In the interests of cost-effectiveness and efficiency, family physicians are hiring more medical assistants (MAs) to help them manage the increasing complexities of patient care and practice management. The Bureau of Labor Statistics projects it to be the fastest growing occupation for the 2002 to 2012 period. 1
MAs’ responsibilities can be tailored to the needs of a practice. They can manage front-office functions and patient flow and handle a wide range of tasks that would otherwise be performed by receptionists, practice managers, nurses and physicians. Many physicians are unsure of what tasks are appropriate to assign to an MA and do not help MAs work to their full abilities and potential. This article should help you to better understand the MA’s role and prepare you to make staffing decisions that will make your practice more productive.
The formal training that MAs receive varies widely, from several months of vocational school coursework to a two-year associate’s degree program that might include classes in math, English, anatomy, medical terminology and disease processes. Most of an MA’s clinical training occurs on the job and is carried out by physicians, nurse practitioners, physician assistants, registered nurses and other MAs. Certification is not mandatory for MAs, and currently only 15 percent of MAs in the United States are certified. 2 , 3 (See “About medical assisting certification.”)
There are several different pathways to obtain certification in medical assisting. Certification is optional for MAs, but hiring a certified MA should provide the family physician with greater assurance of the MA’s competency. The first type of certification is received upon successful graduation from an accredited school in medical assisting. The second type of certification can be obtained by taking a certification examination from either a state or nation al medical assisting organization.
Only graduates of accredited schools in medical assisting are eligible to take certification exams. There are two national organizations in medical assisting, the American Association of Medical Assistants (AAMA) and the American Medical Technologists (AMT). The AAMA awards the Certified Medical Assistant (CMA) credential. For CMAs, recertification occurs every five years through continuing education or re-examination. The American Medical Technologists (AMT) awards the Registered Medical Assistant (RMA) credential. The AMT allows alternate pathways as well. Recertification for RMAs occurs by renewal of yearly dues to the AMT.
Although legal requirements addressing MAs’ scope of practice vary by state, MAs generally work under the license of their supervising physician or the managed care organization that employs them. To learn more about medical assisting scope of practice, contact Donald A. Balasa, Executive Director and Legal Counsel of the American Association of Medical Assistants, by e-mail at dbalasa@aama-ntl.org.
MAs are not licensed to make independent medical assessments or give advice. Physicians must determine the skill level and capabilities of each MA they supervise and take into account liability risk and quality control when assigning them their responsibilities. Physicians should provide initial direct supervision and periodically assess the quality of their work. In practices with nurse managers, medical assistants can receive additional supervision coordinated to maximize workflow in a practice. Communicating the MAs’ roles to other staff and clearly delineating their responsibilities is important in maximizing the productivity of the health care team.
With specific protocols, orders and directions in place, MAs can handle a broad range of duties. (See the outline of MAs’ scope of practice.) In some states, MAs can perform procedures such as urinalysis, strep tests, blood pressure checks, weight checks, electrocardiograms, venipuncture and injections. Some often-overlooked uses of MAs include doing telephone follow-up after visits, notifying patients of lab results, reviewing medications with patients, and engaging in translation and cultural brokering.
Using detailed protocols, MAs have been trained in disease management programs such as tracking PT/INR levels for patients on warfarin or following HbA1c levels for patients with diabetes. Some MAs assist with quality improvement initiatives by tracking and recalling patients who need Pap smears and mammograms, organizing flu vaccine clinics for high-risk patients, ensuring follow up for patients working on smoking cessation or verifying that patients over age 50 have had colon cancer screening.
More advanced roles are delineated in the AAMA advanced scope of practice. These differ in each state and may include placing IVs, helping patients draft a durable power of attorney or educating patients about procedures.
