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Team-based primary care: The medical assistant perspective

Sheridan, Bethany; Chien, Alyna T.; Peters, Antoinette S.; Rosenthal, Meredith B.; Brooks, Joanna Veazey; Singer, Sara J.

doi: 10.1097/HMR.0000000000000136

Background: Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs’ traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs.

Purposes: The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences.

Methodology/Approach: In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction.

Results: Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged.

Conclusion: Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels.

Practice Implications: To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.

Bethany Sheridan, BA, is Doctoral Student in Health Policy/Management, Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts, and Harvard Business School, Boston, Massachusetts. E-mail:

Alyna T. Chien, MD, MS, is Assistant Professor of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts.

Antoinette S. Peters, PhD, is Associate Professor of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Institute, Boston, Massachusetts.

Meredith B. Rosenthal, PhD, is Professor of Health Economics and Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Joanna Veazey Brooks, MBE, PhD, is Assistant Professor of Health Policy and Management, University of Kansas School of Medicine.

Sara J. Singer, MBA, PhD, is Associate Professor of Healthcare Management and Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

This study was approved by the Institutional Review Board at the Harvard T.H. Chan School of Public Health. A portion of this work was presented at the 2015 Society of General Internal Medicine meeting, the 2015 Academy Health meeting titled “The Medical Assistant Experience with Team-Based Care: A Qualitative Study,” the 2016 Organization Theory in Health Care Conference, and the 2016 Academy of Management Annual Research Meeting. Funding for the AIC initiative and this research came from the Harvard Medical School Center for Primary Care. The first author was supported through a doctoral fellowship from the Harvard Business School. No additional funding was provided for this study.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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