Expanding the roles of medical assistants: who does what in primary care?

Adult primary care in the United States faces a dilemma. Many patients report poor access to their primary care clinician. Yet the growing demand for primary care leads to high levels of clinician burnout. A commonly voiced solution is to increase the numbers of adult primary care clinicians—physicians, nurse practitioners, and physician assistants. However, most workforce projections find that there will not be enough clinicians to meet the increasing demand.1 At the same time, many primary care activities do not require a clinician’s expertise, creating dissatisfied practitioners working well below their skill level. To meet the demand for primary care and to improve the work life of clinicians, it is sensible to redistribute responsibilities to other members of the primary care team. Some primary care practices expand the roles of nurses, pharmacists, social workers, and behavioral health professionals to improve patient accesswithout further stressing clinicians. Many primary care practices, however, do not have nurses, pharmacists, or social workers. The clinical workforce in many practices consistsofcliniciansand low-paidunlicensedstaff, inparticularmedical assistants.According to theBureauofLabor Statistics,2 themedian salary formedical assistants in 2012was $29 370 comparedwith $65 470 for registered nurses. To utilize the staff that actually exists in mostpractices, clinicians shouldconsiderexpanding the roles of medical assistants.