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Study reveals inadequate levels of medical assistant staffing in US

A new paper published in Annals of Family Medicine analyzed the current ratio of medical assistants to primary care physicians within medical practices, finding that health-system-owned practices were less likely to be adequately staffed than other practices.

According to the paper, medical assistants are among the fastest growing occupations within the US primary care workforce, and many medical practices have expanded the roles and caregiving responsibilities of primary care medical assistants.

But not much was previously known about medical assistant staffing ratios across the US. This study was the first to assess staffing ratios and to examine the factors associated with ratios consistent with the teamlet model of primary care. The teamlet model includes two medical assistant health coaches and one primary care clinician.

The study analyzed survey answers from 1,252 primary care practices and determined that more than half (56.6%) of the practices had ratios of one medical assistant to each primary care clinician. Slightly more than one in ten (11.4%) had ratios of two or more assistants per clinician while more than a quarter (27.6%) had less than a one-to-one ratio.

“Adequate medical assistant staffing is needed to support the delivery of patient-centered, high-quality primary care. Medical assistants increasingly provide direct patient support, including health coaching to help patients with managing their chronic conditions and conducting patient outreach activities to ensure the reliable provision of evidence-based and recommended care,” said lead author Hector P. Rodriguez.

“Past research indicates that a staffing ratio of 2-to-1 medical assistants to primary care clinicians is needed for ‘teamlets’ to effectively support the provision of preventive care and help manage chronic care, while continuing to do traditional medical assistant functions, such as taking medical histories and preparing patients for examinations. Our study indicates that few primary care practices (~11%) have the capacity to provide the recommended staffing ratios for the teamlet model.”

Independent practices, medical group–owned practices, and Federally Qualified Health Centers were more likely to have ratios of two or more assistants per clinicians than practices owned by health care systems. Low medical assistant staffing levels were not found to be associated with higher levels of staffing of nurses, physician assistants, and nurse practitioners.

“The current study’s results suggest that system-owned practices may be less able to use patient-centered innovations because they have less medical assistant staffing support compared to independent practices and medical group owned practices,” said Rodriguez. “Health policy advocates are increasingly concerned about the potential harms of physician practice consolidation under health care systems because systems may be less responsive to the local needs of vulnerable populations and inadequately resource primary care practices to effectively address patients’ self-management and navigation support needs. Our hope is that the study helps make the connection between medical assistant staffing and the provision of patient-centered care clear to policy makers and health care organizational decision-makers.”

Additional authors include: Dorothy Y. Hung and Stephen M. Shortell of UC Berkeley School of Public Health and Alena D. Berube and Elliott S. Fisher of the Dartmouth Center for Health Policy & Clinical Practice at Dartmouth College.

This research project was funded by the Robert Wood Johnson Foundation.