The Unlikely Heroes of Healthcare

The unlikely heroes of American health care do not have fancy degrees. They are ordinary workers with high school degrees who can do their jobs with as little as an additional year of training. On average, they earn between $30,000 and $40,000 annually. Many have never worked in health care before. They work as employees, and almost all are female. They are the indispensable go to workers of the new American health care system because they are inexpensive to use and they can be plugged into many different workflows within a medical setting. They are medical assistants.

According to the Bureau of Labor Statistics (BLS), medical assistants perform both administrative and clinical duties under the direction of a physician. In 2014 there were almost 600,000 medical assistants employed in the United States, earning on average fifteen dollars an hour. Most of these work in physician offices, primarily in ambulatory care settings. Three states—California, Florida, and Texas—employ almost a third of all U.S. medical assistants. Every health care delivery organization in the Boston area now leans heavily on these workers to meet their production demands.

Medical assistants are a highly practical, cost-effective disruption that makes doctors’ lives easier, nurses able to upskill and do more, and patients gain easier access to and reliability around their care. No other workers in health care are involved in such a wide array of duties. Physicians increasingly rely on them as their jack of all trades support staff. Many patients in primary care now have more face and phone time with an MA than they do with their primary care doctor, who increasingly is hidden from our view, funneled towards the most complex patient visits coming through their door each day.

Beyond their direct interface with patients, medical assistants also support the quality reporting and performance measurement work in today’s doctors’ offices, often making sure quality data are complete and accurate within electronic health records, tracking down needed information, steering patients to required services, and getting performance data to the various insurance plans and accrediting agencies. This work is increasingly important for health care organizations to get paid, and for patients to get better care.

Despite their significance, this heavy reliance on medical assistants merits closer examination. It makes sense to embrace lower-cost ways of doing things, understanding that the physician or nurse cannot be involved in everything. But if medical assistants get used too much as replacements for doctors or nurses on even basic patient care tasks, is that a problem? I’m lucky if I see or talk to my primary care doctor a couple times a year, at most, and I know most others are in the same situation. How should we feel about an industry that continues to shift more of the payment burden onto individuals through increased insurance premiums, and higher deductibles and copays, at the same time giving us decreased access to the best trained experts? Sure, it’s in the name of efficiency, but at what point do the cost savings supposedly resulting from that greater efficiency flow down to the consumer?

For example Massachusetts has the highest per capita health spending in the country. Shouldn’t the extensive use of medical assistants instead of physicians and nurses by the large hospital and physician systems in this state help bring those costs down? In addition, many physicians these days are increasingly unhappy in their work because they have fewer chances to build interpersonal relationships with their patients, which surveys show are still extremely important to them. But this is due in part because they don’t know their patients well enough as people, and have less and less direct knowledge of or face time with us. Does the overuse of medical assistants, particularly in primary care, exacerbate that reality, by removing doctors further from our view?

Medical assistants I have encountered are pleasant, helpful sorts who take their jobs seriously and soften the growing harshness of overcrowded, impersonal medical offices bent on maximizing the number of transactions and perhaps not the quality of individual relationships. They are heroes simply for the sustained doses of compassion, listening, and emotional support they provide to all of us—qualities that many health care organizations and an increasing number of physicians do not exhibit as much as they should, despite frequent use of the term “patient engagement” within the industry.

Without the presence of these workers in doctors’ offices and ambulatory care settings, our experiences as patients would probably be worse than they are now; physicians’ work more difficult to do; the entire health quality measurement and reporting apparatus hindered; and the access problems bigger. That is a lot of benefit packed into a single disruptive innovation. Still, it makes me wonder where health care is headed and if my physician will become even more of a unicorn to me in the near future—powerful but hard to see.

Timothy Hoff is the Professor of Management, Healthcare Systems, and Health Policy

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