Changes of working conditions and job-related challenges due to the SARS-CoV-2 pandemic for medical assistants in general practices in Germany: a qualitative study

Abstract

Background In Germany, general practices are usually contacted first by patients with health complaints, including symptoms characteristic of SARS-CoV-2. Within general practices, medical assistants (MAs) are the first contact person for patients and perform various tasks in close physical patient contact. Working conditions of MAs have been characterized as challenging, e.g., due to low salaries, a high workload, time pressure and frequent interruptions. The potential changes of working conditions and job-related challenges experienced by MAs due to the SARS-CoV-2 pandemic have not been fully explored. We aimed to address this knowledge gap among MAs working in general practices in Germany. Methods Semi-structured telephone interviews were conducted between March and April 2021 with 24 MAs. Medical assistants of legal age, who worked in general practices in Germany, and who were continuously employed and without change of employer in 2020 were eligible for participation. Interview recordings were transcribed verbatim and content-analyzed using MAXQDA, using deductive and inductive coding. Results The SARS-CoV-2 pandemic posed great challenges for MAs, including a dramatic increase in workload, changes in occupational tasks, increased hygiene measures, rearrangements of work organization, childcare issues, and structural and personnel challenges within their practice. Participants described both improved but also worsened collaboration with their employers and colleagues due to the pandemic. Many MAs complained about issues regarding SARS-CoV-2-related billing processes and an increase in unpleasant patient behavior, including disregard of practice rules or frequent verbal insults. Many also did not feel adequately appreciated by politics, media, or society for their efforts during the pandemic. Positive changes were perceived to be the expansion of digital communication channels and a growing social cohesiveness of practice teams. Conclusions Our study suggests that the SARS-CoV-2 pandemic posed great challenges for MAs. The pandemic seems to have worsened MAs’ working conditions, which had been described as challenging already prior to the pandemic. In order to improve job satisfaction and to prevent loss of healthcare personnel, measures must be taken to improve working conditions of MAs in general practices.

Psychosocial working conditions as determinants of slips and lapses, and poor social interactions with patients among medical assistants in Germany: A cohort study

“…This highlights that improvements are needed at the personal, practice and systematic levels. First of all, at the political level, it should be acknowledged that the working conditions among MAs are poor [ 9 ] and that the shortage of skilled MAs increasingly worsens the working conditions of the remaining MAs [ 57 , 58 ]. Political structures should be adjusted to increase the attractiveness of the MA profession and improve retention.…”

Psychosocial working conditions and mental health among medical assistants in Germany: a scoping review

“…Three studies indicated a subjective increase in workload for MA in this setting due to the pandemic [ 40 , 46 , 51 ], whereas the only included study examining mental health among MA during this period [ 40 ] reported a very high prevalence of depressive symptoms (29.9%) and of generalized anxiety disorder symptoms (42.6%) among MA compared with the general female population in Germany during the pandemic [ 65 ]. A qualitative study from our working group published after our retrieval of sources and thus not included in this review highlighted the workload increase and unfavorable changes in the social interaction with colleagues and patients among MA during the COVID-19 pandemic [ 70 ]. These forms of negative impact on psychosocial working conditions and mental health have also been observed among other health care workers during the pandemic [ 71 – 75 ].…”

“…However, the prevalence of depressiveness (17.45%) and anxiety (20.14%) among MA was already high before the pandemic compared with the general female population in the country, which corresponded to 11.3% for any mood disorder and 3.0% for generalized anxiety disorder [ 64 ]. During the pandemic, MA further resented that their profession did not receive the same attention and recognition from society and the government for their contribution during the pandemic as nurses did [ 51 , 70 ], and expressed a decrease of job satisfaction [ 70 ].…”

Prevalence and correlates of workplace violence against medical assistants in Germany: a cross-sectional study

“…Reported sexual harassment in the practice was higher both for female (15%) and male (5%) physicians compared to the prevalence in our study (4%) [ 10 ]. In a qualitative study, MAs reported that since the onset of the SARS-CoV-2 pandemic verbal violence was frequently experienced on the phone or patients behaved aggressively if their demands were not met immediately [ 34 ]. As many of the conflict-laden patient-related tasks are performed by MAs and as MAs are perceived to have a lower social standing than physicians, it seems plausible that MAs are more likely to experience verbal violence by patients and patient relatives compared to physicians in outpatient care settings.…”

“…Finally, our study was carried out during the SARS-CoV-2 pandemic and specifically at a time when the general population in Germany was eligible for the vaccination and when the workload in outpatient care settings and the distress among practice teams was exceptionally high. This may have led to a higher than usual prevalence of verbal violence, as MAs reported that patients became more demanding and behaved aggressively, particularly on the phone (e.g., to schedule vaccination appointments, obtain test results), during longer waiting times, and due to new practice organization approaches due to SARS-CoV-2 regulations [ 34 ].…”