12 MA Career Shortcomings & Deficiencies and How to Fix Them to Make MA a Perfect Job
Views expressed in this article are those of the author, and not necessarily of TheeMedicalAssistants.
The Medical Assistant profession is literally “hot” right now. Many students are enrolling in MA programs, schools that offer these diplomas/degrees are raking in the cash from all this interest, and there are many reasons for thinking more openings will soon be available.
Having said that, it must also be noted that the Medical Assistant profession is also in serious trouble for many reasons. If these deficiencies and shortcomings aren’t fixed, as a matter of fact, there may no longer be such a thing as a “Medical Assistant,” say, 10, 15 or 20 years down the line.
In order to see why or how this could possibly be the case, you will need to read on…
1. It’s an Unlicensed Job That Should Be Licensed
Why is licensing so important? We all benefit from licensing even though most people would be hard-pressed to explain why licensing is so important. If you think about it, there aren’t too many professions out there which deal with people’s health that aren’t licensed.
Licensing allows states to collect fees from holders of those licenses; it’s also a prestige thing – people licensed to do what they do are viewed as true-to-life “professionals,” people a few notches above everyone else who didn’t have to get licensed.
Requiring some people to be licensed in a field, though, isn’t just about putting on appearances or impressing anyone. When people’s lives are at stake in a particular job, licensing is one way to make sure that the person doing this job is fully qualified to do it, in training, in education and in mental capacity. Take physicians, for example.
Someone who is intimately familiar with anatomy, physiology and the other sciences taught in medical schools but who has never been trained at a healthcare facility in order to get hands-on training would not qualify to get a medical license, nor would someone who has passed the academics of medicine, has participated in the required hands-on internships and residencies but who is mentally ill or intellectually incapacitated.
In other words, there is a clear set of criteria anyone who wants to be a physician must follow and meet.
Licensing establishes uniformity of competence, clarity of technical expertise/ability, and clear-cut standards everyone vying for the privilege of being a “doctor” or a “physician.” Just as importantly, licensing protects the public by making sure that anyone calling himself “doctor” has been properly vetted. Were it not for licensing, anyone could just hang up a sign at an office and start seeing patients that same day.
Actually, in the past, that actually went on. Oftentimes there was no government agency or private overseeing institution that made sure that anyone calling himself “doctor” possessed a certain level of education, training and mental capacity. In those environments, there were many charlatans and “quacks” and the result was people dying as much from the bad medicine that was being imparted as the diseases and injuries they were coming to see a doctor about.
The medical profession is protected through licensing; it means that anyone wanting the privilege and prestige of being a doctor has to go to medical school, graduate successfully and then, if they pass a comprehensive test given to all medical students, get licensed.
Licensing also saves lives by making sure that the people treating patients are well-prepared to do such a difficult job. Licensing, in other words, protects and serves the public as much as it serves and protects doctors.
The same arguments may be used defend the profession of nursing. All Registered Nurses (RNs) had to obtain either an associates or a bachelor of science in nursing, which usually includes a certain number of hours of clinical hands-on training. They then have to take a comprehensive test that is given to all persons wanting to be a nurse.
If they pass this test, then this person may apply for a license to practice as an RN in the state in question.
The problem with Medical Assistants, though, is that they presently don’t have to subscribe to a licensing program such as that available for doctors and nurses. Like any other subject we might tackle, there is a long list of pros and cons to consider when it comes to licensing for medical assistants. The pros, though, some people would say, ultimately outnumber the cons.
If medical assistants hope to ever get the respect, status and privileges afforded to doctors, nurses, Physician’s Assistants, Nurse Practitioners – all of whom are licensed – then they should also be working to have a licensing program in place.
Having a licensing program in place, though, will necessarily require that the bar be raised when it comes to the academic requirements, length of programs (which some people say are too short for what is expected from medical assistants), and the level of difficulty required for entry into this profession.
As for academic requirements, there is no question that most MA programs should be enhanced; at the very least, all these different programs need to be much better standardized. Some MA programs, for example, only go for 6 months, while others go 1 year – some others for even longer.
Different MA programs offered at different schools throughout the country are likely to have drastically different curricula – in other words, they don’t teach the same thing, in the same order or in the same way. This needs to be changed.
Then, to make matters worse, there are MA programs that are being offered online (which opens the door for cheating academically and is useless unless it is paired with hands-on clinicals, some that have taken place strictly while on-the-job (meaning that the MA may have been hired with formal education and training to begin with), and some that have been conducted by very disreputable schools of learning.
In fact, many employers of MAs will readily admit (or should) that much of the training that MAs get takes place while on the job. While it is true that all medical personnel (including doctors and nurses) understandably learn something new every day while on the job, it’s rather troubling to expect or go along with the fact that a healthcare professional gets most of his/her training while working on actual patients with real medical problems.
The term for this practice, by the way, is “intern.” Nurses (and most other health professionals) do this kind of thing also but usually as part of their formal education/training. Whether they get paid for this or not isn’t that important an issue, although in most cases, students don’t get paid for internships – at least, nurses don’t.
Money, anyway, isn’t the issue but the fact that a still-learning-the-basics healthcare provider (usually referred to as a student or intern) has to be monitored much more closely than MAs are while on the job. After all, an MA is considered a “professional” the minute he or she steps on the floor of a hospital, nursing home, clinic, or doctor’s office.
It is assumed, in other words, that they have already received basic training. Most MAs have, but probably to a much more limited extent than, say, nurses.
All these are issues that some of us would say are “deficiencies” and “shortcomings” which can be legitimate reasons to question MAs’ credentials in general. To say that “Well, this Medical Assistant got training in those areas they were missing while working for me” or “Gee, they supplemented their rather weak or limited amount of training in all those areas while working on my ward” may sound like worthy reassurances but the problem is that there won’t be any written or verifiable evidence of this impromptu accomplishment.
An employer or the Board of Health (which is supposed to keep an eye on all healthcare providers, in terms of capacity to do their work acceptably whether licensed or not) can always ask to see academic records and written evaluations by health educators. No such records exist for a Medical Assistant receiving training while on the job, unless you consider job evaluations generally provided while under employment.
Unfortunately, these may not be enough and are generally kept and provided for different reasons than academic records. Someone by all appearances doing their job well while under employment might not do as well if they were being evaluated academically. An employer, for example, might pay attention to complaints from patients, negative comments from direct supervisors, and evidence of any major mishaps or poor taste in judgment – all of which hinge on someone noticing something wrong.
At a place of employment, no one is paid to just evaluate personnel below them – at best, staff evaluation is just one of their roles. The nurses that Medical Assistants have over them usually have extensive responsibilities – the last thing they need is a healthcare professional under them whose hands have to be held. Nurses may periodically observe an MA but, in general, they don’t have much time for that.
Anyway, as has been stated, nurses have every right to expect that all the personnel under them (orderlies, CNAs, LPNs, LVNs, PCTs, MAs, etc.) have been fully and adequately trained in the tasks ordinarily assigned to them. If a nurse, for example, has to teach a Medical Assistant the proper way to take a patient’s blood pressure or if all the MA knows is how to use an automatic BP and not how to use a sphygmomanometer, then this would be grounds for serious concerns.
Nurses are already too busy to be turned into on-the-job technical instructors/teachers. That goes for other healthcare providers. Surgical technicians had better walk into an operating room knowing the names of all surgical instruments, the proper way to sterilize things and what to do when given special requests or directions by surgeons.
Do you really think a surgeon can stop in the middle of a procedure to explain to a supposedly-already-trained surgical technician what a Harmonic scalpel looks like, the proper way to hand a surgeon retractors, or what to do with already used rongeurs?
By the same token, MAs should know certain things. But how is that possible if all Medical Assistant programs in the country have different academic content, can last for drastically different time periods, may have been taught by people with somewhat questionable credentials to be teaching, and don’t have to adhere to well-outlined and rather specific academic standards and criteria, including well-specified and detailed clinicals?
Logic (without even doing audits or intense evaluations of all aspects of the discussion at hand) dictates that the MA profession is in trouble just from the perspective of the wide-disparities that exist in their education and training across the board.
For the record, requiring Medical Assistants to be licensed would address all these concerns and deficiencies. It would:
- heighten respect for and confidence in the profession,
- better establish MAs as legitimate experts in their field,
- reduce chances for potentially deadly errors in the field,
- reduce chances for lawsuits and criminal action against MAs (for sometimes performing procedures they are not allowed by law to perform),
- and enhance patient confidence in and respect for Medical Assistants.
Maybe, then, MAs would not have to resort to calling themselves or permitting patients to call them “nurses” – why, so that they can bask in the warm glow of the power and prestige that goes with the name “NURSE?”
Well, the truth is that, if Medical Assistants get licensed, just like nurses and doctors are licensed, then it will lead to a new dawn of respect, acceptability, power and prestige for MAs – no, not as extensive or luminous as that enjoyed by other licensed professionals but, let’s just say, uniquely important, stupendous and worth showing off (or at least basking in, if you are not the “showing off” type).
As for “certification” – please don’t make the mistake, as less-well-informed people do, of thinking that certification can ever take the place of licensing. Certification, while it is an important thing to establish and vie for, is a different thing than licensing. Certification, in general, is granted by a private, often-not-for-profit organization, the main purpose of which is to enhance and protect the interests of a profession or industry.
A “license,” however, is usually granted by the Board of Health of a state, county, city or other designation. While certification mostly enhances a profession, licensing gives you permission to practice that profession; while failing to meet criteria of certification may lead to loss of that certification or a civil court lawsuit, failure to meet criteria for licensing can get you jail time.
From this perspective, licensing has more teeth to its potential enforcement. In general, healthcare professionals can function without certifications but, if a licensing requirement is in place in the location where the person is seeking employment, then that same professional cannot practice his/her craft.
This isn’t to say that certification isn’t important or that licensing is more important. They are, however, totally different things. Just because there are certifications for Medical Assistants doesn’t mean that licensing is not necessary. Yes, certifications have somewhat enhanced the profession of Medical Assistants.
There is no question, for instance, that Certified and Clinical MAs make more money and generally enjoy more prestige than regular medical assistants, but these certifications don’t, for the most part, address the deficiencies and shortcomings addressed in this report. Only a licensing program that includes a nationally sponsored and coordinated exam (such as that taken by Registered Nurses) and more standardized education and training MA programs will make that goal come true efficiently and effectively.
As of right now, no state in the US requires a Medical Assistant to be licensed. Most states, however, have looked into the possibility of requiring licensing; some states have even held meetings or hired consultants to look into the matter. Some people might ask, “Is there anyone out there that could possibly oppose licensing? Strangely, the answer is “Yes!”
Some people fear (or know) that licensing will raise the bar so far in terms of training and educational requirements that many of the schools now offering Medical Assistant programs will either have to remove their programs from their menus or spend more money to fix them. States requiring licensing would demand that persons teaching Medical Assistants have a minimum set of qualifications which, sadly, many such instructors in the country presently probably lack.
When it comes to teaching health courses the impetus has always been to have teachers that exceed the training and education of the profession in question. In other words, nurses are hired to teach lower level positions like PCT, somnography techs, LPNs, etc., especially when it comes to teaching high-level healthcare skills courses. By the same token, nursing schools often have instructors with Masters or PhDs in nursing; they may even have NPs, PAs and doctors teaching some of the courses in nursing (and related or required life science courses).
Some of the instructors that work for what have been called “private, fly-by-night technical school diploma mills,” however, have very limited qualifications, including people with merely a high school diploma and a Medical Assistant certificate. Hopefully, they worked as a Medical Assistant for some time but moved into teaching, why, because they couldn’t cut it as an MA, because they were laid off or fired, or because they were not committed to the profession enough to stay in it permanently?
Such persons, regardless of their motivation to become teachers, would probably not be qualified to teach MAs if a licensing program is initiated at the state or federal level where they reside.
The bottom line is that licensing raises the bar for everyone, not just students. It’s this enhancement of qualification and training/education criteria, though, that finally sets standards everyone has to meet at all levels of the specific industry or profession.
2. The Certifications Available Aren’t Standardized Nationally and Aren’t Necessarily Recognized by Employers
Medical assistants can presently vie for two main types of certifications. Certification for Certified Medical Assistants or CMAs is approved (or denied) by the American Association of Medical Assistants or AAMA. Certification for Registered Medical Assistants or RMAs is provided by the American Medical Technologists or AMT professional association. Both of these certifications have been nationalized (that is, are available throughout the country) and are basically “optional” – in other words, they are not required in most states.
As such, these certifications are not looked upon equally by all employers (some are impressed by them and, therefore, require them, while others don’t think that they make any difference in terms of qualifications) – more importantly, nor are they required to pay a Medical Assistant more money or give them more power/authority just because they have these certifications.
In essence, whether MAs have them and whether employers recognize or give special consideration to anyone having them is 100% optional and left to an employer’s discretion.
One thing that certification has done for the profession is making sure that anyone certified meets certain basic standards, including having graduated from an accredited Medical Assistant educating/training school. Of course, accreditation can come from different accrediting bodies and how acceptable that accrediting body is may be another area of contention since some organizations offer accreditation that isn’t accepted or honored by everyone.
Two accrediting organizations, though, that are generally considered essential for Medical Assisting programs are the Commission on Accreditation of Allied Health Education Programs or CAAHEP and by the Accrediting Bureau of Health Education Schools or ABHES. In general, students graduating from accredited Medical Assistant schools or training program come out enjoying the following benefits:
- Recognition by certified professionals of having met standardized learning requirements.
- Documented evidence of having completed training programs acknowledged to meet nationally recognized standards.
- Eligibility to vie for special certifications or permits available from the AAMA or AMT, provided the MA program graduate can pass tests or meet criteria provided by these institutions.
In order to get these certifications, MAs do have to pass special exams that contain, if not the same questions, the same topics and educational emphases – in other words, basic knowledge of certain topics/subjects have to be demonstrated. Some of the academic areas emphasized include:
- Anatomy & physiology
- Clinical administrative Procedures
- Medicolegal regulations & rules
- Medical expressions & terms
- Lab procedures
- Pharmacological basics
- Medical ethics & law
- Insurance & finance
- Medical & clinical assisting techniques & procedures
Part of the problem with certifications is that they may not be equally viewed or accepted by different employers and government agencies. In fact, a certification that may be highly regarded in one area of the country may not even have been heard of in another. In general, CMA is the certification mostly widely known and best highly regarded, followed by “Registered” and then “Clinical” certifications.
3. Not Sure What MAs Cannot Do at This Time – It’s Rather Vague What They Are Prohibited from Doing
Determining what Medical Assistants may and, more importantly, may NOT do continues to be an unnecessarily burdensome ocean of potentially dangerous vagueness and ambiguity. Most Medical Assistant schools, textbooks and professional organizations will readily provide a list of tasks and responsibilities MAs should be allowed to do at most facilities; they may even provide another list of things MAs should not be asked to do, are not allowed to do by law or shouldn’t be doing unless a doctor or nurse trains them to do it and supervises them while they’re doing it.
The problem with the second list is that, in most cases, it isn’t inclusive enough and gives the impression that anything not mentioned therein may be allowed, under the right circumstances. In other words, nurses and doctors have a certain amount of unclearly-spelled-out “discretion” which some experts opine should be better delineated and documented in order to avoid potential mishaps that may involve serious injuries and/or death – not to mention the end (or the serious setback thereof) an MA’s career.
In a perfect world, the doctor or nurse should be the one that should face a lawsuit or criminal prosecution should an MA be directed by them to do something they were never intended to be doing but, alas, since we don’t live in a perfect, that isn’t necessarily the case when things go wrong at healthcare settings.
Take the case of Betty Guerra, a Medical Assistant who was arrested for giving Botox shots in a state that, supposedly, doesn’t allow Medical Assistants to give shots. This case has been a great learning experience for many people, including doctors and the State Board that is supposed to supervise and/or license all allied health professionals.
Supposedly, the Board has decided to allow MAs to provide some types of shots after all, especially if merely giving flu shot, as long as they do so under the direct supervision of a doctor; giving Botox injections, though, is supposed to be the exclusive parameter of a usually plastic surgeons. Even nurses have been known to get in trouble for attempting to do these since Botox injections are considered a “medical” (i.e., provided only by a doctor) service.
This case, though, is only one of many “alarm bells” that are being sounded about what MAs can and can’t do throughout the country. Betty Guerra, who was, ironically, a physician in her native country of Peru, shouldn’t have been arrested for doing something she was directed to do. More importantly, the state of Nevada (as well as all other states) should get busy better defining what MAs can and can’t do. If they had, this case would have been avoided altogether.
Anyone who thinks that this is the only such case so far or the only case of its nature we can expect in the future is being egregiously naïve. Will state legislatures wait until deaths are realized (if they haven’t already) before they take appropriate action to enact laws that will set the foundation for a licensing program for MAs that may also include better standardized certification programs that all employers will be required to recognize and accept?
Although lists of what MAs can do are generally available and provided to anyone that asks for such, the list of what they clan’t do isn’t as forthcoming or as complete as one would expect it to be; in fact, there are things on the “Can’t Do” list that may not apply in all states or which may be violated, supposedly, as long as the MA performs such under the supervision or permission from a doctor or a nurse.
For the record, here’s what an MA isn’t supposed to be able to do at any time, even if with the permission of or under the supervision of a doctor or a nurse:
- Initiate, discontinue or flush IV lines/connections, except as otherwise indicated by law, statute or permitted policy
- Conduct telephone triage independently (in general, Mas aren’t allowed to diagnose symptoms or interpret data)
- Use direct injections into veins, except as permitted by law or statute or policy
- Operate lasers or related equipment
- Perform medical procedures restricted to physicians, PAs, NPs and Registered Nurses
- Perform significantly invasive procedures of any kind
- Interpret or analyze test results, including blood tests
- Conduct any sort of medical-care plan decision-making or assessment
- Perform surgery of any kind
- Function at any time while not being under the supervision and auspices of a doctor, nurse, PA or NP
- Conduct any test, procedure or function for which the MA has no formal training or certification
- In any way or for any reason, practice nursing or medicine; this includes giving patients the false impression (whether encouraged or not) that they are a licensed nurse, doctor or any other type of licensed professional
- Refill or prescribe medications
- Hand out free medication samples
- Put anesthetics or medications into IV lines
- Perform physical therapy without a doctor’s or therapist’s permission and supervision
In the best case scenarios, doctors and nurses are supposed to delegate tasks performed by Medical Assistants; while the MA then takes responsibility for what he/she does or fails to do (based on technical competence, ability to follow directions, and willingness to comply), ultimately it’s the doctor or nurse supervising the MA that takes responsibility for their actions. Because they are liable, doctors and nurses have a sworn duty (as well as personal responsibility) to closely supervise and monitor all personnel under them, including Medical Assistants.
Regarding state guidance in who can delegate tasks to MAs, interestingly, some states may not allow Physician’s Assistants and Nurse Practitioner’s to delegate tasks, especially if the MA isn’t directly assigned to them. In much of the literature that is already in place in different states (unfortunately, dispersed loosely in different state offices), doctors and nurses are named as the people in charge of MAs.
Accordingly, NPs and PAs may not, at least officially, albeit it’s hard to say (if at all) why they wouldn’t be as qualified as doctors or regular nurses to supervise and manage MAs.
Yet another gray area is MA handling of patient data in regards to Centers for Medicare and Medicaid Services (CMS), which requires only licensed professionals and “credentialed assistants” have access to and be allowed to enter patient data into the records. This is yet another topic that needs to be addressed with more intensity, hopefully leading to a permanent, feasible resolution.
4. MAs Are Being Asked to Do Things Their Original Training Did Not Adequately Prepare Them For
Improving the profession of medical assistant is a win-win situation that everyone should be striving for. Managing a healthcare facility, though, is fraught with all kinds of challenges, hurdles and problems. While administrators want productivity, efficiency and cost-effectiveness, healthcare providers have their eyes on job-fulfillment, career advancement and, last but not least, appreciation for the work being done.
The other variable often forgotten, though, are patients; what they want is the best possible healthcare they can find for what they can afford to pay (or what their insurance is willing to pay).
Although Medical Assistants occupy a rather low position on the totem pole of power, authority and responsibilities, they have nevertheless become key players in healthcare settings. At a time when cost seems to be over-riding everything else (because it’s becoming a matter of financial survival for many healthcare facilities), the position of MA has become more and more attractive to healthcare providers and to administrators.
Accordingly, there is a move underway to put more and more responsibilities on MAs. In some settings (as dangerous a move as this may be), there is a fear that MAs may even be replacing more much more expensive RNs. Although for the longest time, there was a shortage of nurses (mostly because they burn out so quickly or because they just weren’t graduating enough to replace the ones dying, being fired or leaving the profession to do something else or to work independently or abroad), that is quickly changing, to the point that some nurses being graduated today are having difficulty finding employment. This situation, by the way, is expected to get worse in the foreseeable future.
Now, no one is suggesting, one would think, that an MA can possibly replace a nurse – such an idea is preposterous from a medical perspective. But what is possible to do is maybe reduce the number of nurses that used to supervise a growing number of MA employees. Instead of having one nurse for each shift for each ward, floor, wing section, etc., what is being considered (and sometime implemented) is allowing one nurse to supervise several wards, floors, wings, or sections.
If you want to be technical, as long as the supervising RN is in the building, then the hospital or clinic or nursing home can say that the MAs and other supporting personnel are being “supervised.” There is nothing in the books that says that RNs have to be within, say, 50 feet of the MA or that nurses have to be literally holding the hands of these supporting staff members. This concept is already being stretched to the limits in other ways.
For example, nurses were supposed to be supervised by a physician, but that physician could be in his office somewhere in a building where 300 nurses may answer to one physician. Nurse practitioners are taking the whole thing even further.
Whereas they are also supposed to be under the supervision of a physician, many of them are now working at offices (such as small clinics in shopping centers and grocery supermarkets) where there is no doctor to be seen; the doctor supervising these NPs may be at an office, miles away or, for all we know, in another state.
For now at least, these NPs are getting away with something that, in the past, some experts would have said was unlikely or impossible.
Well, will MAs also be pushed aside or behind the walls of limitations presently imposed upon them. Having 1 nurse for a group that may consist of 3 medical assistants, 2 LPNs, 4 CNAs and 3 Orderlies carries a certain monetary cost which some hospitals may no longer be able to afford. Accordingly, some of them may have to combine services, get rid of some personnel and streamline or change the whole Nurse to supporting staff ratios paradigm.
How about having one nurse supervising an entire wing for a whole shift? The idea is not only approachable, it’s likely what will happen in many settings – actually, reports are coming in (albeit mostly through unofficial chat and discussion sites on the Internet) that this is already happening – i.e., that MAs are replacing RNs or, to be more accurate, that the ratio of RN-to-MA is being changed in favor or MAs.
5. MAs Are Basically On-The-Job Perpetual Interns… Was This by Design or by Accident?
As any physician will tell you, their internships were some of the most challenging and exhausting times while completing their education in medical schools. In fact, it’s safe to say that internships are a means by which to separate the truly deserving from the near-do-well, not-fully-committed and possibly not intellectually or personally up to the challenge might-have-beens.
Up to this point, a medical student is merely an academically prepared would-be-doctor; it’s the hands-on experience, though, that truly defines whether someone can be a doctor; it’s also a time when medical students pick up a whole battery of knowledge which simply can’t be committed to books – well, the facts relating to the thing may be but not the feelings, impressions, ethical ramifications, and myriad of complications that may arise while performing, say, a C-section delivery of a baby, a tracheotomy, or a spinal tap (to see if the patient has meningitis).
While the internship that a Medical Assistant has to endure is hardly like the one that doctors undergo, there are some things in common, including the hands-on knowledge that book learning is supposed to prepare you for, which is why they want you take anatomy, physiology, chemistry, biology, etc., before they have you work on dummies and then, if you do well with the dummies, on real patients.
By all means, internships are a good thing. Without internships, all you have is lots of book-learning that was never applied in the field. This section isn’t an attack on internships – that must be understood. If anything, the internships that is provided for MA programs needs to be extended and enhanced.
Having said that, there is a problem in the MA profession that maybe some people may not want to approach or even discuss, but it is a problem that should arouse concern in anyone with a conscience and how wants the MA profession to succeed and to improve with time.
The problem is this: Are Medical Assistants being turned into full-time, on-the-job Interns? Here’s the thing about interns: they usually have very little power, are supposedly always ready to learn, don’t have much of a choice about what they are taught, how or when, are cheap to have on hand, and can be disposed of without too much fanfare or qualms, should things not work out as desired.
Interns, in other words, are almost completely at the mercy of their “instructors.” While this relationship of may be ideally suited for institutions of learning, it may not be ideal for people trying to establish themselves as professionals, elevate their status and progress in their industry. Being a perpetual Intern also presumptuously proposes to create a job that requires the recipient of the questionable “honor” to always be learning something new, to always follow directions (rather than ever using initiative) and to basically be a slate whereon superiors keep writing things the MA must always follow to the letter, even if by doing so, he or she might get him/herself in trouble.
At some point, you want healthcare personnel to stop being students, and, instead, go on to establish themselves as experts in their field. But how does one become an “expert.” You become an expert by repeatedly performing similar functions until you can do the function almost by rote, until you know it so well that you are now ready to perform the function without any supervision (and that includes being able to deal with the many complications and challenges that can often pop unexpectedly).
If, on the other hand, though, you are always being shoved into new tasks, that may not give you the quality (not necessarily quantity) of time required to truly develop expertise in one area. If MAs were to stick to the specific tasks that MAs are supposed to tend to, this should give them ample opportunity to master their profession. What’s happening, though, is that MAs are being required to pick up new skills on a continuous basis, perhaps in preparation of the fact that in the foreseeable future, there will be much fewer personnel working in healthcare facilities.
MAs, some experts are saying, may be replacing LPNs and, possibly, PCTs. After all, the duties of all these three positions overlap rather noticeably. Overlapping tasks isn’t an efficient thing and something that efficiency experts will tell you have to be dealt with, especially if you are striving for cost-effectiveness. Streamlining services and greatly reducing staff at healthcare facilities is coming – it’s just a matter of time before it’s implemented with as much firmness and strictness as some people want.
Auto workers in America lost thousands of jobs that ultimately ended overseas or were eliminated because of robotization. Like it or not, the main thrust for these job losses and changes in the auto manufacturing industry were cost concerns – to put it more bluntly, the need to lower prices of cars, something that could only be achieved by reducing labor costs. Well, the healthcare industry is in the same mad throes right now.
Unfortunately, we can’t export sick patients the same we exported manufacturing facilities – then again, we CAN import healthcare workers (which is already in the works) willing to work for less. This, however, doesn’t appear to be enough and, in some cases, may not be working out as well as expected. Another approach is to simply hire lower-level medical personnel that are willing to work for less.
Sure, these lower-level personnel may not be as extensively trained and educated but, as it turns out, hiring those types of folks has gotten prohibitively expensive. It’s a lot cheaper to hire a Medical Assistant than it is a Registered Nurse. That may sound good for MAs in the short run but, with lop-sided benefits like these, there are bound to be complications and bad ramifications if MAs turn out to be preferred over RNs.
One of the dangerous pitfalls is that an MA isn’t qualified to do what RNs do – people who run healthcare facilities probably know that, so they won’t exactly swat one for the other. What they can do, though, as has been stated, is increase the number of MAs for each supervising nurse and, by additional means, reduce the number of nurses on the payroll. Could just one nurse supervise every supporting staff members, including MAs, for an entire hospital, clinic or senior citizen’s home – of course, he/she can, especially if it’s a highly experienced nurse and things are set up in such away that LPNs, PCTs and MAs are allowed to have tasks formerly performed by nurses only delegated to them.
In theory, as long as a nurse or a doctor is making decisions, implementing health plans and officially “supervising,” just about anything can be delegated to supporting staff. At any rate, whether some people might object or not, drastic changes are coming to healthcare. Having an Intern-like position in place, some people might argue, is in keeping with those changes.
After all, interns are like stem cells. Just as stem cells, basically a “blank slate” type of factotum cell, can play whatever role the body ordains, the Medical Assistant position can do, in theory, whatever doctors, nurses and administrators want them to do. How far that open-ended discretion goes, however, is hard to say. It’s also hard to say whether this whole situation is mostly good or mostly bad.
6. MAs Are Under the Full Control and Direction of Doctors and Nurses – Does That Mean That They Have to Do Whatever They Are Told to Do?
It is said that the lower you go in the totem pole of authority, status and responsibilities of any organization, the less power you possess. Some people might justify this paradigm by reminding us that people in the upper echelons of power/responsibility are more crucial to any operation and, while it’s difficult to deny that fact, one must nevertheless point out that all participants in any operation are important, even if not “equally” important.
One of the negative aspects of being a medical assistant is that, unfortunately, they are placed very low on that totem power mentioned. In fact, few other personnel at healthcare setting rate lower than they rate, in terms of power, authority, responsibility or status.
The main two that come to mind are Certified Nursing Assistants (CNAs) and Orderlies. In some settings, PCTs and EMTs (if any are used on the floor or ward) might also be beneath an MA but, for other positions, including Licensed Practical Nurses (LPNs) and Licensed Vocational Nurses (LVNs), all these positions are either on par with or above MAs.
Okay, so there’s a totem pole of power, authority and responsibility that all healthcare workers have to submit to – so what? Isn’t that the way it is in all organizations. In the military, for example, you have high ranking officers that preside over middle ranking officers – all of whom preside over your basic grunt or enlisted man.
Well, in our scenario, it would be accurate to paint Medical Assistants as your basic Corporal. This person is above a grunt or basic enlisted man, but is basically below everyone else. This is an accurate rendition when you consider that, in most cases, it’s doctors and nurses that delegate tasks and duties.
In healthcare settings there is very little lateral delegating or bossing around – in fact, it’s more accurate to say that MAs, PCTs, LPNs, LVNs, and the many types of techs in healthcare settings sort of collaborate with each other rather supervise or boss each other around.
Since MAs are under doctors and nurses, does this mean that they always have to do what these people tell them to do? What about if the MA feels uncomfortable doing what he or she is told? What if the MA didn’t get enough training in something and, therefore, feels ill-equipped to perform the task? What if the MA is asked to do something he or she knows might be illegal or unethical for him/her to do?
Clearly, these are questions that no MA should have to face in the field but it’s naïve for anyone to think that these questions aren’t being asked by some MAs working in different healthcare facilities. As things stand right, it does appear as if MAs are given very little leeway in terms of what orders or directions from doctors and nurses they can ignore or refuse to abide by. Some think that this is yet another shortcoming of the profession that needs to be addressed.
Wait, now, doesn’t this problem exist also for other low-level healthcare worker? Well, that may be so but it is especially troubling for Medical Assistants because they are often the ones without licenses, often without even certification, and the graduates of programs with the least amount of standardization. As has been stated, in fact, MAs exist in a gray world of poorly defined educational and training qualifying criteria and an over-all role in the industry.
It’s possible that this vagueness and ambiguity has been allowed (if not deliberately introduced) because it serves a useful purpose. As has been stated, MAs may be used as the roles that will replace more expensive healthcare professionals; they may also be asked to do things that, for other licensed professionals, might be illegal or unethical.
MAs, in other words, may be in the process of being used as sacrificial guinea pigs in a bizarre experiment involving a whole industry trying to survive financially troubling, legally demanding and medically complicated times.
Having said all this, what MAs can or can’t do does largely depend on the location in question. Every state may have different rules and expectations – this lack of consistency, though, only adds to the problems already exposed and alluded to.
7. Medical Assistants Are at the Bottom of a Quickly and Significantly Changing Totem Pole of Power
Much can be learned from reading about Dr. Katherine White a dermatologist from Massachusetts that, like many other people in her shoes, had been having trouble managing their practice. At first, she had allowed her staff to use her as sort of a putting-out-the-fire factotum; in essence, Dr. White, was trying to micromanage everyone under her.
The professionals that work in healthcare, however, are supposed to know their job well enough to not need to be micromanaged. For the record, doctors should closely manage a practice and are supposed to be checked-in with in regard to medical questions and situations that clearly fall under their rubric of expertise and responsibilities but this isn’t the same thing as “micromanaging” staff.
Micromanaging suggests or implies that, in addition to doing your job and meeting your clearly specified responsibilities you are also trying to do someone else’s job, something which may include:
- Answering questions that the medical professional should already know the answer to
- Trying to teach basic technical skills, tasks and responsibilities that one would generally acquire during their schooling, internship or otherwise on their own
- Failing to establish and/or enforce a basic understanding of position or job roles, function and responsibilities
- Failing to delegate well enough and clearly enough things that should be taken care of by someone other than a doctor – to be more specific, by lower-level staff
- Focusing too much on little things instead of more on the big picture
- Delving too much into administrative duties (which should mostly, if not exclusively, be handled by lower level staff) instead of medical duties
Dr. White eventually realized that micromanaging her staff members was not the best way to go. For one thing, she was so busy ‘managing that she had been prevented what she did best: practice medicine. One of her patients, for example, came in with what was clearly skin cancer; this easy diagnosis would have been rendered 2 months earlier, but the patient couldn’t get in to see her sooner.
Obviously, changes were needed in how she ran her practice.
This situation, though, is only one of many reasons why medical facilities are often fraught with an unseen yet powerful tension between doctors and their staff, including Medical Assistants. Among the repercussions are doctors who, feeling frustrated & compelled to flex their “muscles” turn to bullying and verbal abuse as a means of managing their staff. The friction that results from these dysfunctional inter-relational dynamics can, among other things, lead to serious medical errors.
Doctors feeling overwhelmed can then become guilty of dissatisfaction and miscommunication; these attitudes, in turn, begin to permeate among staff, who after all are supposed to follow the lead of doctors. The poor supervision that springs from these mismanaged settings lead to staff burnout, something that not surprisingly associated with lack of empathy for patients and medical errors. Burnout ultimately results in high turnover rates that can partly explain the shortage of doctors and nurses in some settings and for some specialties.
Studies show that doctors, like other types of professionals, are often very poor managers; they don’t know how to delegate well or make staff members feel important, needed or valued. This isn’t to say that doctors don’t know how to take over, bark orders, play dictator, and make people below them shake and tremble as they scramble to do what they’ve been told – doctors do all this very well.
There is no question that dictators get things done – but are the people under that style of management doing their jobs compassionately, caringly, devotedly and, most importantly, effectively?
Healthcare settings today are rather complex businesses that encompass not only the intricate dynamics of medicine (which are complex enough by themselves) but medical record keeping, lawsuit prevention & management initiatives, insurance billing, pharmacological rules & complications, ever-widening & growing more complicated government regulations (e.g., HIPAA, etc.), and personnel management.
Unlike other businesses, furthermore, where managers can delegate responsibilities, doctor can’t delegate the ultimate task of diagnosing and coming up with an adequate treatment plan for sick patients. Staff is supposed to make it easier for doctors to perform that “ultimate” function, after each staff member has done his/her job.
What’s been happening as a result of more and more doctors becoming disillusioned with private practice is that they are, instead, turning to salaried jobs at large health centers and hospitals. What many of these doctors are discovering, though, is that even these institutions are having their own problems regarding doctor/staff interactions. Unfortunately, doctors run into many of the same problems they experienced in private practice; there are even a few new problems they may not have had to deal with before.
The hierarchy of power and responsibilities in a hospital, for one thing, can be more complicated than in private practice, partly because more people are involved and partly because mistakes can be harder to just sweep under the rug. Then there is the fact that a doctor’s power is being eroded in a number of ways.
Decisions that used to be left up to a doctor, for example, now fall under the direction of insurance companies, which, incredibly, can often veto or challenge a doctor’s orders or wishes. A physician, for example, who may want to order a CT scan can be told that he/she must first do a series of X-rays before the insurance will pay for the CT scan.
Another glaring difference between today and the past is the fact that the power once given to doctors has not only be eroded by basically carved out and re-distributed among Physician’s Assistants, Nurse Practitioners, RNs, insurance companies, and hospital administrators. There is the story for example, of Mary Meadows a Medical Assistant working for a major city hospital.
One of the physicians working at the hospital was shocked to learn that, although he could give Miss Meadows directions and orders she was expected to follow, he was, first of all, obligated to relay those instructions/orders through nurses; in fact, he couldn’t even fire Miss Meadows (or, for that matter, any low-level staff person) or discipline her for, say, tardiness or not meeting a certain goal. Only the Medical Assistant’s immediate supervisors had those powers and responsibilities.
A doctor may basically be giving directions or orders to people who not necessarily answer to the doctor exclusively. Needless to say, this is creating some accountability issues that appear to be trickling down the totem pole. In the high seas, if something goes wrong in a boat or ship, the Captain is generally held responsible – this has been a time-honored concept that has rarely been challenged, mostly because it has worked out rather well; that is, until a mutiny came about, or the Captain disappeared before action could be taken against him.
Well, the same rule pretty much applied to doctors in the past – in essence, they have traditionally been the Captains of healthcare “ships” (settings). Now, though, what we have is a system strong superficially but, within its core, in several ways weak or altogether falling apart. Don’t bother looking for rioting CNAs, Licensed Practical Nurses and Medical Assistants or for doctors and nurses literally wrestling or trying to gouge each other’s eyes out. There is a “bloody” revolution going in healthcare settings but, if truth be told, it’s patients that are shedding blood, in some cases justifiably.
No, the revolution we’re talking about is mostly a silent one, involving the relational politics, role-to-role dynamics and the shaking down of the traditional power hierarchy that doctors naively thought would always be in place.
The problem isn’t, though, just that doctors need more training in personnel and business practices management, but the fact that the paradigm that makes them effective in a clinical sense is also their Achilles heel as far as relating to staff. Doctors, in other words, have always been taught to always be in command, to never say “I don’t know,” and to never tolerate challenges to their absolute (at least as far as medical decisions, diagnoses and treatment plans are concerned) authority.
There is a name for such a person, as politically incorrect as it may sound: “Dictator.” Well, that designation, though it is still taught in medical schools and expected/fully espoused by most doctors today, is no longer fully workable. This is why people immediately beneath doctors (RNs, NPs, PAs, etc.) are being given some of the powers only doctors could exercise in the past.
A type of RN that could write prescriptions? That would have been an unthinkable idea just a few years ago – now they’re called Nurse Practitioners. Allowing PAs and NPs to work independently without a doctor nearby to hold their hands – though the AMA is fuming about it, it’s happening. You will find many emergency care facilities that are being run, yes, by an NP or a PA.
Somewhere in the paperwork a doctor’s name may be found but the truth is that this in many cases a mere formality.
Where do Medical Assistants come in in regards to these facts? Well, let’s just say that the very foundation upon which medicine has been laid is being re-constructed, whether for worse or better. The point is that the roles that all healthcare providers are being asked to play is changing rather drastically in several ways. The fact that RNs now have much more power, for example, means that Medical Assistants are accountable to nurses more than they are to doctors.
But even that new reality is being shaken in unexpected and potentially far-reaching ways. How so? Well, there is a movement right now (perhaps propelled by the ever-worsening state of the economy) to actually reduce nursing staff to the barest minimum. The reduction of such, furthermore, is being compensated for by hiring more lower-level staff – in most cases, the position that is being used to “replace” nurses are Medical Assistants.
Actually, the word “replace” may be too strong and, quite frankly, unrealistic. Medical Assistants, simply put, aren’t qualified to take over for RNs. Chances are that those persons who are pushing for these changes know that. But probably what they are going for is a change in the traditional paradigm which they think is simply too expensive.
For instance, in a private practice, you usually have one RN and supporting staff that usually includes 1 to 3 Medical Assistants. This may be changed by having one part-time RN or on-call RN who will supervise the staff remotely. In hospital settings, instead of having 2 to 5 RNs per ward or floor or department, this may be cut down to just 1 RN.
To make up for the fewer number of RNs, hospitals and clinics will hire more LPNs, PCTs, and Medical Assistants. Is this really something that will be made to happen? Actually, it’s already happening. This movement is ironic because for the past few years we’ve had a shortage of nurses (mostly because nursing has had very high turnover and burnout rates); the idea that we will now deliberately decimate their numbers, therefore, sounds like a very bad idea for reasons beyond the one already mentioned.
Nurses are a very expensive “luxury,” if money is the thing mainly being looked at, but the stark reality is that reducing the number of nurses in healthcare settings can’t but negatively affect the quality of health for everyone. On the other hand, this is rather excellent news for MAs, if it will lead to many more jobs to be had. If this movement continues to grow, though, what it will mean is the creation of medical settings that will not be properly prepared for what promises to be a more complicated medical industry in the coming years.
For one thing, contagious/infectious diseases will again become major players, possibly in worse ways than existed before the 1900s. Before then, these diseases were the number one killers; after the 1900s, however, chronic diseases took over. Well, chronic diseases will continue to kill and maim many people but, whereas infectious/contagious diseases have remained important factors only in 3rd World countries, they may be coming back with a vengeance in the next 20+ years.
This is because of global warming bringing disease inducing insects further North, the worsening increases in antibiotic resistant diseases, and the ever-present and inescapable presence of bioterrorism, biowarfare and the fact that there are now huge arsenals of pathogens for which humanity does not have adequate quantities (if they exist at all) of vaccines or natural immunity.
Small pox, for example, if it were to come back (either through some natural process or man-created disaster) would kill millions, if not billions, of people.
8. Medical Assistants Are Often Illegally Called a &Ldquo;Nurse&Rdquo; – Sometimes with Their Permission, Knowledge, Encouragement or Participation
Have you ever heard people who were not RNs being referred to as “nurses?” The truth is that it happens more often than you may think. Part of the problem stems from the fact that some people use the term “nurse” generically, as if the word can be used toward any support staff member beneath a doctor. Would those same persons, though, refer to PAs and NPs (or RNs, for that matter) as “doctors?” Probably not.
Most people realize, and are probably thankful for the fact, that the word “doctor” isn’t loosely used or simply thrown around without much regard for accuracy or truthfulness. No one in a healthcare setting calls himself or herself “doctor” except doctors. Why don’t they? Firstly, because it’s illegal; anyone can be charged with a crime and arrested for saying that one is a doctor.
Secondly, it’s a dangerous thing to allow. Imagine, for example, if the receptionist at the hospital told you when you went to the ER, “Hey, I had a rash like that once. It wasn’t anything serious. Give me $20 and I’ll let you have the ointment I made at home for it. It’ll save you a bundle if you don’t have to see a hospital doctor about this. You can trust me, I’m a doctor myself.”
People don’t try a stunt like this because, a) they may end up killing someone that may need real medical help and b) they don’t want to be arrested for pretending to be something they aren’t.
Well, though it may not sound as urgent or even as important, Medical Assistants have no business calling themselves Registered Nurses; it is equally egregious when staff or patients ignorantly call an MA “nurse.” Every Medical Assistant need to refrain from making this mistake; they also need to correct anyone else that falls under a false impression.
Yet another problem that arises is that in some places the terms “RN” is protected but the word “nurse” not as well, if at all. It would be nice if the laws were more uniform in all states, but, until they are, you should side on the side of caution and not make this mistake, if at all possible.
9. MAs Are or Can Easily Become Targets of Lawsuits for a Number of Reasons
Although websites that provide forums where medical professionals of all levels and types can provide feedback or respond to questions/concerns posted aren’t generally considered suitable places to cite as formal “references” or “sources,” they can nevertheless be wonderful places to gather information about topics and issues related to healthcare, medicine and the many fine people that work in this industry. In fact, you will find in these forums attestations, revelations and epiphanies that you won’t find in articles, books or even lectures by medical professionals.
Some of the things you may read may be inane, some charged with too much emotion and not enough facts but, nevertheless, there is information in those forums that can come in very handy. Take the case of things that some Medical Assistants do, mostly out of ignorance or simply because they over-estimate their medical knowledge/expertise, which people with much more medical training, like RNs, pick up on.
Now, it may be difficult for an RN to just let an MA have it when the MA says or does something downright stupid or unprofessional; in some cases, there are interpersonal politics at play that must be considered. For example, the MA may be rather cozy with the doctor or may even be a relative. This can hamper or limit what the RN can do or say. At a forum, however, the RN may speak out, especially if using a fake name or non-identifiable avatar.
A nurse practitioner, asking a question on one of these forums that dealt with liability issues regarding actions by staff members while supposedly being supervised by a doctor or a nurse was given a rather interesting response. To be more specific, the nurse wanted to know if she could be sued if a patient suffered some ill effect after an MA told the patient by phone not to worry about some symptoms the patient was feeling.
The nurse immediately knew the MA was out of line but was not sure of what do to, especially since the MA was not directly under her control. The fact of the matter is that MAs aren’t supposed to even hint at anything related to diagnosis – i.e., they can’t answer question regarding symptoms or what the patient should do or not do about an ailment, except refer them to the nurse or a doctor.
The thing about lawsuits or legal action that may include criminal prosecution and fines is that legal action can be triggered by 2 primary types of liability: exceeding scope of practice and malpractice. While malpractice involves negligence, incompetence or criminal intent (e.g., euthanasia), violating scope or limitations of practice is a little bit more complicated.
The bottom line is that some specific type of wrongdoing must be conducted and, as a result, harm or damage must be incurred from the action or lack thereof; as for the latter, it must be understood that failing to take action (as when an MA doesn’t take any action after a patient tells her that her blood glucose has been averaging over 400 for the past 2 weeks) may be as egregious as giving the wrong advice, meds, injection or some other procedure.
But in most cases, some type of harm or damage must be incurred for a lawsuit. Having said that, an MA may be disciplined, fined, or charged with a crime (along with his/her supervisor) if he/she does something or says something that is outside of his/her scope or clearly had the potential to do harm. Discipline taken by a health board or the state where someone practices a medical role/profession, in other words, can take place even if no actual harm/damage was done to anyone.
It should also be noted that supervisors of MAs can be held liable or responsible by the actions (or lack thereof) of MAs put under them. For that reason, the supervision of any lower-level medical professional should be taken very seriously. By the same token, MAs need to understand and accept the fact that everything they do can affect not only patients they deal with but the medical professionals they work with or for.
With this in mind, every MA should strive to never exceed or step out of the bounds of his or her medical scope or do/say anything that may grounds for malpractice – i.e., proof of incompetence, negligence or criminal intent.
Scope of Practice
The problem with determining and sticking by their own scope of practice is that in some states this hasn’t been as well delineated for MAs as it has been done for RNs and other medical professionals. This has left a vagueness and lack of clarity which badly needs to be addressed and fixed.
Until then, though, MAs need to know, specifically, what they may safely do at work and what is definitely not a good idea for them to attempt to do. Since it’s the latter that may open or subject an MA to legal or disciplinary action, here’s a short list thereof:
MAs should not:
- Independently treat or diagnose patients
- Without supervision conduct telephone triage
- Independently diagnose specific symptoms or interpret medical data for patients
- Prescribe medications
- Unless directed to do so by a supervisor, hand out medication samples
- Independently refill or renew prescription requests
- Without supervision/direction, perform any kind of triage
- Give injections, except for those allowed by policy or law and appropriately supervised
- Initiate, flush and/or discontinue IV solutions/meds, unless permitted by law, policy and appropriately supervised
- Interpret or analyze test results
- Design and implement treat plans for patients
- Give advice about treatment regimen or medical conditions (except as directed or delegated by a supervisor)
- Conduct medical assessments or engage in any type of healthcare decision making
- Administer anesthetic agents, except perhaps for topical ointments/ gels (e.g., EMLA cream)
- Introduce or provide ABX agents, except as directed by policy or supervisor and permitted by law
- Participate in any tests that involve invasive procedures (i.e., skin/tissue penetration), except for those tests permitted by law or policy and appropriately supervised/delegated
- Give patients any type of interpretation of medical tests performed
- Operate any kind of laser equipment
- Participate in or perform any type of surgery, except perhaps as an assistant to a supervising surgeon or MD
- Perform any test or procedure for which the MA has not received adequate “formal” training
- Participate in or perform any function the MA doesn’t feel entirely confident doing or for which he/she hasn’t received adequate training (even if delegated by a supervisor)
- Ever call himself/herself by the title of “RN” or “nurse” or allow other people to use such terms without correcting their erroneous use of these terms
- Ever attempt to perform his/her regular duties outside of a healthcare setting while not under the supervision of a qualified medical professional – except for things like basic First Aid, CPR, etc.
Unfortunately, though, there is a lack of uniformity regarding what MAs can do or not do in each state. To confuse things even further, the description of what a Medical Assistant is can differ from state to state; additionally, most states give a rather vague recommendation that an MA may basically do just about anything (though things may not be worded in these terms anywhere) as long as they have received training for the procedure/action and are being suitable supervised by a nurse, doctor or any other upper-level medical professional.
10. The Profession, Training and Education Programs Need to Be Better Defined and Structured
Unfortunately, the profession of Medical Assistant right now is one of the most vague, unstructured and in-need-of-further-functional-clarity jobs not only in healthcare but in any industry you can name. In fact, when asked to describe what a Medical Assistant is supposed to do at a job site, a healthcare expert quipped rather impudently (or so it seemed) “What can’t an MA do?”
This may sound farfetched but that pretty much describes the awful situation most MAs find themselves in right now. In a way, we can be excited for them. Unlike other healthcare professionals, their role isn’t as carefully diagrammed and controlled. If this sounds like a blessing, though, then you’re just not looking at the big picture, at the potential consequences of having such unrestricted functional freedom.
Now, no one is saying that MAs can do anything – it just appears as if that’s the case. In some circles this situation might be termed “unlimited room for power.” But, alas, that’s not what MAs are being given. In fact, it’s more accurate to say that MAs are being “used” by the healthcare system and the upper-level professionals that run it. Here is someone, after all, that doesn’t have to be paid much that you can nevertheless ask to do just about anything, as long as you train them and make sure that they were properly supervised while doing their tasks.
The question we then have to ask is “What, then, are the restrictions for MAs?” The scary part is that each state may answer this question differently – some of them don’t answer it at all (at least not officially) and, what’s worse, some answer it rather vaguely/uncommittedly. Clearly, this is a situation that can tempt even some conscientious people to take advantage of it.
For the record, that’s exactly what’s happening in some settings. The topic that was spoken about earlier in this paper about nurses being replaced by MAs is, one can easily argue, one of the many dysfunctional correlations and results that can be attributed to the aforementioned “vagueness” and “lack of job clarity” presently in place. An RN has to be paid much more money, in most cases, than MAs and you can’t really ask RNs to step out of the well-delineated functions of their profession – why, you can’t even ask an RN to change a bed or bathe a patient (though it would be a waste of resources to ask them to do so anyway).
But, when it comes to MAs, well, they can be asked to do anything. An MA can perform the functions of a lowly CNA (some of whom got only 6 weeks of training!) and, by the same token, you can also ask them to perform an EKG, draw blood, or perform even more sophisticated tests and procedures, as long as you can say (whether true or not) that you trained them to do a function and that you supervised their performance at all times.
How Does One Become a Medical Assistant? That Door Is Wide Open As Well!
Incredibly, there are Medical Assistants out there that never got a degree, certificate or diploma; they either got trained by their present employer or they got a dubious certificate from an online (unaccredited) technical school. Here’s how anyone can get away with this: in most states there are not specific requirement to enter this profession, though anyone who works an MA or who wants to become one will tell you that it’s better and easier if you get a diploma, degree or certificate from an accredited school.
Many employers also require that you have some experience before they will hire you. Of course, this is one of those Catch-22 situation also seen in other industries and for other types of jobs. Actually, as this paper has already argued a Medical Assistant is little more than a permanent Intern. In other words, MAs can expect to receive on-going training as part of their jobs.
This is, no doubt, to make up for the training and education that MAs didn’t get enough of in school, especially for those super short MA programs that last as little as a mere 9 months – there are some online programs that last even less, a mere 6 months. It’s no wonder, therefore, that MAs are expected to undergo additional training on an on-going basis.
Another reason is the fact that MAs are expected to do things that, quite frankly, they were not meant to do, when considering the small amount, comparatively speaking, training that they receive to get their credentials.
The fact is that the Medical Assistant profession needs to be overhauled, re-defined and restructured from foot to top, including how one becomes an MA, what duties MAs need to be limited to, and what role MAs play in relation to the other low-level healthcare professionals; finally, it should be much clearly stated what things MAs may not do, even if (or especially if) their supervisors insist that they do a particular thing.
11. Too Many MA Program Schools Are Exaggerating or Misrepresenting Employment Facts
All over the country, especially in large cities, schools are turning out Medical Assistants by the thousands. It’s easy to see why these programs are attract so many people. After all, other than CNAs, Patient Care Techs, and Licensed Practical Nurses, programs leading to the title of Medical Assistant are some of the shortest gateways into a rewarding profession.
A short program means having to spend less time away from family and from a regular paycheck; it also means having to spend much less money than, say, an RN program – even the associate degree in nursing takes two years, but you can add another one to two years to really get settled as a nurse.
MA programs, in other words, are perfect for people financially challenged, that aren’t the smartest people out there, that don’t have the best academic records (those people go for RN or higher placed programs), that want a quick route into a good-paying job, and that want a relatively easy entry intro the healthcare field.
Because schools have been graduating more MAs than there are jobs for in the industry, there is now a glut of MAs in many parts of the country. If you look at job reporting agencies and services, you will be told that the employment picture for MAs is looking good and, to be sure, they aren’t lying.
The fact is that MAs have, for the most part, done well finding jobs. Many of the people that have graduated with an MA diploma/degree in the past 10 to 15 years have indeed found jobs. That doesn’t erase the fact, though, that there are many other persons with MA degrees/diplomas that haven’t been able to find a job.
Some schools need to start being more sincere with prospective students. As of right now, the law permits many of these unscrupulous schools to continue to tell prospective students that they will find jobs after they graduate. This needs to be changed. This is yet something else that needs to be changed about the medical assistant profession.
12. MAs Will Soon (If It’s Not Happening Already) Have Difficulty Qualifying for Liability Insurance or It Will Become Very Expensive
Of all the points made in this paper, this one is the least supported by the literature available on this subject. As of right now, insurance companies aren’t reporting a problem with their desire or willingness to provide liability insurance for MAs. Actually, many MAs don’t have any liability insurance or are covered by the liability insurance of their employer (or assume that they are).
Right now, there aren’t that many lawsuits specifically targeting MAs. This isn’t because there aren’t good reasons right now to sue an MA but more because MAs are not considered wealthy enough (in either pay or possessions) to make good targets. Money, of course, isn’t the only reason for suing a medical profession.
Some medical professionals are sued simply because there are ethical reasons in place as motivators; either that, or people want to lash out at the “professional” that screwed up their health with their negligence, incompetence and/or criminal intent.
As insurance companies start to realize the many deficiencies presently weighing down the profession, they will hesitate more and more to provide coverage for MAs – either that, or they will greatly increase the fees they will require. The fact is that MAs make excellent legal targets for lawsuits. Everyone will see this, including lawyers, insurance companies and the public, as more and more mistakes will be blamed on MAs.
This will get worse as nurses begin to lose their jobs so that more MAs can be hired. All in all, these things will spell “disaster” for everyone in the long run. If you still harbor any doubt about any of this, you should read the article “Is Your Medical Assistant Practicing beyond His or Her Scope of Training?” put out by the state of California.
Is the profession of Medical Assistant in trouble? Actually, the numbers look rather good for the profession for the foreseeable future. But statistics often don’t tell the whole story.
In the case of Medical Assistants, for example, it’s not a matter of numbers but of shortcomings and deficiencies that in time, if not addressed and fixed, will put this profession out of business – either that, or the job will be greatly re-structured, re-defined and even re-titled, if it becomes necessary.