Medical assistants are unlicensed individuals who perform non-invasive routine technical support services under the supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife in a medical office or clinic setting without the need of receiving a certification. The supervisor must be on the premises in order for the medical assistant to perform non-invasive technical support services.
A medical assistant gains experience by training in one of two ways:
- Per Title 16 of the California Code of Regulations section 1366.3(a)(1), training under a licensed physician or podiatrist, who shall ascertain the proficiency of the medical assistant; or under a registered nurse, licensed vocational nurse, physician assistant, or a qualified medical assistant acting under the direction of a licensed physician or podiatrist who shall be responsible for determining the content of the training and proficiency of the medical assistant except that training to administer medication by inhalation shall be provided by a licensed physician or respiratory care practitioner; or
- Per Title 16 of the California Code of Regulations section 1366.3 (a)(2), in a secondary, postsecondary, or adult education program in a public school authorized by the Department of Education, in a community college program provided for in Part 48 of Division 7 of the Education Code, or a postsecondary institution accredited by an accreditation agency recognized by the United States Department of Education or approved by the Bureau for Private Postsecondary Education under Sections 94130 or 94311 of the Education Code. A licensed physician or podiatrist shall serve as advisor to the medical assistant training program. The instructor in a public school setting shall possess a valid teaching credential issued by the Commission on Teacher Credentialing. The instructor in a private postsecondary institution shall meet the requirements of Sections 94310 and 94311 of the Education Code and any regulations adopted pursuant to those sections.
"Qualified" Medical Assistants
Qualified medical assistants, who are sometimes used for the purpose of initial training or teaching, must meet specific qualifications and pass an examination given by a certifying organization in order to obtain certification as a qualified medical assistant.
Per Title 16 of the California Code of Regulations section 1366.3 (c)(1)(2)(3), a “qualified medical assistant” is a medical assistant who:
- Is certified by a medical assistant certifying organization approved by the Board (see below for list of Board approved medical assistant certifying organizations);
- Holds a credential to teach in a medical assistant training program at a community college; or
- Is authorized to teach medical assistants in a private postsecondary institution accredited by an accreditation agency recognized by the United States Department of Health or approved by the Bureau for Private Postsecondary Education.
A list of "Frequently Asked Questions" addressing the appropriate training, supervision, and scope of practice issues, is available to assist members of the public and profession to understand the role of the medical assistant within the health care system.
A copy of the Business and Professions Code, the Health and Safety Code, and the California Code of Regulations, relating to the scope of practice of medical assistants in the State of California, may be obtained below.
Board Approved Medical Assistant Certifying Organizations
Is Your Medical Assistant Practicing Beyond their Scope of Training?
The Medical Board receives numerous inquiries concerning the use of medical assistants in a physician's office. (By law, a medical assistant may not be employed for inpatient care in a licensed general acute care hospital.)
Medical assistants are unlicensed, and may only perform basic administrative, clerical and technical supportive services as permitted by law. An unlicensed person may not diagnose or treat or perform any task that is invasive or requires assessment. The responsibility for the appropriate use of unlicensed persons in health care delivery rests with the physician.
The classification of medical assistant is defined under the provisions of the Medical Practice Act (Business and Professions Code sections 2069-2071) as a person who may be unlicensed who performs basic administrative, clerical, and technical supportive services under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife.
Under the law, "technical supportive services" are simple, routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. "Supervision" is defined to require the licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife to be physically present in the treatment facility during the performance of those procedures.
Prior to performing technical supportive services, a medical assistant shall receive training by either (1) a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife or (2) an instructor in an approved school program to assure the medical assistant's competence in performing a service at the appropriate standard of care.
A medical assistant who has completed the minimum training prescribed by regulation may administer medication by intradermal, subcutaneous, or intramuscular injections, perform skin tests, and other technical supportive services upon the specific authorization and supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife.
"Specific authorization" means a specific written order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed on a patient, which shall be placed in the patient's medical record; or a standing order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed, the duration of which shall be consistent with accepted medical practice. A notation of the standing order shall be placed in the patient's medical record.
Other technical supportive services which a medical assistant may perform have been established by regulation and include: applying and removing bandages and dressings, removing sutures, performing ear lavage, preparing patients for examinations, and shaving and disinfecting treatment sites. A medical assistant may also hand patients properly-labeled and pre-packaged prescriptions drugs (excluding controlled substances) that have been ordered by a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. The properly-labeled and pre-packaged prescription drug must have the patient’s name affixed to the package, and the physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife must verify it is the correct medication and dosage for that specific patient and provide the appropriate patient consultation regarding use of the drug prior to the medical assistant handing medication to a patient. The regulations governing medical assistants can be found in Title 16, California Code of Regulations, sections 1366-1366.4. Medical assistants who have completed the minimum training prescribed by regulation may draw blood.
Medical assistants are not allowed to perform such invasive procedures as:
- placing the needle or starting and disconnecting the infusion tube of an IV.
- administering medications or injections into the IV line.
- charting the pupillary responses.
- inserting a urine catheter.
- independently performing telephone triage.
- injecting collagen.
- using lasers to remove hair, wrinkles, scars, moles or other blemishes.
- administering chemotherapy.
Medical assistants may not interpret the results of skin tests, although they may measure and describe the test reaction and make a record in the patient's chart.
In summary, medical assistants are not licensed, and it is not legal to use them to replace highly trained, licensed professionals. The medical assistant is present to assist and perform basic supportive services in the physician's office.
Those duties must be appropriate with the medical assistant's required training.
What can medical assistants (MAs) do and not do?
Medical assistants (MAs) have a narrow list of things they can do for patients or a physician in a doctor’s office. It’s often difficult to know what’s allowed, because there are not strong laws regarding medical assistants in place.
In fact, most MAs learn their skills on the job. They’ve only recently started earning medical assisting certifications and/or getting certified with national agencies or community colleges.
But recently, there have been some U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) posts and even a complaint filed in New Jersey regarding the use of an MA and the patient perception of what an MA is and what they are legally able to do. Many physician practices refer to their back-office staff as “nurses.” This general term can range from an actual Registered Nurse (RN) to an NP (Nurse Practitioner) to an APP (Advanced Practice Provider). But as noted, the term has also been used to refer to the physician’s back-office ancillary staff and MAs as well – that is an incorrect title, and can give a patient a false impression that they are working with a medical decision-making professional. They are not.
There are no specific federal rules for MAs, and it is imperative that practices read up on their state statues before undertaking any task about which they are unsure. Each state has different rules.
That’s why it’s important to know your medical assisting scope of practice.
The profession as a whole is lacking a unified scope of practice.
Medical Assistants and Delegation
Whenever a medical assistant performs a task, he or she is doing so under a doctor’s supervision. The doctor assumes responsibility for whatever the medical assistant does.
But there’s a gray area that can leave medical assistants open to litigation.
Doctors can tell a medical assistant to do anything, but if the doctor is out of line, and telling him or her to do something outside his or her medical assisting scope of practice, then they may be liable for doing something that they are not qualified to do.
Many states have in their laws that a medical assistant can perform duties they are adequately trained to perform, and are not prohibited from performing, under state medical or nursing laws.
As a medical assistant, you need to make sure that you understand what state nursing law reserves for nurses. Nurses can delegate certain duties to medical assistants, but some duties must stay strictly with the nurse.
What Medical Assistants Can Do
Medical assistants can perform certain basic tasks without any supervision from a doctor or nurse. These include the following:
- Prepare medical records;
- Maintain patient charts;
- Order supplies;
- Maintain medical office equipment;
- Manage money accounts of patients; and
- Schedule appointments.
They can also prepare instruments for examination, prepare exam rooms, and record vital signs. Assisting the doctor during procedures and minor surgical interventions may also be within the medical assisting scope of practice, but again, check with your state. In California, for example, an MA cannot assist with minor procedures, but in Texas, they can, on a limited basis.
Medical assistants can collect specimens, such as urine, blood, or sputum, for lab tests, and perform STAT screenings, under the supervision of a physician or NPP, not independently. They can relay questions from a patient to a doctor by phone, and can transcribe dictated medical documents for the doctor.
Medical assistants can also relay lab test results, but can’t provide an interpretation of them. In some states, they can even start an intravenous line.
What Medical Assistants Can’t Do
There are a few things that medical assistants can definitely not do.
They cannot treat or diagnose patients. They can educate patients about a diagnosis a doctor has given, or perform a prescribed treatment, but cannot treat or diagnose on their own.
Medical assistants also cannot assess, plan for, or evaluate a patient or their care. A doctor or nurse has to examine a patient to determine the plan of care for them.
Medical assistants cannot interpret test results or advise a patient about their medical condition in any way.
Medical assistants also cannot give IV medications or administer anesthetic medications for the purpose of rendering a patient unconscious.
Prescribing and refilling medications independently is not within the scope of practice either, and they cannot perform physical therapy, except in an assisting role.
Medical assistants cannot perform any procedure, technique, or treatment that would constitute the practice of medicine.
Every state is different, so check with your state board of medicine to determine what your medical assisting scope of practice is. For instance, in Connecticut, medical assistants are not allowed to perform X-rays or give medication by any route, including oxygen or injections.
In Maine, a doctor must be a reasonable distance away from the practicing medical assistant to help, in case anything should go wrong. Of course, if anything should go wrong, the responsibility falls on the physician.
In Nevada, a medical assistant was sued for illegally administering medications. That state is currently revising its scope-of-practice laws for medical assistants and their ability to work with medications. In New Mexico, medical assistants have to be trained to use equipment before they can be reasonably delegated the responsibility.
Even then, it cannot be invasive equipment.
As you can see, each state has its own ideas about what a medical assistant can reasonably do in their scope of practice. You are open to liability if you do not know your limitations, so do your homework and learn what your scope of practice is in your particular state.
Programming Note: To hear more on this topic, tune in to Talk Ten Tuesdays today, when Terry Fletcher will continue her guidance on MAs and their role in a physician practice.