2. The Professional Medical Assistant

INTRODUCTION TO PROFESSIONAL MEDICAL ASSISTING

Medical assisting came into existence as a career during the second half of the twentieth century. As recently as 1950, most physicians established their own practice when they completed their medical education and hospital training. A physician (almost always a man) usually saw patients and had no assistance, except possibly from his wife who answered the telephone and often did the billing.

The physician spent a large portion of each day making house calls. During a house call the physician would examine a patient with only the equipment he could carry in his medical bag. The physician’s office was often located in a room in his house or the first floor of a building, with the physician living in an apartment above. Patients who went to the physician’s office may or may not have had an appointment. They expected to wait to be seen.

In the first 20 years after World War II (before the increas­ing use of technology caused medical costs to skyrocket), a physician usually charged $2 to $5, possibly $10, for an office visit, a sum that seems small today. For some patients, however, even this small charge was more than a day’s pay. For physicians the low fee was enough because the expenses of the practice were also low. In fact, physicians rarely pressed poor patients for full payment. They always had many patients who owed them money, and it was not uncommon for patients to pay small amounts on a weekly basis for many months or even years, especially the parents of young chil­dren. Sometimes physicians would even barter by exchang­ing medical care for goods or services provided by the patient. For example, a patient might pay for his medical care by bringing the physician fresh produce from his farm.

In the past 60 years, the practice of medicine has changed dramatically. This, in turn, has changed the way in which physicians operate their medical practice. With the advent of government insurance programs, not only were office visits covered by insurance, but the medical office was also expected to complete and submit the insurance forms to receive payment. Physicians soon discovered that the cost of employing a person to complete these forms was offset by improved collections and cash flow. Gradually almost all insurance billing shifted to the health care provider.

Advances in medical science made many more diagnostic tests, laboratory tests, and treatments available and even necessary for good medical care. It made sense to have an assistant in the office to perform these tests and allow the physician to concentrate on seeing patients.

Even as laboratory and diagnostic testing has increased in amount and in complexity, so too have the administrative equipment and technology used in a physician’s office. Today there are computers, wireless electronic devices, printers, fax machines, photocopiers, intercoms, and voice­mail systems.

Physicians send claims to a number of different insur­ance companies. Many insurance plans require prior approval for certain medical procedures, referrals to special­ists, or surgical procedures. Insurance companies and gov­ernment programs prefer electronic claims filing and often make electronic payments directly into physicians’ office accounts at banks. This creates a need not only for more staff, but also for more highly trained staff.

Physicians have also almost completely stopped making house calls. Because of this, physicians need more office space. In addition, patients with more complex needs are seen in physicians’ offices, rather than the hospital emer­gency department or outpatient department. Sometimes a patient must occupy an examination or treatment room for an extended period of time, such as when an individual with asthma is receiving an inhalation treatment.

Another change that has had an impact on the medical practice involves the increase in medical litigation. Since the 1970s, physicians have practiced what has come to be called “defensive medicine.” Because of the fear of a malpractice lawsuit and the high cost of malpractice insurance, physi­cians began to perform more laboratory and diagnostic tests to rule out even the most unlikely cause of an illness.

As services expanded, physicians employed nurses to help them in their offices. This helped ease their burden of performing procedures and caring for patients, but nurses were often unable and unwilling to assist with the admin­istrative aspects of the practice. As a result, many physicians found a willing candidate and trained that person to assist first with administrative duties and then with both patient care and administrative duties. This evolved over time into what today is the medical assistant position.

In 1956, medical assistants from 15 states organized to form the American Association of Medical Assistants (AAMA). In 1978 the profession was recognized by the U.S. Department of Education. The AAMA and other organizations, especially the American Medical Technolo­gists (AMT), have worked to define professional training for the medical assistant and to provide certification for medical assistants through national examinations.

EDUCATIONAL PROGRAMS FOR MEDICAL ASSISTANTS

Initially, medical assistants received on-the-job training, but as the profession grew, formal educational programs were established. These programs vary in length from 6 months to 2 years. Medical assisting programs include theoretical and practical preparation in all aspects of the medical assist­ing profession. To maintain quality, many of these programs seek accreditation, credit, or recognition for maintaining certain standards from a regional or national organization. The two recognized accrediting agencies for medical assist­ing programs are the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in collabo­ration with the AAMA and the Accrediting Bureau of Health Education Schools (ABHES).

A medical assisting program seeking accreditation from one of these agencies must prepare a written report showing

how the educational standards of the agency are being met. After the report has been submitted, an accreditation visit is made to validate the information presented in the report. Once accreditation has been granted, graduates of the program are eligible to take either the certified medical assistant (CMA) (AAMA) or registered medical assistant (RMA) certification examination. Accredited programs must include at least 160 hours of practical work experience in a medical office or clinic, known as an externship or practicum.

CHARACTERISTICS OF MEDICAL ASSISTANTS

Medical assistants possess or develop a number of charac­teristics that make them effective in their work. Although a person’s character and personality have been shaped by heredity and environment, a medical assisting student can work to enhance the traits that are important for health care delivery. Appearance and behavior are important means of projecting competence in the medical office (Figure 2-1).

Character Traits

The most important character traits of a competent medical assistant are dependability, honesty, and tolerance. The medical assistant is an integral part of the office practice and must arrive at work on time and not take days off, except when ill or if a family emergency arises. A medical assistant must be reliable enough to organize the day’s work and be prepared for each patient interaction.

Figure 2-1 A professional appearance projects competence and increases the patient’s confidence in the medical assistant.

A medical assistant projects honesty by working within his or her “scope of practice”—that is, doing only what he or she is trained to do and being comfortable in saying “I don’t know” or “I don’t know how to” when appropriate. The medical assistant must always maintain confidentiality and behave ethically. The medical assistant must recognize that a high level of trust is an important component of high-quality patient care. Tolerance or a willingness to accept the beliefs and practices of others is an important character trait. Tolerance allows the medical assistant to work effectively with co-workers and patients from a variety of religious, ethnic, and cultural backgrounds.

Personality Traits

Certain personality traits are essential to being a successful medical assistant. A medical assistant needs to be genuinely interested in helping people. The medical assistant must be outgoing, warm and caring, and able to put the needs of others first. The ability to remain calm in challenging or difficult situations is also important.

certified medical assistant. I attended a medical assisting training program at the community college near my home. I was the first person in my family to go to college, and my family was very proud of me. After the first year (two semesters), I received a certificate in medical assisting, and I found a job in our town at a group practice specializing in obstet­rics and gynecology. My instructor encouraged me to take the CMA (AAMA) examination, and I was glad when I found out that I had passed it. I continued to take night classes so that I could get my associate’s degree. I also attend the state and local chapter meetings of the AAMA so that I can get the contact hours I need to renew my CMA (AAMA) certification.

The practice of medicine is one of the “caring profes­sions.” Each professional in the medical office needs to have a serious interest in helping people. Although the medical assistant must know how to perform the necessary admin­istrative activities effectively and efficiently, the first priority is the care of patients who visit the office.

The concepts of warmth and caring are discussed in more detail in Chapter 4, in the section on communication. For now, it is important to say that caring is a key personal­ity trait. Some aspects of caring can be learned and prac­ticed. If an individual does not have a naturally caring personality, he or she will find it much harder to learn the communication skills needed to express caring.

Figure 2-2 The patient judges the medical assistant’s professionalism when called from the waiting room.

What Would You Do? What Would You Not Do?

Case Study 1

It is a busy Monday and Beth Ann is getting ready to leave the office for her lunch break at 1:30 pm when a male physician steps out of an examination room and asks her to assist him with a Pap test and pelvic examination. Beth Ann knows that it is office policy to always have a female staff member in the examination room when a pelvic examination is done. She tells the physician that she is about to go for lunch, but she will find someone to assist him. She goes to the front and finds the receptionist at the desk checking in patients, but neither of the two other medical assistants working that day is in sight. ■

The ability to put the needs of others first is important. The medical assistant must not allow personal circum­stances to interfere with interactions with patients, col­leagues, or physicians. Remaining objective and concentrating on the situation at hand is important. The patient’s needs take precedence over the needs of the medical assistant.

The atmosphere in a medical office may change quickly from calm and orderly to rushed and somewhat disorga­nized. The medical assistant who can remain calm when things do not go as planned will be more successful than one who is thrown completely off balance by sudden changes in schedule or plans and who becomes emotionally unable to respond effectively.

Appearance

Personal appearance influences both the feelings and the behavior of the medical assistant. It also influences the way in which the patients respond to the medical assistant. Psychologists have long recognized the importance of physi­cal appearance. Important judgments are made within seconds of meeting a stranger on the basis of appearance and body language.

When the medical assistant calls a patient to come from the waiting room to the examination or treatment room, the patient immediately forms an impression of the quality of care the medical assistant—and the physician—are going to provide (Figure 2-2). A medical assistant who is neat, clean, and well groomed projects a sense of professionalism, authority, and competence. When medical assistants are courteous, they project respect for a person’s dignity. This is important because many patients feel awkward, especially when dressed in underwear and an examination gown. In the same way, anything that the patient experiences as nega­tive can result in an instant feeling of doubt in the medical assistant’s ability. This may be generalized to a general feeling of doubt about all office staff. Patients often react negatively to rumpled clothing, dirty or worn shoes, unpleasant body odor, strong scent from perfume or per­sonal products, piercings, tattoos, or an appearance that seems too “dressed up” because of jewelry, false nails, heavy makeup, and/or elaborate hairstyle.

Most medical offices require that medical assistants wear a uniform when performing clinical tasks. The uniform worn by most medical assistants consists of scrub pants with a scrub top or short-sleeved shirt; clean, white, soft-soled shoes; and a laboratory coat or jacket as needed. The top and/or jacket may be patterned, especially in a pediatric practice. Both top and bottom should fit well without being too tight. Pants should be hemmed neatly so that they do not drag on the ground (Figure 2-3). In some practices all staff wear coordinated uniforms. When performing admin­istrative tasks, the medical assistant wears scrubs or street clothes. If street clothes are worn, they should project a businesslike appearance (Figure 2-4). Jeans, for example, are always unacceptable attire in the medical office.

Neatness and good grooming are also important for health and safety reasons. Hair carries bacteria, even if regularly washed. Medical assistants who perform clinical activities should pull their hair back and tie it, usually in a ponytail. A little bit of makeup can enhance a female medical assistant’s professional image, but too much is not appropriate for a work environment. Both female and male medical assistants should always present a businesslike appearance.

Figure 2-3 Scrub tops and pants should fit well and look professional.

Figure 2-4 Street clothes may be worn for administrative tasks in some offices.

Medical assistants should maintain scrupulous personal hygiene and avoid perfume or scented personal care prod­ucts. Many patients have allergies or respiratory problems that can be aggravated by perfumes, colognes, and scented hairspray or deodorants.

Nails should be kept relatively short and should not be polished. Long nails are not functional for keyboard work, patient care, or laboratory procedures. The Centers for Disease Control and Prevention (CDC) recommends that artificial nails not be worn and fingernails be kept 14 inch or shorter when caring for patients at high risk of acquiring infections.

Traditionally, health professionals were allowed to wear only “functional” jewelry—a wristwatch and a plain wedding band—because jewelry is not regularly washed and can become tangled in equipment. Today, most medical offices allow staff to wear small earrings that do not dangle below the earlobe and necklaces that can be tucked into the shirtfront. Wearing rings other than a wedding band is not a good idea. Rings can cut through protective gloves or scrape a patient. Also, they need to be taken off frequently for handwashing. Most medical offices do not allow visible piercings, except for the ears. It may also be a policy of the medical office that visible tattoos must be covered. Tattoos on the arms can be covered with a long-sleeved jersey worn under the scrub top or special sleeves designed specifically to cover tattoos.

Initiative and Behavioral Skills

Initiative is the ability to begin or follow through on a plan without being supervised. Initiative is an important quality for a medical assistant. The willingness to take initiative and perform tasks that need to be done without being specifi­cally instructed to do so improves the functioning of the office as a whole.

Initiative, however, does not mean taking over. The office is the physician’s place of business, and the physician expects to run it. Initiative does not mean redecorating the waiting room without asking the physician. It does mean doing things that need to be done without being asked, keeping up with current issues in practice without being told, and identifying helpful educational opportuni­ties and asking permission to attend. It also means finding useful things to do when the office is slow, such as restock­ing supplies, ordering supplies, and cleaning out cabinets and cupboards.

Office managers who supervise medical assisting stu­dents during externships relay that some medical assisting students do not take enough initiative. Taking appropriate initiative is an important skill to develop. While in school, students learn to wait for someone to tell them exactly what to do and how to do it. In the workplace the opposite quality is valued. A medical assistant is expected to figure out what needs to be done and how to help out—even during a practicum or externship.

When a medical assistant begins a practicum or a new position, he or she must learn when to jump in and perform a task without being asked. The task that is most comfort­able for the medical assistant to perform may not be the one that shows the most initiative. Medical assisting stu­dents often work on filing during slack periods because they are comfortable with the task, but it might be more impor­tant to restock examination rooms or make telephone calls to remind patients about appointments.

Initiative is a quality that employers look for in new medical assistants. An employer may even test a new employee’s initiative by showing them how to do something, such as restocking an examination room at the end of the day, and then watching to see if the new medical assistant restocks the examination room without being told.

Managing activities, tasks, and schedules efficiently requires attention and effort first as a student and later as a professional medical assistant. This concept of time management goes beyond day-to-day use of time to include planning, setting goals, prioritizing, and analyzing the effec­tiveness of how time has been used.

Getting organized requires a method to keep track of personal, class, and/or work schedules. An effective schedule includes classes, work schedules, meetings, and/or other regular activities, but it can also be helpful to schedule time for specific tasks such as homework (for a student) or pre­paring an inventory (for a working medical assistant). There is a tendency to put off tasks that seem difficult or unap­pealing. Scheduling specific times to work on these types of tasks increases the likelihood of completing them so that they are done well and on time.

For class and work activities, it may be helpful to create and update a task list. In its simplest form, this is created daily as a list of tasks to be done; each task is checked off or crossed off when it is completed. Task lists do not have to be limited to a single day, and they can be prioritized with the tasks placed in order from most important to least important. In analyzing a schedule, some unimportant activities may stand out as items that can be eliminated or reduced in frequency. It may provide a psychological boost to limit the task list to tasks that can really be completed within the allotted time span.

In order to perform many tasks efficiently, it is important to have easy access to information including names, addresses, and telephone numbers of friends, classmates, or business contacts. Reference materials needed for the job or for schoolwork should also be easily accessible.

There are many tools to facilitate effective use of time, including a personal organizer, or personal planning book, or scheduling and information management software on a smartphone or computer. Address books and reference materials can also be in book or index card format or elec­tronic format.

The willingness to adapt to change is important for medical assistants, as well as all health care workers. The pace of change within ambulatory care is fairly rapid, so it is unwise to become attached to one way of doing things. Changes in equipment, procedure, staff, and setting can occur quite frequently, but patient care needs to remain excellent. When the medical assistant approaches changes with tolerance and even enthusiasm, the office runs more smoothly. The medical assistant needs to adapt to the office setting rather than expecting the office to adapt to his or her preferences.

Finally, it is important for the medical assistant to work well with others and be a team player. Behavior that enhances patient care includes helping others, maintaining a positive attitude and not complaining, avoiding gossip, working within the established chain of command, and handling stress without losing emotional control or creating emotional scenes. Keeping perspective, accepting correc­tions or criticism without becoming defensive, and learning from mistakes are important. These behaviors facilitate working with others over the long term with a minimum of discord.

What Would You Do? What Would You Not Do?

Case Study 2

Dawn Elliot, a 48-year-old woman, brings her mother, Ruth Mitchell, who is 70 years old, to the office with complaints of vaginal bleeding. The physician asks for blood to be drawn in the office to determine if Mrs. Mitchell has anemia from blood loss. Diane, a medical assisting externship student who has been working with Mrs. Mitchell, comes to Beth Ann and says, “Can you draw the blood from my patient? She says she doesn’t want a student to draw her blood.” ■

PROFESSIONALISM

Professionalism is behavior based on a body of knowledge and ethical standards to serve the public. The particular body of knowledge is different for each profession, but ethical standards for professionals are similar.

Professionalism for Physicians

For physicians, professionalism means treating patients based on the body of scientific knowledge the physicians have accumulated, and continue to accumulate, over their working lifetime. In addition, physicians are bound by both ethical standards and legal regulations.

One source of guidance for physicians is the American Medical Association’s (AMA’s) Principles of Medical Ethics. The AMA code of ethics is reviewed and updated periodi­cally by that organization.

Other sources of professional guidance for physicians include the following:

° State and federal regulations

° Regulations of the hospital(s) to which the physicians admit patients

° Any open-panel health maintenance organizations or preferred provider organizations in which the physi­cians participate

° The national medical board of their specialty or subspecialty

Physicians may have traditionally taken guidance from Hippocrates (c. 460-377 BC). Hippocrates was an ancient Greek physician who wrote the Hippocratic Oath. The Hippocratic Oath served as a guide to good conduct for ancient physicians, and parts of it are still applicable today. Its philosophic underpinnings are still taught in medical school and adhered to by physicians, especially the key concept: “First, do no harm.”

For more information on unprofessional activities of physicians, and by extension all office staff, see Highlight on Unprofessional Conduct for a Physician.

Professionalism for Medical Assistants

The AAMA maintains a code of ethics that is similar to the AMA principles for physicians. The AMT also maintains a set of standards that define professional practice. These codes of ethics can be viewed at the websites of each organization.

Highlight on Unprofessional Conduct for a Physician

Even if they are not illegal, many activities are considered unpro­fessional for physicians, and by extension for their employees, including the following:

  • Receiving payment for referrals to other physicians, labora­tories, treatment centers, or pharmacies. Although physi­cians often make specific referrals, it is unethical for them to have arrangements to receive payments for those referrals, and especially to refuse to refer a patient unless a payment is made. This practice is sometimes called fee splitting. It is also unethical to charge a patient simply for being admit­ted to a hospital, without any other service being provided.
  • Prescribing medication or diagnostic tests for financial gain rather than because of the patient’s need for the test.
  • Pressuring patients to use pharmacies or laboratories in which the physician has a financial interest. It is also unethi­cal to prescribe medication, tests, or procedures that are not medically necessary. Billing an insurance company for unnecessary procedures is illegal.
  • Accepting gifts from pharmaceutical companies or medical equipment manufacturers or suppliers in return for promot­ing the company’s product or prescribing only the compa­ny’s drug. Physicians may accept inexpensive or educational gifts with the understanding that they have no obligation to promote the product.
  • Allowing another physician or surgeon to perform surgery without informing the patient. The patient has the right to know who is performing a procedure.
  • Failing to disclose the source of sperm used for artificial insemination (e.g., husband, sperm bank, paid donor). The physician may not substitute sperm without informing the patient.
  • Failing to practice medicine appropriately.
  • Practicing medicine under the influence of mind-altering drugs, alcohol, or any prescription medication that may impair mental function, alertness, or physical performance.
  • Allowing an unlicensed person to practice medicine.
  • Failing to order a consultation for any medical problem that is beyond a physician’s personal experience and expertise. For example, a gynecologist should not treat a patient for renal failure.
  • Withholding information about a patient’s medical care from another medical facility just because the patient has an outstanding bill.
  • Putting a patient at risk of human immunodeficiency virus (HIV) infection, or refusing to treat a patient who is HIV positive. It is considered ethical for physicians to limit their practice to certain medical specialties and to refuse to accept specific types of insurance.
  • Performing a procedure that might transmit the HIV virus to a patient if a physician or any other health care worker is HIV positive.
  • Engaging in a sexual relationship with a patient. Something inherent in the relationship between two individuals in which one is perceived to be more influential than the other puts pressure on the “weaker” party to please the more powerful party. Because this makes it difficult to determine if consent is freely given, such a relationship should never be sexual in nature. Sexual relationships between professionals and the people they serve (e.g., physician-patient, attorney­client, teacher-student) are thus considered unethical and unprofessional. ■

The medical assistant’s ethical responsibilities are to admit mistakes, stay within the personal limits of his or her training, maintain confidentiality, stay current, and uphold the honor of the profession. This may mean having to confront a co-worker who is not adhering to such principles.

Dealing with a co-worker’s inappropriate conduct is dif­ficult, especially for a new employee or if the co-worker is higher in the organizational hierarchy. We live in a society that does not like “tattletales.” On the other hand, unprofes­sional behavior in a medical office is disruptive to the concept of teamwork. Even if the unprofessional behavior does not pose an immediate threat to a patient, any behav­ior that results in people not working well together can lead to an uncomfortable or dangerous situation. The medical assistant should first discuss the situation with the co-worker by calmly and objectively describing the actions or behavior that he or she considers unprofessional. If the person does not correct the situation, it is appropriate to report the behavior to the office manager.

What Would You Do? What Would You Not Do?

Case Study 3

Before examining Ruth Mitchell, the physician asked Beth Ann to recheck her blood pressure. It was 190/100 in the right arm and 186/98 in the right arm. Beth Ann noticed that the blood pressure had been taken that day by Diane, a medical assisting externship student, who had recorded it as 130/80. Beth Ann asked Diane if she was confident about the blood pressure reading she obtained from Mrs. Mitchell. Diane said, “It was really faint, and I didn’t hear it that well, so I wrote down the same blood pressure as she had the last time she was here. I didn’t want to look incompetent. Besides, I was afraid it might affect my grade if you thought I was having trouble hearing the blood pressure.” ■

CREDENTIALS OF MEDICAL ASSISTANTS

Medical assistants usually graduate from an educational program that may vary in length from 6 months to 2 years. If the medical assistant graduates from a program accredited by CAAHEP or ABHES, he or she is eligible to take a national certification examination. Certification is a process by which an organization, often a national body, validates the credentials of an individual or a program. Certification is important for health care professionals. Certification is also important for medical assistants who live in a state that does not regulate unlicensed health professionals. When an unbiased national organization validates knowledge and skills, the employer can be sure that the medical assistant has excellent qualifications.

Two organizations provide nationally accepted certifica­tion for medical assistants: the AAMA and the AMT. In many areas, employers hire only medical assistants who have passed a certification examination. As medical assistants perform more specialized clinical tasks, employers have become increasingly concerned about validating skills and knowledge before hiring them.

Certified Medical Assistant

A CMA (AAMA) has passed the certification examination administered by the AAMA. In order to take the examina­tion, the individual must have graduated from a medical assisting program accredited by CAAHEP or ABHES or be a CMA (AAMA) recertificant.

The examination is computer-based and is administered online at testing centers. Most states have several testing locations.

Passing this examination allows a medical assistant to use the title CMA (AAMA) after his or her name on all official documents, including patient records and business cards.

Registered Medical Assistant

An RMA has passed the examination administered by the AMT. The AMT is an organization that certifies medical assistants, medical technologists, medical laboratory techni­cians, phlebotomists, and other health professionals.

In order to take the RMA examination, an individual must have (1) graduated from a medical assisting program accredited by CAAHEP or ABHES; (2) graduated from a medical assisting program that includes at least 720 hours of training in an institution that is accredited by an organi­zation approved by the U.S. Department of Education; (3) graduated from a formal medical services program of the U.S. Armed Forces; or (4) been employed full-time in the profession of medical assisting for 5 years. The AMT may also grant the credential of RMA to an applicant who has passed another approved medical assisting certification examination.

Passing this examination entitles the medical assistant to use the initials RMA after his or her name on all official documents.

Obtaining Additional Credentials

A medical assistant may need to validate other skills as a condition of employment.

Training in cardiopulmonary resuscitation (CPR) is offered directly through the American Red Cross (ARC) and the American Heart Association (AHA) and by hospitals and other health care agencies. Like other health professionals, medical assistants recertify at the health care provider level every 2 years to be sure their skills are current as required by their professional organization and/or employer. Most health care facilities require current CPR credentials.

Medical assistants may also take courses in performing first aid, hearing tests, limited x-ray examinations, or other specialized tests, depending on state law and the needs of the medical practice. In many areas, medical assisting cer­tification or registration is a valid qualification to perform phlebotomy, but some states and/or institutions require separate certification in phlebotomy. This can be obtained through the AMT, the American Society for Clinical Pathol­ogy (ASCP), or the American Society of Phlebotomy Tech­nicians. The websites of these organizations are listed at the end of the chapter.

A medical assistant who obtains experience working for a podiatrist or ophthalmologist may obtain certification as a podiatric medical assistant, certified (PMAC) or a certified ophthalmic assistant (COA).

If the medical assistant has specialized in the administra­tive area, additional credentials can be obtained, such as the certified medical administrative specialist (CMAS) from the AMT or one of the various certifications in medical coding, such as a certified coding associate (CCA), a certified coding specialist (CCS), or a certified coding specialist-physician- based (CCS-P) from the American Health Information Management Association (AHIMA). The CCS-P is a coding practitioner who specializes in coding for physicians in set­tings such as physician offices, group practices, multispe­cialty clinics, or specialty centers. Additional education may be required to obtain these credentials.

PROFESSIONAL ORGANIZATIONS

The AAMA and the AMT are professional organizations for medical assistants. For an annual membership fee, many benefits are available. Medical assisting students can join either the AAMA or the AMT for a reduced annual rate and receive member services. Membership information is available at the website for each organization.

Peer Support

Through local and national meetings and workshops, medical assistants are able to enter a network of peers with whom they can share and from whom they can learn. They can also obtain insurance at reasonable cost, professional journals, and access to other sources of information impor­tant to the profession.

Continuing Education

With the constant change in the medical field, it is not merely important but necessary to keep skills up to date, attain new skills, and obtain new information about profes­sional practices. Most health professions require a certain amount of continuing education for licensure or certifica­tion renewal. These are designed either as contact hours or continuing education units (CEUs). A CEU is a unit of participation in professional continuing education.

Medical assisting contact hours and CEUs can be obtained from educational programs that have been approved by the particular certifying agency. The AAMA validates continuing education programs given through the state and national organization. Attending meetings of pro­fessional organizations is the best way to find educational programs specifically for the needs of professional medical assistants. Home study programs are also available to obtain continuing education credit.

An individual must be recertified as a CMA (AAMA) every 5 years. This can be accomplished by retaking the certification examination or by successfully completing the required continuing education programs. Sixty points must be accumulated during the 5-year period: 10 in the admin­istrative area, 10 in the clinical area, and 10 in the general area, with 30 additional hours in any of the three categories. Of these, 30 points must be CEUs (one contact hour each) from AAMA-approved programs.

If certified after January 2006, RMAs must accumulate 30 points of continuing education every 3 years. (One contact hour is equivalent to one point.) Those who were certified before this date are expected to keep up to date with current practice, but there are no specific continuing education requirements.

Legislative Advocacy

One of the tasks of professional organizations is to monitor legislative initiatives at the state and national level that may affect the profession. In many states the profession of medical assisting is defined in state law, whereas in other states it is not. The state professional organization provides a forum to push for legislation that will advance the medical assisting profession.

Publications, Newsletters, and Websites

Both the national and state organizations provide a means for communication among professional medical assistants, including CMA Today, published by the AAMA, and the Journal of Continuing Education Topics and Issues, published by the AMT. The national organizations have state associa­tions, often with several chapters within the state. The state organizations may produce newsletters and maintain web­sites. Conferences are held annually both nationally and at the state level to enhance communication and contact among members of the profession.

ROLE OF THE MEDICAL ASSISTANT

Administrative Responsibilities

Various administrative responsibilities must be performed on a daily basis in a medical office. We like to think of a physician’s office as a place where patients receive medical treatment, but in reality much of the activity in a physician’s office involves managing the logistics of scheduling patients, preparing to provide services, and receiving payment for services. The medical assistant may be responsible for a number of these activities, although larger offices may employ specialists to perform these tasks.

  1. Scheduling appointments, both over the telephone and in person, is a primary responsibility of the medical assistant. A patient may also need to have appointments made with other medical facilities; examples include a consultation with a specialist, a diagnostic procedure, outpatient surgery, continuing therapy or rehabilitation, and a hospital admission. Some patients may need to schedule multiple appoint­ments with other facilities as the result of a single office visit. The medical assistant must learn the pro­cedure for making and documenting each type of appointment.
  2. Maintaining the medical record and filing records and reports has traditionally been one of the medical assis­tant’s roles. With the increasing use of electronic medical records, there is less actual filing in many offices, but it still may be necessary to scan paper reports and keep track of laboratory and diagnostic test results. Each patient encounter with a clinician— physician, nurse practitioner (NP), or physician assistant (PA)—is followed by documentation of the patient’s visit. Clinicians create handwritten or dic­tated patient notes, or they may enter information directly into an electronic medical record. If the dicta­tion method is used, it may be transcribed using voice recognition software or it may be sent to an outside service electronically. In this case the medical assistant prints the reports after they have been returned and files them after the physician has approved them. The medical assistant may prepare letters and other docu­ments for the physician.

Figure 2-5 Medical assistant taking a payment.

  • Every patient visit generates activities that are neces­sary for the physician to be paid for the services pro­vided. The medical assistant must know how to accept and document payments (Figure 2-5), total and enter charges, code the procedures and/or diagnostic tests performed, and enter payments received. These charges and payments are entered into the office com­puter and sometimes into various paper records, such as the day sheet, to keep track of money owed to and received by the practice. In turn, the charges are used to generate insurance claims and patient bills. In larger offices and clinics, a separate business office usually handles financial matters. Small offices often send billing information to an outside billing service. If billing is performed in the office, the medical assis­tant must be able to create patient bills and submit insurance claims.
  • On a regular basis, checks and cash need to be depos­ited into the office’s bank account. Preparing bank deposits and recording the deposits in the office’s checkbook are activities that medical assistants often perform.
  • Every business has bills to pay. These include rent (or mortgage, if the office is owned), electricity, lease pay­ments on equipment, staff salaries, and a number of other regular payments, such as liability and malprac­tice insurance. Medical assistants, or business office personnel, usually pay these bills and maintain records of these and other bills owed by the office. (Some offices have an outside bookkeeping service perform these tasks. Even in many offices that pay their own regular bills, salary is handled by an outside payroll service.)

Figure 2-6 Medical assistant preparing an examination room.

Clinical Responsibilities

Depending on the type of medical office, clinical activities may make up the bulk of the medical assistant’s responsibili­ties. The medical assistant prepares patients for examina­tion, performs diagnostic tests, performs treatments, and assists the physician with examination and treatment.

  1. Medical assistants are often asked to collect and process specimens. Some specimens are tested in the office, and others are sent to an outside laboratory.
  2. Medical assistants perform several diagnostic tests, such as electrocardiograms and respiratory testing.
  3. Medical assistants prepare patients for examination, including taking medical histories, weighing the patient, measuring vital signs, and obtaining informa­tion about the chief complaint. Having this done by a medical assistant may allow the physician to see at least one extra patient per hour.
  4. After each patient appointment, the medical assistant prepares the examination and/or treatment room for the next patient (Figure 2-6). This involves making sure there is fresh paper on the table, that the proper instruments and supplies are available for the next examination or procedure, and that the necessary equipment is available and in working order.
  5. Medical assistants help the physician with examina­tions and procedures. The medical assistant settles a patient into an examination room and positions and drapes the patient for portions of the examination. Another duty is to pass instruments and supplies to the physician during procedures. The medical assis­tant may also remove sutures and change sterile dressings. If minor surgery or sterile procedures are performed in the office, the medical assistant sets up the equipment and supplies and then assists the physi­cian as needed.
  6. Medical assistants perform treatments, including neb­ulizer treatments or application of hot and cold packs or compresses.
  7. Medical assistants prepare and administer medica­tions and immunizations. The administration of

Figure 2-7 The medical assistant uses brochures to teach a patient.

medication requires concentration and precision. All medications must be documented according to office procedure.

  • Sometimes a medical assistant also has to perform emergency care and administer first aid or assist with an office emergency. This does not happen often, but every medical assistant must be prepared.

Managing the Medical Office

The medical assistant may have many responsibilities to keep the medical office running smoothly.

  1. Operational activities involve maintaining the inven­tory of supplies. This can include everything from purchasing tongue blades and gauze to contracting with a uniform service to launder the staff’s labora­tory coats or patient gowns. It may also involve evalu­ating and recommending changes in the supplies purchased and evaluating new equipment for poten­tial purchase or lease.
  2. A second group of activities involves personnel policy and procedures. Businesses are always reviewing their policies and procedures and updating and revising them as needed. As offices move from one or two physicians and a small staff to a larger organization, policies and procedures become more important to standardize the way all employees are dealt with.
  3. Risk management is the development of policies and procedures that minimize the chances of the practice being sued by a patient or disciplined by a regulatory agency. Every physician’s office needs to have one person responsible for risk management, which involves, among other areas, the promotion of health and safety for office personnel and patients, imple­mentation of a quality control program, maintenance of proper infection control measures, fire prevention, and the proper disposal of hazardous waste and con­trolled substances.
  4. Record keeping is an important activity for the indi­vidual who manages a medical office. In addition to patient records, many other kinds of records must be kept, including office insurance records, quality control records, maintenance contracts, personnel records, and financial records.

Patient Education

Instructing patients is an important role for medical assis­tants because the medical assistant actually conveys infor­mation to the patient from the physician.

  1. The medical assistant is often responsible for educat­ing the patient about office procedures, including giving information to a new patient who is making the first appointment, as well as instructing an estab­lished patient whose circumstances have changed.
  2. The medical assistant may provide information about maintaining health to patients directly as directed by the physician or by making educational materials

available in the office. These are always reviewed by the physician before being given to patients (Figure 2-7).

  • The medical assistant may locate community resources for a patient or provide brochures from community agencies in order to improve follow-up care for a patient.

Beth Ann Wilson: I could not believe how nervous I was before I went to my externship the first day. I had worked at several jobs and even done filing at a medical office during the summer when I was in high school, but it felt totally different to know that I would be respon­sible to act like a “real” medical assistant. Fortunately, the staff members at my placement were wonderful. They let me shadow one of the medical assistants until I felt comfortable to work with patients on my own. They were also careful to expose me gradu­ally to each part of the medical office, so it didn’t get overwhelm­ing. The person who helped me the most was Cheryl, the office manager. Every day she sought me out and asked how it was going. There was one time when a physician asked me to take out a patient’s sutures, and I hadn’t even seen someone perform that procedure. I didn’t know what to say, but I told him I would find another medical assistant to help him. Then I went to Cheryl. She found someone else to perform the procedure and made sure that I had an opportunity to observe. I never could decide whether I liked checking patients in up front or assisting the physicians better, as long as I had a chance to interact with patients. It has always made me feel good to know that I am helping others. ■

EMPLOYMENT OPPORTUNITIES

According to the U.S. Department of Labor Bureau of Labor Statistics, medical assisting is projected to be one of the fastest-growing occupations in the period between 2008 and 2018. Job prospects are expected to be excellent,

MEDICAL PRACTICE and the LAW

especially for medical assistants who have completed a formal educational program. Certification may help to dis­tinguish a medical assistant who meets recognized standards from an entry-level assistant.

The majority of medical assistants work in physician’s offices. Other common places of employment include hos­pitals and offices of other health practitioners, such as chi­ropractors, podiatrists, or optometrists. Medical assistants also work in outpatient care centers, schools or other edu­cational facilities, medical laboratories, government agen­cies, employment services, and nursing care facilities.

The median annual income reported by medical assis­tants in May 2010 was $28,860, but salaries varied greatly depending on geographic location, skill level, and type of facility in which the medical assistant was employed.

The Bureau of Labor Statistics reported median annual income for medical assistants in May 2010 as follows:

Offices of physicians                                                     $30,110

General medical and surgical hospitals                        $30,770

Offices of other health practitioners                            $26,820

Outpatient care centers                                                 $30,490

The most direct route for career advancement is proba­bly to become an office, practice, or department manager. This may require additional education, especially in business administration, but often management skills can be learned mainly on the job. In order to become a medical assisting instructor, it is necessary to have an Associate in Science degree or a higher degree in a related field and to be either a CMA (AAMA) or an RMA (for an accredited medical assisting program). Clinical advancement usually requires additional training in a formal educational program preparing for a health career, such as dental hygiene, labora­tory technology, nursing, radiologic technology, or respira­tory therapy. Medical assistants are not licensed, and in most states their role is not clearly defined in the law. State medical practice laws usually allow physicians to delegate clinical tasks to qualified medical assistants under their supervision, provided that the task is not prohibited by another law. Some states do define the role of a medical assistant, sometimes related to general duties and sometimes related to specific tasks that the medical assistant is allowed to perform. In some states, medical assistants are required to register with the state before practicing as a medical assistant. Because state laws vary so greatly, a medical assisting student should always find out the legal status of a medical assistant in his or her own state or the state in which he or she intends to work after graduation.