In the interest of cost-effectiveness, efficiency, and employee satisfaction, medical assistant (MA) responsibilities can be tailored to the needs of a practice. In a large academic medical center with over 100 specialty clinics, it was difficult to gain consistency in MA responsibilities. Although an evidence-based institutional guiding document outlines approved performance tasks, it is the obligation of clinic leaders to staff the appropriate skill mix according to workflows.

Given the national shortage of available MAs, annual turnover rates of 20-30%, and replacement costs that reach 40% of the MA annual salary, it is imperative to assess MA, medical practitioner, and nurse concordance on delegation authority and delegable tasks. Integrating more highly skilled tasks into the MA role creates differentiation on the career ladder that can promote employee retention.

Qualitative insights into actual and potential MA tasks were collated through direct observations, interviews, and in group forums from an interdisciplinary team of MAs, nurses, leaders, and medical practitioners. A group of key stakeholders was formed to evaluate these insights against state regulations, payment models, and institutional and national evidence-based best practices. Task inconsistencies were analyzed for root causes, and opportunities to expand the MA scope to more advanced skills were evaluated for workflow efficiencies.

In general, the findings showed consensus amongst healthcare staff that the MA role is underutilized and brought to light a common misconception that the MA functioned under the authority of the registered nurse rather than the provider. Organizational MAs primarily expressed a willingness and confidence in their ability to perform more highly skilled tasks with the appropriate training. Three patient care categories emerged as focus areas to narrow inconsistencies in practice: rooming process, documentation (pain screen, health maintenance, allergies, medication intake), and medication administration. Of the thirteen potential tasks considered, five were deemed not feasible: create and sign medication orders, ultrasound-guided procedure monitoring, medication refills, complex wound dressings, and insertion of peripheral IVs. After a thorough review, eight new tasks were added to the approved MA task list: communication of abnormal results or simple prescription changes, CGM placement, peripheral IV removal, patient forms, renewing expired lab orders, updating lab order location, and orthopedic casting.

Healthcare delivery model reform begins with education and a mutual understanding of roles and responsibilities. Once achieved, implementation depends on the willingness of medical practitioners to delegate, nurses' agreement to relinquish tasks, and medical assistant buy-in to assume new responsibilities. The pace at which change can be implemented is contingent on clinic leaders' evaluation of workflows, redistribution of tasks, modifications to team composition, and training of MAs to the newly delegated tasks. Patient outcomes and the ability to retain MAs will be indicators of scope optimization effectiveness. A successful culture shift is ultimately dependent upon staff engagement, satisfaction, and a value-based payment model.

Future analysis will focus on licensed vocational nurse overlap of tasks with MAs. We will also explore opportunities to optimize registered nurses to top-of-license practice with care coordination, care management, patient education, and billable services.

Allece Merchant MBA, BSN, RN, NE-BC

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