A key to practice efficiency: Advantages of medical assistants

According the U.S. Bureau of Labor Statistics, the fastest-growing health profession in the country -- the fastest-growing profession, period -- is medical assistant. Physicians such as Catherine Tabb, MD, are one reason why.

Dr. Tabb, a solo family physician in Louisville, Ohio, started practice in 1980 with one medical assistant. She now has three full-time and three part-time MAs. They're used for all tasks -- front, as well as back office -- not performed by her or the practice's single nurse practitioner.

Dr. Tabb likes the flexibility of staff who can assume either front- or back-office duties to make up for vacations or illness. But having people with clinical knowledge at the front desk, making them more useful to patients, is even better. "They can answer basic questions about taking medications without having to transfer the patient to me," she says. "They help patients decide if they need to come in."

Like most doctors who make extensive use of MAs for clinical tasks, Dr. Tabb believes she's in no financial position to hire nurses. But more than that, she says, they're not necessary, particularly when most of the clinical work can be handled by MAs.

Charles Reed, MD, a pediatrician with 12-doctor St. Christopher Pediatric Associates in Philadelphia, says MAs bring versatility atypical of other types of staff. "We can move them from office to office," he says. "We can use them for clinical tasks, and if we need to fill in, we can put them in the front office, registering patients and answering phones."

The combination of versatility and comparatively low cost is driving the demand for MAs, 60% of whom work in physician offices. According to an American Assn. of Medical Assistants survey of 4,057 MAs nationwide, 61.6% of an MA's time is spent on clinical duties, including obtaining patient history and vital signs, assisting with patient exams, scheduling patient appointments and performing injections; 25.8% is spent on administrative duties; 7.3% is taken up with administrative management; and 5.3% is spent on clinical management. If they're certified, MAs make an average salary of $27,951. First-year MAs average $22,650, according to the AAMA.

Those in the field say doctors are just beginning to tap the potential of MAs.

"Only a minority of physician groups know how to utilize MAs and take full advantage of what they can do," says Don Balasa, AAMA executive director and chief counsel.

But hiring and integrating MAs into your practice is not necessarily an easy task. The duties a medial assistant can perform and the level of supervision a physician must provide can vary depending on your state and its regulations.

Generally, states define what MAs may or may not do through scope-of-practice laws -- if a task is limited to a doctor, nurse practitioner, physician assistant or nurse, it's off-limits to an MA .

Finding a qualified MA isn't easy because of the high demand. Another difficulty is that few have received certification -- estimates are at around 15% -- through the AAMA or the American Medical Technologists, giving physicians less evidence an MA might be up to the job.

Hiring an MA

Plenty of colleges and institutions offer two-year programs for aspiring MAs. But doctors vary on whether they require certification, which is generally not required by law.

Dr. Tabb will hire only certified MAs.

Dr. Reed prefers but does not require a candidate to be certified. He typically hires only candidates who have graduated from an accredited post-secondary training program. In fact, most of his hires are candidates who have completed internships in his office.

Nick Fabrizio is a consultant with MGMA Consulting Group and serves as practice administrator for a 12-doctor clinic that is part of the Dept. of Family Medicine at State University of New York Upstate Medical University, Syracuse. He says the best way to find a good MA is to work with a local educational organization that trains them. His group works with Bryant & Stratton College, a community college in Syracuse. By inviting students to undertake internships at his group, "we get to know the people intimately before we make any hiring decisions," Fabrizio says.

Because training and clinical knowledge have been established during the internship, when Fabrizio interviews someone for a medical assistant position, he primarily tries to ensure the prospect will be happy with the type of work entailed. In Fabrizio's group, MAs are placed either in the clinical or front-office side with little rotation except for emergencies.

"Some MAs have their hearts set on dealing with patients; others are more clerically-oriented and don't want to have anything to do with patients. If you don't match the preference with the job, you may lose them," he says.

Fabrizio adds that groups that rotate MAs have to do their best to determine whether the person will be happy on both sides. "If MAs have to spend one week a month doing something they really don't like, as soon as a position more to their liking comes along, they'll move on," he warns.

St. Chistopher's nine MAs do most of their work on the clinical side, Dr. Reed said. They are the first contact after the registration clerk. They greet the patient and parents; they weigh and measure the patient; they conduct vision and hearing testing if appropriate; they administer inoculations. And while they don't draw blood (the office has a lab for that), they handle the paperwork for lab tests.

Rotating through the office

Dr. Reed is aware that other medical offices often use LPNs for many of these tasks, and many patients and parents refer to his group's MAs as "nurses." But Dr. Reed points out that MAs can work in the front office, handle incoming phone calls, pull folders and do check-in, jobs nurses because of training, experience and expectations might eschew. "Honestly, nurses would be overqualified. I'm not sure they'd be happy here."

Actually, many MAs have somewhat similar clinical training to that of LPNs. One major difference between the two is that in almost every state, an MA does not have to have any formal medical assisting education or a medical assisting credential or license, Balasa explains.

Dr. Reed says when he needs to move one of his MAs to fill in for a clerical worker, he rotates them to ensure they all get a chance at front-office tasks every few weeks. "The less you use them in different office tasks, the less versatile they become," he says.

Dr. Tabb's MAs perform many of the same clinical activities as in Dr. Reed's office with the addition of drawing blood. All but one of Dr. Tabb's MAs are expected to rotate into weeklong front-office jobs about once a month. There, they answer phones, schedule appointments and call in prescriptions, among other standard duties.

Stephanie Taché, MD, an assistant clinical professor in family and community medicine with the University of California, San Francisco, has worked with MAs who have performed advanced functions, under appropriate supervision, often thought of as the purview of someone higher up on the medical totem pole.

For example, she has seen MAs manage disease registries such as mammogram or pap smear results, where they track and follow up on results and make sure appropriate responses are taken. And one MA also managed an anti-coagulation registry, tracking patients' International Normalized Ratio, following up on abnormal values for the physician and calling in different medications as prescribed by the doctor.

"I think [these activities are] very innovative tasks for MAs. They are following protocols and providing organization and follow-up that is essential but does not require years of training and expertise," Dr. Taché says.

No matter how experienced the candidate, expect to spend time training. At the very least, the MA must be taught office procedures and computer systems. Dr. Reed says the most challenging aspect is teaching MAs how to deal with children. Many MAs are right out of college and have had little or no experience interacting with babies or toddlers.

Dr. Tabb says limiting recruiting to certified MAs reduces training requirements. But she still watches MAs the first few times they perform any clinical procedure.

MAs can be versatile and cost-effective medical office workers. But because they are not licensed, doctors must be careful about hiring and assigning them to specific jobs. Still, if used correctly, they can make an office much more efficient.