Being "low on the totem pole": What makes work worthwhile for medical assistants in an era of primary care transformation

Alden Yuanhong Lai*, Bram P.I. Fleuren, Jennifer Larkin, Lynda Gruenewald-Schmitz, Christina T Yuan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Primary care is undergoing a transformation to become increasingly team-based and multidisciplinary. The medical assistant (MA) is considered a core occupation in the primary care workforce, yet existing studies suggest problematic rates and costs of MA turnover.

PURPOSE: We investigated what MAs perceive their occupation to be like and what they value in it to understand how to promote sustainable employability, a concept that is concerned with an employee's ability to function and remain in their job in the long term.

APPROACH: We used a case of a large, integrated health system in the United States that practices team-based care and has an MA career development program. We conducted semistructured interviews with 16 MAs in this system and performed an inductive analysis of themes.

RESULTS: Our analysis revealed four themes on what MAs value at work: (a) using clinical competence, (b) being a multiskilled resource for clinic operations, (c) building meaningful relationships with patients and coworkers, and (d) being recognized for occupational contributions. MAs perceived scope-of-practice regulations as limiting their use of clinical competence. They also perceived task similarity with nurses in the primary care setting and expressed a relative lack of performance recognition.

CONCLUSION: Some of the practice changes that enable primary care transformation may hinder MAs' ability to attain their work values. Extant views on sustainable employability assume a high bar for intrinsic values but are limited when applied to low-wage health care workers in team-based environments.

PRACTICE IMPLICATIONS: Efforts to effectively employ and retain MAs should consider proactive communications on scope-of-practice regulations, work redesign to emphasize clinical competence, and the establishment of greater recognition and respect among MAs and nurses.

Original languageEnglish
Pages (from-to)340-349
Number of pages10
JournalHealth Care Management Review
Issue number4
Early online date4 Apr 2022
Publication statusPublished - 1 Oct 2022


  • Health workforce
  • medical assistant
  • primary care
  • sustainable employability
  • turnover
  • Medical assistant
  • Primary care
  • Sustainable employability
  • Turnover

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