How must Doctors supervise Medical Assistants?

Your primary purpose as a medical assistant is to facilitate the smooth and efficient operation of the front and back areas of a medical practice, health clinic or medical facility where you work. Specific duties will be set forth by the doctor who hired you to match the practice’s specific needs. Almost every state has specific laws as to how doctors must supervise their staff and how their employees, including medical assistants may be utilized within their jurisdiction.

The medical assistant’s scope of practice is limited to what the law allows for specific education, experience and specific demonstrated competencies. Each jurisdiction has laws, licensing bodies, and regulations that describe requirements for education and training and define the scope of practice of health professionals and workers.

In a nutshell: The Medical Practice Act and the State Board of Medical Examiners govern the practice of medicine to protect the health, safety and well being of citizens in the United States. They oversee and regulate licensing, renewals, laws and rules directed at various segments of the health care industry and monitor adherence to applicable statutes, regulations and requirements for those who practice medicine within their state. These boards have ruled that physicians are accountable for the actions of hired staff, especially medical assistants under their employ and must be present and able to immediately respond to any unforeseen situations that may arise when direct patient care is provided under their supervision.

regulatory authority State Medical Board

What does this mean for the medical assistant?

It means that while laws and regulations may change from state to state, and doctors have their own expectations, the medical assistant must serve in an assisting role to the doctor ONLY and is not authorized to give any kind of independent medical advice, independently triage patients, nor practice the art of medicine in any form or fashion, whether they are certified, or not. All medical assistants, regardless of their amount of education, training, experience must realize that they are subject to laws and limitations and can function only within their scope of practice at the workplace.

1.) Direct Supervision
Direct supervision requires the physical presence of the supervising doctor in the office before, during and after the administration of medications, healthcare procedures, application of therapeutic modalities, and any services provided directly to a patient. Any disregard and transgressions of this law will be taken very seriously and may have SERIOUS consequences.

2.) Proper Identification
Medical assistants, who provide services that involve direct contact with the public (e.g. patients and clients) must properly introduce and identify themselves as such, regardless whether they were trained on the job, or certified, or registered. To avoid confusion they must clearly state their name and job title when rooming a patient: “Hello, I am your medical assistant, my name is Marcy,” and wear a name badge to avoid being mistaken as a nurse, doctor, or other licensed health care professional. Allowing patients to address them as nurse is never acceptable! Whenever a medical assistant is mistaken for a RN or LPN they should be quick to politely correct the patient by responding: “I am not a nurse, I am the doctor’s medical assistant.”

3.) Careful Documentation
Along with proper identification and direct supervision comes complete and careful record keeping. Complete and careful record keeping is critical. In your role as a medical assistant each aspect of a patient encounter, whether directly face-to-face, or over the phone, should be carefully documented to protect yourself, your employer and also the patient: ask about personal and family histories, allergies to medications, or latex, medications administered and prescribed, physical exam findings (such as vital signs), imaging and lab test results, discussions with patients, including specific questions and responses and procedures performed during course of the visit. If it is an emergency call, do not place the patient on hold, but keep him/her on the line. Immediately instruct another staff member to call 911 from another line if necessary and also notify the doctor. All this should go in the patient’s record, along with the date and initialed by the doctor, nurse, or medical assistant who recorded the information into the chart. REMEMBER: if it isn’t documented it didn’t happen! Everything must be documented.

5.) Accuracy
Taking patient measurements and vital signs is a fundamental skill every medical assistant must competently and correctly handle. They must know the normal value ranges and the proper techniques for the procedure. If the medical assistant has a difficult time obtaining an accurate reading or measurement he/she must reach out to the supervising nurse or a more experienced co-worker. Any abnormal findings must be charted, verified and IMMEDIATELY reported to the doctor, e.g. an abnormally high pulse or blood pressure reading, as this could be an urgent situation or emergency.

5.) Controlled Substances
It has been asked whether a medical assistant can be entrusted with the key to the controlled substances locker. This decision is left up to the discretion of the supervising physician. As an integral part of the medical office and health care team medical assistants must practice consistent with legal standards and state regulations that apply.

Where can I go for more answers?

A good place to start asking questions regarding the medical assistant’s scope of practice is the State Board of Medical Examiners. Nationally recognized credentialing bodies such as the American Association for Medical Assistants (AAMA), American Medical Technologists (AMT), or National Healthcareer Association (NHA) may further be of assistance to define the role of the medical assistant.

Guidance and Information:

State Medical Board/Board of Medical Examiners
The State Medical Board may investigate, assess and handle certain questions or concerns about a medical practice, doctors and their medical assistants.

State Department of Public Health
Contact your local Health department.

State Board of Nursing/Nursing Department
The State Board of Nursing establishes rules and regulations for the licensure and practice of professional and practical nursing and may also include rules regarding medical assistants.

Professional Membership and Certification Bodies
Certified medical assistants may also receive guidance regarding national guidelines and scope of practice from their professional association and certifying body’s local chapter. American Medical Technologists (AMT) maintains a list of the Medical Assistant’s Lawful Scope of Practice, published in AMT Events March 2003 and a MA Task List that includes various tasks that medical assistants may perform.

Additional resources may be found in professional literature, medical assistant textbooks and and continuing education publications.

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