As healthcare payment and delivery models are changing, medical assistants have an outsized presence in today’s healthcare environment. Practices are increasingly reliant on medical assistants to improve health outcomes and access to care, and reduce costs, not to mention reduce provider burnout.
The soaring demand for medical assistants reflects the need: The field is expected to grow 18% between 2020 and 2030, from 720,900 to 853,500 positions. That’s compared with 16% for other healthcare support jobs and 8% for all occupations.1
But one downside to increased reliance on medical assistants is that within a physician practice, sometimes the jobs of medical assistant, licensed nurse, registered nurse, physician assistant and even physician can overlap. In such situations, it can become unclear who should be delivering care.
That creates major risk for private practices, which simply cannot allow this blurring to happen. The risk is spelled out in the form of regulatory action and fines — and higher medical professional liability insurance rates.
Medical assistant and scope of practice
Medical assistants are certified and trained for administrative, clerical and clinical tasks. They are not trained or licensed to practice medicine.
But given the shortage of medical professionals nationwide, medical assistants may be given tasks that involve some level of medical service, including taking patient histories, assisting physicians during examinations and performing basic lab tests (state laws circumscribe medical assistants’ allowed duties, which vary by state).2
Accountability for patient outcomes rests with licensed medical and nursing professionals, and medical assistants are not allowed to complete tasks in which medical or nursing judgements are involved.
There’s an obvious risk in having medical assistants perform work for which they have no training or skills. But the lines between what can and can’t be delegated are increasingly blurred, especially since “scope of practice” provisions diverge substantially from state to state.
Even in states where medical assistants can do tasks, such as drawing blood after completing additional training in phlebotomy, there’s the potential to run afoul of scope-of-practice rules. In many states, medical assistants can administer flu shots, but not medications.
In the most highly regulated states, delegating a medical task to someone who’s not legally authorized to perform it can lead to professional misconduct charges.
Regulators are noticing an expansion of medical assistants’ duties. For instance, Connecticut regulators issued an advisory on use of medical assistants in private practices, citing prohibited activities such as radiography and any form of medication administration. The advisory reiterated that delegating activities that require professional judgment, like evaluation or diagnosis, is strictly prohibited.
The value of delineated privileges and reducing risk
Private practices can guard against medical assistance mission creep by borrowing from the hospital credentialing process. These processes give physicians strict admitting rights and a specific list of privileges. For example, an OB/GYN and neurosurgeon cannot use equipment approved for the other’s use.
It’s a model that can be applied to all medical staff in private practices: Delineating privileges offers a clear understanding of each scope of responsibilities.
Such a process starts with determining the minimal years of education for each level of medical professional and listing the tasks each is permitted to perform.
For example, a general medical practice could put down in writing that electronic prescriptions, including refills, are delineated privileges of medical doctors, advanced practice registered nurses and physician assistants only. Registered nurses, licensed practical nurses and medical assistants cannot prescribe medicine — codifying these rules and training staff on them will help reduce risk.
Medical professional liability insurance won’t cover mistakes arising from improper delegation in the delivery of care services. Delineation of privileges and strong staff training will help guard against the confusion over roles as dependence on medical assistants continues to grow.
HUB International's healthcare experts are ready to help your organization respond to the opportunities and risks in a constantly changing healthcare environment.
1 U.S. Bureau of Labor Statistics, “Medical Assistants,” September 13, 2021.
2 American Association of Medical Assistants, “What Is a Medical Assistant?” Accessed December 9, 2021.