Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations/PRACTITIONER APPLICATION

By Gray, Caroline P.; Harrison, Michael I. et al. | Journal of Healthcare Management, May/June 2016 | Go to article overview

Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations/PRACTITIONER APPLICATION


Gray, Caroline P., Harrison, Michael I., Hung, Dorothy, Trask, Amanda, Journal of Healthcare Management


INTRODUCTION

The challenges facing primary care in the United States are well documented. Demand for primary care providers is increasing, whereas the number of medical students opting to enter primary care is decreasing (Bodenheimer & Smith, 2013). Healthcare experts have proposed a variety of ways to address this gap. One cogent position is that the physician-centric model of care delivery is outdated; healthcare organizations need to adopt team care approaches (Margolius & Bodenheimer, 2010). A number of team-based primary care innovations are being vetted and adopted, with a particular subset of innovations focusing on expanding or reconfiguring the role of medical assistants (MAs). MAs are allied health professionals who generally support routine clinical and administrative duties under the direct supervision of a healthcare professional, often a physician. Though MAs are relatively new to medicine, primary care workforce innovations that expand or reconfigure MA roles appear to improve overall efficiency and quality. However, like most healthcare innovations, implementing these newly reconfigured roles is not without its challenges.

Drawing on our own empirical study of a large, multispecialty delivery system engaged in a Lean redesign of primary care, we identify and explore challenges associated with including MAs in primary care teams. The corporate team leading the redesign assigned MAs in primary care the additional role of serving as flow managers. MAs and clinic physicians were asked to partner as a care team so that the MA could help manage the flow of patients in and out of the clinic. Drawing on qualitative data collected over a 2-year period, we describe the most significant challenges that emerged when the organization implemented the flow-manager role.

BACKGROUND

Until recently, nonclinical staffmembers have not typically been actively involved in the actual delivery of care (Friedman et al., 2014). However, given the increased demands on primary care departments, staffmembers are playing a larger role in the provision of direct patient care. As an occupational group, MAs have experienced a dramatic increase in employment (Tache & Hill-Sakurai, 2010), and aside from physicians, they are currently the largest occupational group employed in ambulatory clinics (Chapman, Marks, & Chan, 2010). Though requirements differ somewhat from state to state, MAs typically receive training at for-profit colleges and can be certified within 6 to 9 months (Chapman et al., 2010). However, not all MAs need to be certified to work in clinics, though some training is generally expected. At our organization, all MAs must be certified nationally or by the state to work in clinics. They are given a 1-year grace period to secure certification.

The actual work that MAs perform in primary care depends on their designated roles and their interactions with physicians, nurses, and other caregivers (Tache & Hill-Sakurai, 2010). Hence, MA work patterns vary considerably. Some of the new roles and expanded duties for MAs include taking on a greater share of the administrative duties that usually fall to primary care physicians (Grumbach & Bodenheimer, 2004); serving as health coaches for patients with chronic conditions (Nelson, Pitaro, Tzellas, & Lum, 2010); and partnering with a clinician to create a dyad care team (O'Connor, Spinks, Mestas, Sabel, & Melinkovich, 2010). One innovation that has not been thoroughly studied (Tache & Hill- Sakurai, 2010) is having MAs work as flow managers in clinics. In this role, MAs are tasked with managing the overall flow of patients in and out of a physician's clinic. They typically sit next to a physician partner at a flow station, communicate with the physician partner throughout the workday, ensure that patients are seen in a timely manner, see that physicians sign necessary forms, and make sure that patient concerns received via e-mail and telephone are addressed promptly. …

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