburban Urban Rural/suburban -
CMA = certified medical assistant; MA = medical assistant; RMA = registered medical assistant.
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↵a Physicians and nurse practitioners.
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Group Clinician Perceptions MA Perceptions Nurses (RNs and LPNs) Starting IVs Starting IVs Ability to answer patient questions RNs only (not LPNs): ability to answer patient questions Assessing and triaging patient clinical concerns Teaching patients Ability to provide clinical information (eg, results) to patients Independence to work with less supervision Less on-the-job training needed MAs Lower salary Lower salary Trained in clerical office work Trained in clerical office work Able to serve in back and front office Able to serve in back and front office More malleable to on-the-job training Often from lower SES; may connect with lower-SES patients Sufficient knowledge to handle all office-based medical questions, education, and care -
IV = intravenous line; LPN = licensed practical nurse; MA = medical assistant; RN = registered nurse; SES = socioeconomic status.
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Office Trust and Verification MA Hiring and Management Social Familiarity Office 1 Low trust, low verification Hands on High Office 2 High trust, low verification Hands on High Office 3 High trust, low verification Hands off High Office 4 Low trust, low verification Hands off Low Office 5 Low trust, high verification Hands on High -
MA = medical assistant.
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Additional Files
The Article in Brief
Patterns of Relating Between Physicians and Medical Assistants in Small Family Medicine Offices
Nancy C. Elder , and colleagues
Background Medical assisting is one of the fastest growing professions in the United States, and MAs are vital to new primary care practice models, yet little is known about their relationships to the clinicians with whom they work. This study aimed to understand MA roles and describe the clinician-MA relationship.
What This Study Found MAs' roles in small practices are determined by their career motivation and relationship with the clinician(s) with whom they work. Based on these findings, the authors propose a new model for this relationship, which they call trust and verify, characterized by different configurations of physician trust and verification of MA?s clinical activities.
Implications
- These findings may assist small offices undergoing practice transformation and guide future research to improve education, training and the use of MAs in the family medicine setting.
