Medical Assistant – a “Hot” Profession Facing Extinction?

Views expressed in this article are those of the author, and not necessarily of TheeMedicalAssistants

Why Online Discussion Boards and Chat Rooms Can Be Legitimate Research Sources

Although discussion boards, chat rooms and social networking sites are generally discouraged as legitimate, useful sources for serious research projects, the fact is that they can often supply information that may otherwise not be as readily available elsewhere.

This is not to say that everything you find therein will be accurate or even informative. In fact, often times these places are merely anonymous venting stations. But it’s this anonymity that provides some of the value of the postings.

Beyond that, how often does the public get to interview or depose members of the healthcare community? Even when you get to speak to lower-level healthcare providers (MAs, CNAs, LPNs, PCTs, EMTs/Paramedics, etc.), it’s usually a very short conversation relating to your symptoms and “what brings you to our facility today?”

If you think about it, there are very few places left where healthcare providers (at any level) can go to safely and sincerely tell the public what they really think. If there were such settings, some of the questions to put to them would be:

Are they satisfied with what they’re being paid?
Are they being treated with proper respect by superiors?
Are they being taken for granted?
Are they being asked to do unethical (or even illegal) things at times?
If they see or know of a mistake, is there a safe, practical way they can let other people know, without putting their jobs on the line?
Do they feel that they have job security?
Are they indispensable, essential members of the healthcare community or, in reality, are they just disposable employees with too many responsibilities, not enough power to match their awesome responsibilities, and too low in the totem pole to contribute to significant changes (if such were necessary)?

If you visit such sites, you will get the sense that maybe things aren’t as rosy and picture-perfect as most of the sites suggest. You might make the mistake of thinking that maybe these people making negative comments are just a few malcontents, not representative Medical Assistants in general but, if you dig deeper into their complaints/concerns, you will see that maybe, just maybe, there is some validity to what they say.

Who Are These People Tripping Over Themselves to Praise the Profession?

There are many people who have a vested interest in the profession of Medical Assistant. These people can’t see anything wrong with the profession because it’s in their best interest to ignore some of the problems that are, as shocking as it may sound, surreptitiously threatening to bring this profession down, if significant changes aren’t introduced.

Who are these people? They include:

Technical and trade schools that need students to keep signing up for their programs regardless of whether there are jobs realistically waiting for them after they graduate;
Government educational funding programs that have to justify their existence, not so much whether what they are funding is that important . . .
Young students eager to get a job in the supposedly-lucrative, job-security-giving healthcare industry without having to spend too much time in school or spend too much money. In general, you can become an MA in 6 months to a year, which is much less than, say, an RN, who has to invest from 4 to 6 years just to earn her/his title;
Doctors and healthcare facility managers that greatly appreciate hiring someone that earns very little, is relatively easy to fire & reprimand, can be asked to do things that most other lower-level providers aren’t allowed to do, and exist in a virtual “gray world” of do’s and don’ts.
MA professional associations and others entities benefiting from the profession.

So, Is the Profession of Medical Assistant in Trouble or Is It Really “Hot?”

The interesting thing is that, yes, the profession of Medical Assistant is indeed “hot” right now. There is a demand for MAs. As for those persons already working in the field, whether they have job security is a separate issue.

Then again, although this fact isn’t being paraded loudly, it must be mentioned that in some cities (especially the large, congested ones) there is already a glut of unemployed diploma-bearing MAs. This condition will, unfortunately, continue to get worse if technical/trades schools continue to graduate students that are, essentially, not needed in these saturated areas.

Although mostly good, the bad news is this: There are certain aspects and concerns concerning the profession which, if not properly addressed/fixed, will eventually lead to the profession of MA being eliminated, re-defined, re-structured or, at the very least, re-named.

As it presently exists right now, the profession of Medical Assistant is resting on several ethical, legal and medical powder kegs or time bombs.

Up to now, these issues have been mostly ignored or tactfully manipulated, but, eventually, one or more of these issues/concerns will trigger events that will most likely culminate in major changes that the following examples and arguments will hopefully illustrate, explain and, possibly, predict.

Major Problems and Challenges Threatening The MA Profession

Shortcomings of the MA Profession

In assessing, the future prospects of the MA career, it’s essential that we keep a close eye on the most salient discrepancies, deficiencies and challenges facing the profession. They include:

The job qualifications for Medical Assistant are at best minimal in comparison to other healthcare careers.
Very limited education is required. An MA diploma in 12 months or less.
No licensing programs in place.
Vague qualification requirements in the books.
No standard national test required (except for “Clinical” & “Certified” MAs).
Most positions require on-the-job-training.
Very limited training in phlebotomy.
Mostly work in physician’s offices.
Earning only about $30,000/yearly.
Smack in the center of several legal, ethical and medical loopholes.
Many people in the profession have negative things to say that aren’t being reported by health sites/news articles on the Internet.
MA programs merely skimming over phlebotomy… a very rudimentary introduction to blood-drawing.
The job is often subject to the no-experience-no-job dilemma (they want you experienced/trained before hiring you).
Can vie for 2 different certifications most MAs don’t pursue.
In some areas, there is high Ma unemployment.
You may have to work very hard to find a job.
You may have to move in order to find a job.
May be asked to do too much or things they haven’t had enough formal training in, i.e., phlebotomy, X-rays, EKGs, etc.
Unlicensed, not-uniformly-certified professions like MA engender misinformation, misunderstandings and assumptions.
Lack of uniformity and common standards in the profession.
Positions that require very little start-up education and training leave the door open for less-than-passionately-devoted individuals to enter the profession. Healthcare should be a difficult profession to get into. Reserved for the smartest, most-dedicated students since people’s lives are at stake.
There are too many fly-by-night diploma-mill medical assistant programs (including the online/correspondence types that don’t even include any hands-on clinicals!).
MAs are subject to the same high burn-out rates generally applicable to all Allied Health professions.
Some MAs make much less than the national average; this will probably worsen over time.
The terms “Certified” and “Clinical” are MA career “upgrades” that you generally have to wait to earn…
This isn’t a job for people who can’t handle continuous, heart-pounding stress and who can’t multi-task well.
It’s also not a job for people with bad vision or poor hearing.
MA requires lots of movement/physical straining. Consequently, it’s not ideally suited for people in poor physical shape or in bad health.

The Advantages of Being an MA

Earn about $30,000 a year, according to the Bureau of Labor Statistics (while PCTs earn only about $25,000.
Aging population motivating doctors to need/hire more assistants.
May be replacing Licensed Practical Nurses (LPNs), supposedly more expensive to keep on the payroll.
Job growth rates are expected to be higher for MAs than PCTs.

MA-Related Myths & Unfounded or Not-Always-True “Assumptions”

MAs get more initial education and training than LPNs.
MAs are generally qualified to replace LPNs and LVNs (are they?).
It’s easy/practical to compare these lower-level medical positions to each other…
LPNs and LVNs are on the way out & may be replaced by MAs.
MAs are required to have continuing education… no, but they are constantly being given additional training so they can be asked to do more and more for the same low pay.
These “magic” words mean that everything is okay/kosher: “accredited,” “certified,” “licensed” and “clinical”.
Schools can give out their own “certification”.
Pay doesn’t matter. It’s love for the work that matters most!
MAs can expect their places of work to be “professional working environments”.

What MAs Can Do to Improve Their Lot – “Best Practices” Recommendations

Get certified either through AAMA or AMT.
Write to legislative bodies, politicians and heads of major health organizations and agencies advocating for a national licensing procedure/test for the position of MA.
Make sure the school you intend to get your MA education from is accredited by ABHES or CAAHEP.
Be ready to vie for other medical health professions in case MAs are phased out or re-structures/re-defined.
Don’t perform any medical procedure/test you don’t feel confident or adequately trained to perform.
Be ready/willing to report violations of law by supervisors.
Continue to get training but preferably through schools (so you can get written credentials for your efforts).

Are MAs Being Asked to Practice Beyond the Scope of Their Education & Training?

Every year complaints and letters of concern are filed with Medical Boards regarding potentially dangerous or unethical roles that MAs may be playing in physician’s offices – which is where most MAs find employment. As to why MAs work mostly here it’s partly due to laws that basically prohibit/discourage MAs from being used in in-patient services/programs at acute care hospitals.

In general, as unlicensed professionals, MAs are supposed to perform only basic administrative and medical technical support services. Unlicensed personnel is not supposed to treat, diagnose or perform tasks that are blatantly invasive (phlebotomy, some people would say, may qualify as such) or that require medical assessments (e.g., diagnostics).

That’s what the laws in some states say. The problem is that, at the same time, the role of MAs is also left to the discretion of RNs and doctors, under whom MAs must operate at all times. In other words, if there is no RN or doctor on the premises, then an MA isn’t supposed to keep working.

By all means, this “discretion being left to supervisors” is a potential minefield, if you follow its implications deeply enough. Some experts feel that this so-called “discretion” needs to be defined much more clearly since, as it is being reported in many cases, this privilege may have been exploited or abused at times, at the expense of MAs, who might be left to face the consequences for being asked to do things that they were, quite frankly, never supposed to be doing.

Beyond the “discretion” concerns is the suspicion that, sometimes, MAs aren’t being supervised as closely and consistently as the law requires.

Thirdly, the idea of being restricted to “technical supportive services” that are routine, simple and non-invasive may also not have been followed strictly in many settings throughout the country.

How this description is compatible with allowing MAs to conduct EEGs, EKGs, drawing blood, giving X-rays, and other similar services is a question that is being asked by people who assert that these allowances are indeed infractions of the so-called “discretion” given to doctors, nurses, PAs and NPs.

Yet another “loophole,” is the idea that MAs can perform certain tasks if they receive training from a qualified supervisor (ideally a doctor), as long as the supervisor is present during the performance of such new duties. Here is the problem: what services or functions (if any) are disqualified from such open-ended training discretion? This isn’t clear in most of the literature at hand.

Most health providers are limited to the functions and skills that they were taught when they received their education and these functions/roles are clearly delineated in the literature. This is not to say that all healthcare providers aren’t always learning something new – that is a given in healthcare settings. But what is being brought up here are standard treatments, functions, tools and procedures.

In terms of training, though, there have always been limitations. For example, nurses, in general, aren’t supposed to intubate patients (with some exceptions like critical care nurses trained to perform that highly-complicated role); CNAs aren’t supposed to pass out medicine or assess how a diabetic’s foot looks; and Nurse Practitioners and PAs aren’t supposed to work without a physician being over them (even if the physician is in another location).

When it comes to MAs, though, some of these questions have been left unanswered or unclearly answered. This is undeniably a reason to be concerned – to put it more bluntly, it’s something that needs to be fixed or more clearly defined/specified.

This isn’t to say that some restrictions aren’t on the books already. The question is, are any of these being violated? Here are sample restrictions:

Placing a needle; disconnecting/starting an infusion tube for an IV.
Introducing meds/an injection into IV lines.
Charting/recording pupillary responses.
Introducing a urine catheter.
Using injections of collagen.
Participating in phone triage independently.
Utilizing lasers to remove wrinkles, hair, scars, blemishes or moles.
Giving patients chemotherapy.

MAs are also not supposed to be used to replace the duties or functions of more highly-trained professionals but, clearly, this has been happening in some settings. Lower pay has been named as the motivating factor here.

Sadly, though, as of 2003 only 7 states (AZ, CA, FL, NJ, MD, SD & WA) have specific regulations on the books regarding the scope of practice for MAs. In every other state, it’s a virtual free-for-all, as long as the MA has been given appropriate training and is supervised closely.

Are MA Program Schools Over-Selling Their Programs & Misrepresenting Career Prospects?

It’s not difficult to find online stories of persons who entered an MA program only to be highly disappointed at the job prospects after they graduated. Some people might say that these people maybe were simply poorly motivated from the start or didn’t try hard enough to find a job or maybe they were victims of a bad economy.

Actually, all of those things may apply to some of the people who have been disappointed by the profession of MA. But what about all those persons who did find jobs in the profession but went on to discover that the things they were promised or told about were simply lies or exaggerations.

The fact is that there are many unscrupulous MA programs and schools out there. It’s so bad, in fact, that maybe the government should step in order to streamline the process of becoming an MA, thereby giving the profession more reliability, sustainability, and acceptability within the healthcare field.

After all, the reputation of these schools and programs will likely affect the profession in distinct ways. How MAs will be treated, how well they will be paid, how much respect they will get from colleges – all these things enter into the picture.

For that reason, schools and their programs need to be made more consistent, professional and realistic. If the job market is bad for MAs in, say, a certain big city, then schools in that big city need to be required to tell students that they may have to move in order to find a job. Such sincerity, though, is missing in many areas of the country.

Are MAs Being Misrepresented or Misrepresenting Themselves as “Nurses?”

It’s not unusual for both medical personnel and patients to use the word “nurse” loosely – in essence calling anyone wearing scrubs and assisting patients, and not clearly identified as a doctor, PA, or an RN, a “nurse.” If truth be told, some people make this mistake innocently.

These people should know, though, that addressing someone as a “nurse” that isn’t a nurse is a crime. It’s easy to see why patients might make the mistake, though, but the harder question is why medical staff could possibly make such a mistake.

Well, this is when a little cynicism has to enter the picture. When medical staff misuse the term “nurse,” rather than being a mistake, it’s probably an attempt to misrepresent the facts to patients. After all, the term “nurse” is more prestigious and authoritative than “Medical Assistant.”

Patients will more willingly follow directions and pay attention and the staff member’s ego gets stroked at the same time. Feeling like a big shot, though, isn’t being professional – in fact, it’s counterproductive. Medical Assistants need to be working on enhancing their own, unique image, improving their reputation and gaining the trust and respect of both patients and colleagues.

You don’t do any of those things by misrepresenting facts – any facts!

For the record, only a person licensed as an RN, NP or some other derivation of “Nurse” should be addressed by the term. Even LPNs/LVNs and CNAs should not be addressed as “nurses” – again because it’s giving patients the wrong impression that they are RNs, which isn’t the case.

If we were going to make an exception, it might be for LPNs and LVNs, both of which have the term “nurse” in their titles but, if so, the distinction should be made to patients so they don’t get a false idea that LPN/LVN is an RN – they are not!

Are MAs Increasing the Chances for Serious Mistakes in Doctor’s Offices?

Yet another complaint that has been brought up is that mistakes are more likely to occur the less training, education and experience medical personnel have. It’s difficult to argue against this point since it probably applies to other less-in-need-of-constant-perfection settings. There is a reason why doctors undergo so much training and education. It’s so that they are prepared well for what is a very difficult job.

The same goes for nurses and PAs. It takes years of training and education just to be able to get the title, never mind treat and assist patients.

Then again, this isn’t necessarily an attack against MAs as much as an attack against the people appointing, supervising and assigning duties to them. They are irresponsibly putting responsibility on these folks that maybe, just maybe they are not qualified to be burdened with.

The problem at hand becomes more evident when you see a doctor, pharmacist or nurse (or other upper-level professionals) call a doctor’s office only to be addressed by an MA. Almost immediately, you notice that MAs can often not go head to head with these more-knowledgeable professionals – not to say that they are supposed to be able to do so. But MAs are often put in the middle of transactions that should be exclusively handled by a nurse or a doctor. End of story.

Are Some People Already Trying to Fix the MA Profession but Meeting with Opposition?

There is a strong lobby in most state legislatures that fight for the rights of all Allied Health professionals. That’s a good thing. These people deserve to have a voice in these places that defend their interests. But sometimes these entities are misused, as in the case of MAs.

The MA profession has some serious flaws that need to be fixed. Some people don’t want them fixed because the result might be a re-defined profession (MAs) that might then, after being redefined, be more expensive to hire. Right now, MAs are a wonderful “bargain.” They will do anything (why some people call them “jack-of-all-trades” and will work for less than other personnel at their level.

But they are also being asked to do things that will eventually hurt them as individuals or the profession as a whole. That’s not fair to MAs; it is certainly not fair to the patients whose lives may be at risk because of the medical and ethical loopholes regarding the profession of MAs.

In some states, some legislators and politicians are working to either get rid of or fix the profession of MA. If they had their way, MAs would be licensed, after taking a test (like nurses) and their role would be much more clearly defined and restricted. These people may at present not have the power to make the changes they think are necessary but, as lawsuits and complaints mount, the pendulum is sure to swing in their direction – it’s just a matter of time.

Are Ethical Dilemmas/Discrepancies Putting MAs in Harm’s Way?

Beyond those noted already, here are some ethical challenges the MA profession is always potentially facing:

MA’s decisions being unduly affected by the realization that their livelihood is completely tied to a physician or practice if that physician or practice are engaging in illegal or unethical activities.
Physicians and nurses asking MAs to do things they aren’t comfortable with but feel pressured to learn and do.
MAs being asked to do things that may favor the doctor/practice but not the patient (such as erasing information from medical records, etc.).

CONCLUSION

The good news is that, indeed, the profession of Medical Assistant is very much alive and kicking. Supposedly, job opportunities are supposed to improve into the year 2022. At the same time, though, there are many people with MA diplomas who can’t find a job in the industry; part of the reason is the fact that there is a glut of MAs in some cities.

The bad news, however, is that this profession isn’t likely to survive in its present legal, ethical and medical form. In fact, it will be phased out completely, re-structured or, at the very least, re-named, unless the problems plaguing the profession are adequately addressed in the near future.

Simply put, Medical Assistant has the unique quality of being a “hot” profession that is, at the same time, on its way out – unless its problems are adequately fixed in the foreseeable future.

After reading this, you might be interested in the follow-up article called Other Professions Medical Assistants Can Transfer Into.