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This entry is the fifth in a series on health professionals who work in the author’s primary care clinic.
When Terri Egan graduated from high school in 1974, she was curious about health care so she jumped right into a job as a medical assistant. Thirty-six years later, she has made a career out of training young medical assistants to follow in her footsteps and to eventually outpace her.
For decades, medical assistants have managed many of the routine clinical and administrative tasks in outpatient clinics. Training programs take a few months to years and prepare students for tasks like scheduling appointments, measuring vital signs, performing EKGs, and drawing blood, but many of the estimated 523,260 MAs working as of 2010 take on more duties as their comfort level and colleagues allow.
For most, medical assisting is a transitional career - either a re-entry point into the working world after raising kids or a stepping stone to more training. Terri attended a year-long medical assistant training program at the Carnegie Institute in Boston, then stayed on to work at the Cambridge clinic where she’d done her internship. After a few years of work as an MA, she had picked up a few extra skills and started nursing school at Boston’s Laboure College. After six months, her mother’s illness and a budding relationship intervened, and Terri dropped out to return to work as an MA.
In her subsequent jobs at small practices around Boston Terri wore several hats, filling in at times as a medical secretary and office nurse. Eventually, a temp agency assigned her to Mass General’s Bulfinch Medical Group and the one-month gig lasted sixteen years. Terri gradually took on the job of training and supervising other medical assistants. She brought over MA students from Bunker Hill Community College for six week internships and helped create a handbook for trainees.
For Terri, mentorship and teaching were perhaps the most exciting parts of her job. “It’s like taking a sculpture, clay or whatever -making something into how you’d want it to be,” she says. The ideal MA listens well and is a good listener, inquisitive, adaptable, and eager to better herself, she felt. If a student lived up to those expectations, Terri would hire her into the practice.
Medical Assistant Karen Esty was one such student, though she wouldn’t have predicted it about herself. “I wasn’t pushed educationally by my parents,” she tells me. Their goal for her “was to graduate high school and that’s what I did.” She had been drawn to health care after watching her brother survive a brain tumor, but “didn’t think I could be a nurse because I couldn’t deal with the blood and gore.” She tried out occupational therapy for a while, then worked a few odd jobs before an eight year stint at the New Balance corporate office. When she was laid off, she decided that this was her chance to explore health care and looked into training programs that wouldn’t outlast her unemployment benefits. Though she “wasn’t thrilled” about the medical assistant job description or salary, she discovered that she was eligible for free tuition and her decision was made.
From January to June of that year, Karen took courses on topics like medical terminology and EKGs. She met Terri during her subsequent internship at Bulfinch Medical Group and was hired full time. Both trainer and trainee found that good communication between MAs and other providers was lost in the bustle of the busy practice. They felt dismissed by some doctors who snatched charts out of their hands in irritation and didn’t trust them to measure blood pressures. “It’s not rocket science, but it takes a certain personality to deal with people,” Karen says. It’s “a very demanding job and sometimes MAs don’t get the respect they deserve.” So when one of the Bulfinch doctors asked Terri to help start a clinical practice with an emphasis on teamwork, she quickly agreed and brought Karen with her to the Ambulatory Practice of the Future (APF).
At APF, Terri handles many of the day to day operations, like ordering supplies and arranging for lab specimens to be picked up. As part of our clinical team, she and Karen bring patients into rooms and begin the visits with questions on vaccines and seatbelts. They draw blood, set up referrals, and act as a liaison in many ways between patients and the rest of the team. "What’s great is I feel that I’m valued for having a brain even though I may not have a ton of medical training,” Karen says.
But there’s plenty of room for improvement. “I like to see medical assisting especially at MGH change a lot in how [MAs] are treated, to get them more involved,” says Terri. “MAs have to show that they’re responsible and that they can do the job.” At APF, for example, they might triage phone calls from patients and administer shots, lightening the workload for our nurses.
The Bureau of Labor Statistics predicts that between 2010 and 2020, the number of MAs in the United States will grow by 31%. Among some innovators in health care delivery, MAs are seen as under-utilized members of the health care team with a growing role in smoothing out office workflow and improving patient satisfaction. One study found that having MAs call medically complex patients after hospital discharge decreased the likelihood of readmission to the hospital. Another showed better health outcomes and lower costs when MAs taught patients to manage their diabetes.
But even if many MAs are being asked to take on more responsibility, their salaries haven’t reflected it, Terri says. In 2010, the average hourly rate was $14.31 and this number hasn’t changed much. This may represent an opportunity to cut health care costs, but it’s also a deterrent for would-be or current MAs. It’s one of the reasons Terri encourages her mentees to get further formal training, though she herself is a lifer at the job. And in fact, Karen now splits her time between medical assisting, waitressing at a bar in Dorchester, and taking nursing school prerequisite classes. After spending more time with patients, she’s found that she can handle the blood and gore after all.
The author is solely responsible for the content.
About the authorIshani Ganguli, MD, is a journalist and a second-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her More »
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