Medical Assistants: Managing the Risk

Medical assistants (MAs) are ubiquitous in the office practice setting. According to the Bureau of Labor Statistics, approximately 811,000 MAs were employed in the United States in 2024. That number is expected to grow by 12% over the next decade to meet the increasing healthcare demands of an aging population. While some MAs work in the hospital setting, the majority work in offices under the supervision of a licensed practitioner, typically a physician.

In many cases, MAs keep practices running smoothly. They perform various administrative and clinical tasks, such as fielding phone calls and messages, taking vital signs, and rooming patients. MAs are often able to build strong relationships with the practice population and communicate effectively with patients. They can improve the patient experience by serving as a liaison between the practitioner and patient, leaving the practitioner free to focus more on patient care and less on administrative duties.

Because MAs are generally less expensive to hire than nurses, employing MAs can enhance office profitability. When MAs are used improperly, however, they can expose an organization to risk. MAs as a group can have inconsistent education and skill levels. Although there are several MA certification programs, curricula vary. Most states do not require MA licensure, and many states do not require MA certification. In fact, some states require no training at all, allowing MAs to gain experience “on the job.” This can result in widely varying skill levels among MA candidates.

Physicians rely heavily on MAs, especially those with whom they have long-standing relationships. Consequently, physicians can lose perspective on the tasks they delegate to their MAs and on whether unlicensed employees can safely and skillfully perform those tasks. Without clear office communication policies in place, MAs may find themselves providing patients with clinical advice that falls outside the scope of their practice.

Telephone communication with patients is often delegated to MAs. While communicating logistics, relaying data, and taking messages are administrative tasks that MAs can handle with ease, clinical communication can be problematic. Many incoming telephone calls require clinical triage and decision-making by the treating or covering practitioner. Telephone triage or calls involving clinical judgement require the ability to make independent clinical decisions based solely on what the caller verbally communicates.
 
While in most cases, registered nurses and advanced practice providers may dispense clinical advice and triage, these types of clinical decisions are not within the MA’s scope of practice and can lead to patient harm.

Risk Recommendations 

While qualified MAs who operate within the scope of a well-designed program offer many benefits, those who are used incorrectly or in the context of a poorly designed program can expose a practice to liability. Consider the following risk recommendations when designing an MA program:
 

• Know the law. Despite the wide variation in state law regarding MA regulation, most states do provide some guidance regarding an MA’s scope of practice and appropriate delegation. In addition, The Centers for Medicare & Medicaid Services requires MAs to be credentialed in order to perform certain functions in the medical record. When implementing an MA program, it is important to ensure that job descriptions, policies, procedures, and protocols reflect current state and federal law. 
•  Develop detailed job descriptions. Standardized written job descriptions ensure the consistent delivery of quality patient care. Job descriptions and competencies should comply with state and federal law and be based on the practice setting and patient population. Update job descriptions as roles evolve or as regulations change.
• Provide adequate supervision. Practitioners who delegate tasks to an MA should understand that they are responsible for the MA’s actions. They should also be familiar with the MA’s role and scope of practice and provide supervision appropriate for each delegated task. Ensure that a licensed practitioner is immediately available when the MA performs any clinical task or procedure.
• Evaluate and document competency. Screen potential candidates and perform a background check to verify their qualifications for the position. Establish a concise checklist of competencies that are consistent with scope of practice regulations and practice setting. Use the checklist to evaluate, by return demonstration, the skills of each MA upon hire and periodically thereafter to ensure maintenance of competency. Require the MA to demonstrate competency in each task prior to performing it on patients. Document competency evaluations in the personnel file.
• Develop telephone protocols. Each practice should develop telephone communication protocols that outline clear expectations for licensed and unlicensed staff who handle phone calls. In those protocols, specifically address the types of calls that unlicensed staff can handle and the calls requiring referral to a licensed practitioner. Also address communication of test results and documentation of telephone encounters. Educate staff on the protocols during orientation and periodically thereafter. Periodically audit the quality of telephone encounters to ensure consistency with office policies, procedures, and protocols.
• Delegate within the scope of practice. As practitioners become more comfortable with the MA’s role in the office setting, they commonly assign the MA increasingly complex tasks. Some of these tasks may push the boundaries of the MA’s acceptable scope of practice. For example, while it may be appropriate for an MA in a urology office to pass a catheter in a patient with a healthy urethra, it may require clinical judgment and expertise to pass a catheter in a patient with a diseased urethra. Be cognizant of the types of tasks being delegated to MAs to be sure they do not require medical skill, clinical judgment, or specialized expertise.

 
MAs are an integral part of the modern office practice setting. Proactive implementation of sound, well-designed policies, procedures, and protocols can ensure MAs continue to enhance the patient experience and keep the office running smoothly for years to come.