Patterns of Relating Between Physicians and Medical Assistants in Small Family Medicine Offices

Abstract

PURPOSEThe clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician-medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. METHODSWe conducted an ethnographic study of 5 small family medicine offices (having <5 clinicians) in the Cincinnati Area Research and Improvement Group (CARInG) Network using interviews, surveys, and observations. We interviewed 19 MAs and supervisors and 11 clinicians (9 family physicians and 2 nurse practitioners) and observed 15 MAs in practice. Qualitative analysis used the editing style.RESULTS MAs' roles in small family medicine offices were determined by MA career motivations and clinician-MA relationships. MA career motivations comprised interest in health care, easy training/workload, and customer service orientation. Clinician-MA relationships were influenced by how MAs and clinicians respond to their perceptions of MA clinical competence (illustrated predominantly by comparing MAs with nurses) and organizational structure. We propose a model, trust and verify, to describe the structure of the clinician-MA relationship. This model is informed by clinicians' roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs.CONCLUSIONS Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting.

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

“…While we qualitatively studied a relatively small sample of 15 practices in New Jersey, we found similar barriers to MA role shifts reported by others in Pennsylvania and Ohio, including resistance to implementation due to practice culture, insufficient communication from practice leaders, lack of clinician trust in MAs' competence due to their insufficient training, lack of MA engagement with the PCMH model, and MAs' frustration with added workload without additional compensation. 3,20,27 To facilitate the transitioning of MAs into these expanded roles, it is paramount to develop a teamwide shared understanding of how new MA responsibilities contribute to practice transformation and to secure buy-in from staff and all clinicians. Our findings illustrate the importance of having open communication via regular meetings and establishing an environment where the MAs feel safe to voice concerns and be involved in decision making.…”

Teamlets in Primary Care: Enhancing the Patient and Clinician Experience

“…21 While many clinician-MA teamlets develop mutual trusting relationships, others are less collaborative. 22 Some clinicians are difficult to work with, and some MAs are unenthusiastic about their work. We have observed practice leaders paying close attention to clinician/MA pairings to maximize collaborative team culture.…”

Using segmented regression analysis of interrupted time series data to assess colonoscopy quality outcomes of a web-enhanced implementation toolkit to support evidence-based practices for bowel preparation: a study protocol

“…Outpatient colonoscopy requires relationship-centered care [23] where staff provides patients with education for bowel preparation that reflects the physician’s choice of bowel preparation medication and dose to maximize the potential for a clean colon on the day of the procedure. The structure and qualities of the physician-staff relationship for outpatient colonoscopy remain unstudied.…”

“…While there is convincing evidence on interventions to improve bowel preparation for patients, the evidence on how to implement these patient interventions in outpatient colonoscopy settings is less obvious. Outpatient colonoscopy requires relationship-centered care [ 23 ] where staff provides patients with education for bowel preparation that reflects the physician’s choice of bowel preparation medication and dose to maximize the potential for a clean colon on the day of the procedure. The structure and qualities of the physician-staff relationship for outpatient colonoscopy remain unstudied.…”