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Leaving the profession as a medical assistant: a qualitative study exploring the process, reasons and potential preventive measures
Background
Worldwide growing shortages among health care staff are observed. This also holds true for medical assistants in Germany. Medical assistants mainly work in outpatient care and are the first point of contact for patients while performing clinical and administrative tasks. We sought to explore profession turnover among medical assistants, that is, in terms of the underlying decision-making process, the reasons for leaving the medical assistant profession and potential retention measures from the perspective of former medical assistants.
Methods
For this qualitative study, we conducted semi-structured telephone interviews with 20 former medical assistants between August and November 2023. Eligible for participation were medical assistants who (i) were of legal age, (ii) completed medical assistant vocational training and ii) were formerly employed as a medical assistant, but currently employed in another profession. The interviews were recorded, transcribed verbatim and content-analyzed.
Results
Former medical assistants expressed various, often interrelated reasons for leaving the profession. These were changes in priorities throughout their career (e.g., in terms of working hours and salary), a constant high workload, barriers to further training, poor career prospects, and poor interpersonal relationships particularly with supervisors, but also within the team and with patients as well as the perception of insufficient recognition by politics and society. Suggestions of former medical assistants to motivate medical assistants to stay in their profession included amongst others higher salaries, more flexible work structures, improved career prospects, and more recognition from supervisors, patients, and society.
Conclusion
Our study provides insights into the complex decision-making process underlying ultimate medical assistant profession turnover. In light of an already existing shortage of medical assistants, we suggest to further explore how the suggested interventions that aim at retention of working medical assistants can be implemented.
Journal Article
Psychosocial working conditions as determinants of concerns to have made important medical errors and possible intermediate factors of this association among medical assistants – a cohort study
Objective
We sought to examine the association of psychosocial working conditions with concerns to have made important medical errors and to identify possible intermediate factors in this relationship.
Methods
We used data from 408 medical assistants (MAs) in Germany who participated in a 4-year prospective cohort study (follow-up period: 03–05/2021). Psychosocial working conditions were assessed at baseline by the effort-reward imbalance questionnaire and by a MA-specific questionnaire with seven subscales. MAs reported at follow-up whether they are concerned to have made an important medical error throughout the last 3 months, 12 months or since baseline (yes/no). These variables were merged into a single variable (any affirmative response vs. none) for primary analyses. Potential intermediate factors measured at baseline included work engagement (i.e., vigor and dedication, assessed by the UWES), work satisfaction (COPSOQ), depression (PHQ-2), anxiety (GAD-2) and self-rated health. We ran Poisson regression models with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). Doing so, we employed the psychosocial working condition scales as continuous variables (i.e. z-scores) in the primary analyses. Potential intermediate factors were added separately to the regression models.
Results
Poor collaboration was the only working condition, which was significantly predictive of the concern of having made an important medical error (RR = 1.26, 95%CI = 1.00–1.57,
p
= 0.049). Partial intermediate factors in this association were vigor, depression and anxiety.
Conclusion
We found weak and mostly statistically non-significant associations. The only exception was poor collaboration whose association with concerns to have made an important medical error was partially explained by vigor and poor mental health.
Journal Article
“ … we were like tourists in the theatre, the interns assisted almost all procedures … ” Challenges facing the assistant medical officers training for the performance of caesarean section delivery in Tanzania
Background
Training of mid-level providers is a task-sharing strategy that has gained popularity in the recent past for addressing the critical shortage of the health workforce. In Tanzania, training of mid-level providers has existed for over five decades; however, concerns exist regarding the quality of mid-level cadres amidst the growing number of medical universities. This study sought to explore the challenges facing the Assistant Medical Officers training for the performance of Caesarean section delivery in Tanzania.
Methods
An exploratory qualitative case study was carried out in four regions to include one rural district in each of the selected regions and two AMO training colleges in Tanzania. A semi-structured interview guide was used to interview 29 key informants from the district hospitals, district management, regional management, AMO training college, and one retired AMO. Also, four focus group discussions were conducted with 35 AMO trainees.
Results
Training of AMOs in Tanzania faces many challenges. The challenges include: use of outdated and static curriculum, inadequate tutors (lack of teaching skills and experience of teaching adults), inadequate teaching infrastructure in the existence of many other trainees, including interns, and limited or lack of scholarships and sponsorship for the AMO trainees.
Conclusions
The findings of this study underscore that the challenges facing AMO training for the performance of Caesarean section delivery have the potential to negatively impact the quality of Caesarean sections performed by this cadre. A holistic approach is needed in addressing these challenges. The solutions should focus on reviewing the curriculum, deploying qualified tutors, and improving the competencies of the available tutors through continuing medical education programmes. Furthermore, the government in collaboration with other stakeholders should work together to address the challenges in teaching infrastructure and providing financial support to this cadre that has continued to be the backbone of primary healthcare in Tanzania. Long-term solutions should consider deploying medical officers at the primary facilities and phasing out the performance of Caesarean section by AMOs.
Journal Article
How do patients, medical assistants and physicians accept and experience tablet-based cognitive testing by medical assistants in general practice? - A qualitative study
Background
Approximately 1.8 million people with dementia live in Germany and the number is expected to increase in the coming years. Between 360,000 and 440,000 new cases are diagnosed each year. General practitioners (GPs) are often the first point of contact for people with concerns about their memory performance or already noticed symptoms of dementia. However, structural barriers can hinder timely diagnosis by GPs, resulting in diagnoses frequently being made later in the disease’s progression. Tablet-based cognitive testing, carried out by medical assistants (MAs) in GP practices, is being tested in the iCreate feasibility study, and could facilitate detection of dementia, allowing those affected to receive timely treatment and support. However, the acceptance, user experience and perceived benefits and consequences of routine implementation of such a not established procedure remain unclear until now.
Methods
In this qualitative study, seven GPs, six MAs and eight patients were qualitatively interviewed regarding the acceptance, user experience of the tablet-based procedure and its implications for GP care. Semi-structured interviews were conducted using newly developed guidelines, recorded, transcribed and analysed according to Kuckartz and Rädiker using MAXQDA.
Results
All respondent groups had a positive perception of the digital testing in GP practices. Interviewed MAs welcomed the new responsibilities, and patients gladly accepted the opportunity of cognitive assessment in response to their memory concerns. GPs supported delegating additional tasks to MAs. Patients found the digital testing tasks feasible to complete on the tablet and MAs also had positive experiences using the tablet as test administrators. All groups can generally envision a long-term implementation of the tests in practice, but also noted possible barriers, like the need for additional communication with specialists, limited time resources, and currently insufficient remuneration of cognitive testing.
Conclusions
The positive user experience and high acceptance of participants indicate that tablet-based cognitive testing in GP settings can be highly feasible and can thus lead to indicated specialist referrals. Consequently, the management of patients exhibiting dementia symptoms should increasingly commence in GP practices, receive adequate funding, and occur in close collaboration with other specialized disciplines.
Journal Article
Pathologists' Assistants in Nontraditional Roles: Uncovering the Hidden Value in Your Laboratory
Pathologists' assistants (PathAs) have been involved in the traditional roles of macroscopic examination (\"grossing\"), frozen sections, and autopsy since the profession was developed in the 1970s as a response to the perceived workforce shortage in pathology. Additionally, PathAs are well suited for nontraditional roles in the laboratory, but are often underused in these roles because a PathA's value is easier to see in traditional roles.
To describe the nontraditional roles PathAs are involved in and how PathAs in these roles bring value to pathologists, patients, and health care organizations.
Literature about PathAs was reviewed, and interviews with pathologists and PathAs in nontraditional roles were conducted.
PathAs are capable of handling a wide range of nontraditional roles in the pathology laboratory. Using PathAs to the full extent of their knowledge, skills, and interests will bring value to pathology practices, PathAs, organizations, and patients through increased quality of care, saved pathologist time, higher revenues, and improved department reputation. Using PathAs in these roles also has the potential to evolve pathology practices and the PathA profession.
Journal Article
Time-motion study in primary health care in moldova: How do family doctors and medical assistants spend their work time?
Despite efforts to strengthen primary health care, Moldova faces continues challenges related to health personnel shortages and distribution disparities, resulting in high workloads. To better understand the current situation, we sought to assess the work-time allocation of family doctors and medical assistants in primary health care centers in Moldova.
An observational, cross-sectional study was conducted to investigate health personnel's time allocated to activity categories, the number and duration of consultations for different health conditions, and the reasons for patient's visits in nine primary health centers in Moldova. 24 family doctors and 24 medical assistants were observed for five consecutive working days, covering in total 233 workdays and 4,916 consultations.
Family doctors used 49.2% of their time on direct patient care, 20.4% on administrative tasks and 9.8% on outreach activities. Medical assistants spent 33.6% on administration tasks, 30.9% on direct patient care and 13.6% on outreach activities. Of their direct patient care time, family doctors and medical assistants used 49.8% and 51.7%, respectively, on non-communicable disease consultations. The median duration of doctors' consultations was 8.55 minutes, whereas medical assistants' consultations lasted 5.65 minutes. Hypertensive disease and pediatric visits were the most frequent and time-consuming consultations. Health personnel contracted for 1.5 full-time equivalents worked over 10 hours per week shorter than required by their working contracts.
Family doctors used nearly half of their work time on direct patient care, while medical assistants spent less than one third, with administrative tasks taking up most of medical assistants' time. Consultation durations were short for both cadres, especially among medical assistants, reflecting the high workload in primary health care in Moldova. Additionally, health personnel contracted for 1.5 full-time equivalents worked consistently fewer hours than required by their contracts, indicating this system does not improve patient access or resolve personnel shortages.
Journal Article