Variations in medical assistant to primary care clinician staffing ratios may reflect differences in practice ownership and organizational culture

Background and goal: Medical assistants (MAs) are among the fastest growing occupations within the U.S. primary care workforce, and many practices have expanded the roles and caregiving responsibilities of primary care MAs. However, little is known about organizational factors associated with MA support levels for primary care clinicians (PCCs). 

Study Approach: This study analyzed the current ratio of medical assistants (MAs) to primary care clinicians based on responses to the second National Survey of Healthcare Organizations and Systems (NSHOS II), a 52-question survey of a nationally representative sample of adult primary care physician practices. Practice characteristics such as practice ownership (independent, group-owned, system-owned) and aspects of organizational culture (e.g., practice goals and values) associated with MA to PCC staffing ratios were taken into consideration in the analysis.

Results: Of 1,252 responding practices, most (56.6%) had ratios of 1 MA per PCC, while only 11.4% had ratios of 2 or more MAs per PCC; 27.6% had ratios of less than one-to-one, and 4.3% of practices did not employ MAs. Independent practices, medical group–owned practices, and Federally Qualified Health Centers (FQHCs) were more likely to have ratios of 2 or more MAs per PCC than practices owned by health care systems. In terms of organizational culture, innovation-oriented practices were more likely to have staffing ratios of 2 or more MAs per PCC. Low MA staffing levels were not associated with higher levels of staffing of nurses, physician assistants, and nurse practitioners.

Why It Matters: Health-system–owned practices are less likely to be adequately staffed with MAs than practices with other organizational structures. Inadequate MA staffing negatively affects patient care and may also contribute to physician burnout. Policy makers and insurance companies might consider financial incentives to promote adequate staffing.

Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios

Hector P. Rodriguez, PhD, MPH, et al

School of Public Health, University of California, Berkeley, California

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