Developing a Better Understanding of Medical Assistants’ Roles and Functions in Primary Care Settings

Investigators: Erin P Fraher, PhD, MPP, Allison Cummings, MD, Dana Neutze, MD PhD

Background: Medical assistants (MAs) are a flexible, low-cost and redeployable resource in primary care practices and their roles are swiftly transforming. A robust literature has identified a gap between the full potential of MA role expansion and its implementation in primary care practice. This gap has been attributed to role confusion, shortcomings in MA training, physician resistance to delegate tasks, and MA reluctance to take on new roles.

Methods: We surveyed medical assistants and family physicians in primary care practices in North Carolina about MA roles related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. MA surveys were delivered by practice facilitators employed by the NC Area Health Education Centers (AHEC) program. Family Physicians were reached through the NC Academy of Family Physicians newsletter. MAs and family physicians were surveyed to gauge whether they agreed on the roles MAs were currently performing and to identify their level of confidence in MAs’ ability to perform these tasks. For those tasks not being currently being performed, we assessed physician willingness to transition tasks to MAs with additional training and MA willingness to pursue that training.

Results: 118 medical assistants and 175 family physicians responded to the surveys. The majority (59%) of MAs in our sample reported experiencing a role change since beginning their current position. Findings suggest that many of the activities related to visit planning, direct patient care, and documentation that were once considered extended roles are now routinely performed by MAs on most days. MAs and physicians generally agreed on the tasks currently being performed by MAs, but they had diverging perceptions of MA roles on tasks related to patient education, coaching and counseling. While 44% of MAs reported performing motivational interviewing (MI), only 13% of physicians said MAs in their practices currently perform MI. 41% of MAs report assisting patients with chronic diseases to set goals compared to 18% of physicians who believe their MAs do this; 44% of MAs said they educated patients with chronic disease about preventive care while only 25% of physicians reported MAs took on this role.

Physicians and MAs agreed on the tasks that MAs perform least frequently with only 9% of physicians and 27% of MAs reported that MAs performed scribing. Tasks in the survey that physicians indicated that they would be most willing to delegate to MAs that MAs are currently not performing in their practice were population health activities such as identifying patients in need of preventive screening (mammography, colorectal screening, etc); finding patients with diabetes who are overdue for A1c tests and pending the order; and extracting data from the EHR to manage patient lists

Conclusion: Closing the gap between MA potential and actual roles in population health and panel management; patient education, coaching and counseling; and scribing will become even more important as our health care system moves toward value-based and risk-based payment models that emphasize addressing the upstream, preventive and chronic care needs of patients. While these results are promising, deploying MAs in the new roles will require increasing MA to physician staffing ratios, protected time for MAs to perform these functions, and redesigning workflows to accommodate these changes.

• Fraher EP, Cummings A, Neutze D. The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians. Medical Care Research and Review. October 2020. https://doi.org/10.1177/1077558720966148

• Fraher E, Cummings A, Neutze D. 2015 May 11. Medical Assistant (MA) and Family Physician Perceptions of MAs’ Evolving Roles in Primary Care Practices in North Carolina. AAMC Health Workforce Research Conference. Tysons Corner, VA.