P23A - A Medical Assistant Advancement Model: Implementation and Outcomes

In 2013, an academic medical center’s strategic plan projected a significant expansion in outpatient services with an increased focus on care coordination and population health initiatives. Leadership recognized that increasing the medical assistant (MA) workforce, a group uniquely trained in both clinical and administrative support skills, was necessary to meet this goal. It was determined that the development and implementation of an MA professional advancement model (PAM) would enhance the organization’s ability to attract and retain highly skilled and engaged MAs.

The ambulatory services professional development council (PDC) was charged with this project. This work was primarily driven by a subcommittee of three nurse managers, a human resources business partner, and one medical assistant. The group began with a literature review and survey of local health organization advancement practices. The team also utilized state regulations, the American Association of Medical Assistants scope of practice guidelines, and the medical center’s human resources department to distinguish the new roles and create job descriptions. The MA model’s application process and structure followed the hospital’s existing nursing advancement model. The completed PAM received final approval from the ambulatory coordinating council in spring 2014. The advancement model was launched in August 2014, accompanied by a series of informational sessions targeting both managers and MAs. The first promotions took place in November 2015. A year later, participation in the PAM was offered to all MAs on the medical center’s second campus.

The PDC continues to oversee the MA advancement model. The council has updated the application criteria as needed, emphasizing the MA’s clinical expertise, operational leadership skills, and advanced administrative responsibilities. The PDC now has four MAs actively involved in subcommittee work. Several MAs IIIs serve as “coaches” and mentor potential candidates interested in advancement.

The medical assistant workforce has increased by 30% since program inception to approximately 86 full time positions spanning two campuses. There have been 17 promotions to MA II and 7 promotions to MA III. The current MA position distribution is as follows: MA I: 60%; MA II: 26%; MA III: 14%. As skilled MA IIIs now take on tasks previously performed by registered nurses, the model has supported both nurses and MAs to work to the maximum of the MA credentials. Medical assistants also now have opportunity to perform as unit “charge,” serve as annual competency trainer, and lead unit safety initiatives.

Although the all-cause turnover rate since program implementation has increased from 20% to 38% between fiscal year (FY) 2014 and FY 2018, lower turnover rates are associated with higher advancement levels. The FY 2018 turnover rates were 42% for MA I, 22% for MA II, and only 3% for MAIII. Future work will explore strategies to reduce MA I turnover, encourage advancement participation, and continue efforts to develop, recognize, and reward the contributions of this valuable workforce.