Labor is the single largest expense in urgent care operations. Rather than hire more expensive clinicians, urgent care startups should adopt a lean staffing model that optimizes the training of medical assistants (MAs) so they can perform both clinical and clerical duties. This kind of medical assistant-heavy staffing model can help keep labor costs in check so a new urgent care center doesn’t blow its budget on staffing expenses before its business is financially viable.
The Urgent Care Staffing Model
Many urgent care centers run into financial trouble because they follow hospital system staffing models that employ specialized labor for each task, such as registered nurses for medication distribution, RTs for x-rays and lab technicians/phlebotomists for blood draws. The problem with this staffing model is that many of these specialized tasks are only needed a few times a day in the urgent care setting, so hiring for these positions creates unnecessary spikes in labor costs.
This is why the position of medical assistant aligns so well with the urgent care model. Depending on your state laws, a medical assistant with the proper training and certifications can perform many of the clinical functions typically completed by a registered nurse, providing urgent care startups with significant cost-savings. According to the Urgent Care Association of America’s 2016 Benchmarking Survey, the average hourly pay of an RN was $25.68 compared to $14.86 an hour for an MA. The reality is that RNs are more highly paid clinicians than are actually required in the urgent care setting. And RNs agree; they turn over pretty quickly in pursuit of higher-paying positions in long-term care or nurse management, or they pursue advanced credentials, such as nurse practitioner or nurse doctorate.
Medical Assistant Clinical Scope of Practice
There is no national standard of education or government regulation defining what clinical functions a medical assistant can or cannot perform by law. Each state sets its own laws, so it’s critical that you familiarize yourself with your state’s laws. However, in all states, the licensed physician is legally and professionally responsible for the actions of the medical assistant. Medical assistants essentially act as auxiliaries to physicians. While they are not licensed, they practice under the license of their delegating physician. However, under no circumstances can a medical assistant be presented as a licensed practitioner, and any tasks delegated to the medical assistant must be within the licensed physician’s authority to perform.
Medical assistants typically take patient vital signs, explain and set the expectations for the office visit, and prep the patient for the exam. Properly trained and certified medical assistants can also take on some clinical duties, such as blood draws; operating the x-ray machine; assisting with medical exams; removing sutures; changing dressings; administering medications, vaccines and immunizations; and reporting the provider’s direction on lab results and recommendations to patients. In all states, MA’s are not allowed to provide medical advice without a provider’s direction. They can also work the front desk by helping with clerical, administrative and patient registration tasks.
Ultimately, the scope of clinical tasks that states allow physicians to delegate to medical assistants is quite expansive, making an MA-heavy staffing model a no-brainer.
Physician Resistance to Medical Assistants
One of major barriers to the medical assistant staffing model is physician resistance. Many physicians who get into urgent care have emergency department backgrounds, where they are used to working with nurses. In the ED, nurses tend to manage themselves, while medical assistants require active management from physicians. Coupled with the fact that physicians are liable for the medical assistant’s mistakes, many physicians are resistant to the idea of a medical assistant staffing model.
However, there is no denying the financial benefits to this staffing model, so physicians should keep an open mind about working with medical assistants. Establishing well-defined protocols and directions in advance will give medical assistants structure on how to approach and prioritize clinical and administrative tasks. Clearly communicating the medical assistants’ roles and responsibilities to the care team will take the guesswork out of what the MA should be doing at any given time, and periodically sitting down with the medical assistants to talk about work quality and overall performance will help them start to work more independently.
It may seem like a lot of work up front, but it’s worth the investment. Well-trained medical assistants can perform most clinical tasks in most states, so by forgoing higher paid clinicians such as RNs and moving to a medical assistant staffing model, your urgent care startup can realize tens of thousands of dollars in annual labor cost savings.