As defined by Donald Basala, JD, MBA, the CEO and Chief Legal Counsel of the American Association of Medical Assistants (AAMA), “Medical assistants are allied health professionals who work predominately under licensed provider authority in outpatient settings—including outpatient departments of primarily inpatient institutions. Medical assistants may be delegated certain clinical, patient-communication, and administrative tasks by licensed providers. The category of licensed providers most often includes physicians, nurse practitioners, and physician assistants.”1
Within nearly all medical practices, the role of the medical assistant (MA) is essential for effective operations and patient care. When utilized properly within their legal scope of practice, a knowledgeable and skilled MA can improve workflow and productivity, increase patient satisfaction, and reduce provider and staff burnout. In addition to managing front-office functions, MAs can perform limited clinical duties. Relying on an MA to perform tasks outside the state’s defined legal scope of practice can, however, place both the provider and the patient at risk. It can also compromise patient safety and result in adverse patient outcomes and claims.
Scope of Practice
Because an MA’s scope of practice varies by state, regulations may include very specific lists of approved and unapproved activities. Conversely, some states do not address MA scope of practice at all, and the MA generally works under the license of the supervising provider. Consider these strategies to help your MAs stay within their designated boundaries:
- Be familiar with the regulations in your state pertaining to the clinical functions that MAs are allowed to perform. Check state regulations through the medical board, state medical association, or the AAMA State Scope of Practice Laws.
- Develop job descriptions, protocols, orders, and instructions to ensure that every MA in your office knows how to perform approved functions and all duties are carried out consistently across the practice.
Only physicians or qualified licensed staff, such as registered nurses, nurse practitioners, or physician assistants, should provide telephone advice. Office staff must use written protocols and standing orders that include instructions on standard questions to ask the caller, recommended responses for minor problems, and which calls to refer immediately to a licensed provider. For more information, see our article, “Telephone Triage and Medical Advice Protocols.”
MAs cannot—under any circumstances—make independent medical assessments, triage, prescribe, renew prescriptions, or give any type of medical advice. Consider the following recommendations:
- Caution your MAs about expressing opinions to patients, even if asked during a casual conversation. MAs should refer any patient concerns to the licensed provider.
- Emphasize that MAs are allowed to convey basic clinical information on behalf of the provider and follow established clinical protocols when speaking with patients—and only when the information conveyed does not require independent medical judgment, assessment, or advice from the MA.
- Never delegate to MAs the task of providing an informed consent discussion with the patient. This task, which must be performed by the provider, cannot by law be delegated.
- Do not refer to your MAs as “nurses” and caution office staff against doing so. The term nurse implies advanced education and licensure and, if used inappropriately, could result in professional board investigations and prosecution. All staff members should wear nametags that designate their professional title, and MAs should be instructed to correct patients who refer to them as “nurse.”
Training and Oversight
The following strategies can help ensure adequate training and oversight for the MAs in your practice:
- Delineate the MAs’ responsibilities in a written job description; provide comprehensive onboarding for each new MA.
- Review each new MA’s educational curriculum and work experience carefully. Assess and document the skill level and core knowledge of each MA that you supervise, and incorporate checklists, hands-on demonstrations, and written tests as they relate to specific job duties within your specialty. This should be done when each MA is hired and repeated periodically as needed. Provide and document additional training for any areas of deficiency or newly acquired skills. Maintain all records in administrative files.
- Provide in-depth training and monitor adherence to medical record documentation protocols to ensure quality and consistency across the practice and that all medical records are complete.
- Provide training on patient relations and communications as the MA-patient interface significantly affects patient satisfaction within your practice.
- Introduce MAs to the concept of safety culture and how it is prioritized within your practice.
- Incorporate team training (e.g., TeamSTEPPS®) and emphasize the important role of MAs as members of a highly effective team. (See our complimentary on-demand course, TeamSTEPPS® Teamwork Training in the Office Practice.)
- Provide direct supervision until each MA demonstrates the required level of competency.
- Assess the quality of each MA’s work periodically and provide feedback.
Enhance safety with these risk mitigation strategies:
- Ask your MAs to pursue certification (for example, through the American Association of Medical Assistants) and provide access to continuing education resources.
- Provide periodic in-service training and ongoing skills verification.
- Create a culture of psychological safety in which MAs feel comfortable asking questions about job tasks or clinical duties and speaking up about patient safety concerns without fear of reprisal.
- Do not ask MAs to perform any duties that run counter to the scope of practice within your state or that conflict with the written job description.
Continuing Education and Additional Assistance
We offer complimentary on-demand courses that can help you reduce risk and improve safety. Some courses can also help office staff enhance patient relations, manage challenging patients, and improve teamwork communication. For a complete catalog, visit our Education and CME page.
For additional guidance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.