A medical assistant can be called a doctor
Medical assistant - a changing job description
Integrated care medical assistant - a changing job description Nicole Schwänke Summary The involvement of medical assistants in control instruments such as disease, case and quality management and in operative care processes in a doctor's practice are central to quality-oriented patient care in private practice. Up-to-date training, a structured, recognized modular further training concept and the possibility of personnel development in the practices make it possible to deploy the practice staff in a supply-oriented manner to patient and practice needs and to relieve the doctor in a targeted manner. This leads to a quality improvement in outpatient care. Keywords Qualified Doctors assistants and practice managers are necessary for the quality improvement of the ambulant medical care in the german health care system The approx. 300,000 female employees in the approx. 90,000 resident medical practices are neither actively involved in change processes nor specifically noticed. In doing so, they make a decisive contribution to outpatient care. The demands on the profession and the range of tasks of a medical assistant are controversial in relation to the quality and content of the current training. In addition, there is no systematic qualification concept for this profession. The range of training opportunities is diverse, but often unstructured. Medical assistant is still a "dead end job". Vocational training situation Medical assistant is one of the most popular training occupations in Germany. In 2002, 16,705 training contracts were concluded nationwide. The currently valid training regulation for this occupation dates back to 1985. Its training content is insufficient to meet the requirements and changes in the health care system. Likewise, the complexity of a doctor's practice is not conveyed adequately and not in an action-oriented manner. The 1999 Mettin study (1) came to the conclusion that a reorganization of vocational training was urgently required. The content to be conveyed in the areas of communication, patient care, teamwork, practice organization, quality assurance, EDP, emergency medicine as well as prevention and health advice were described as deficient. In 2001, the German Medical Association commissioned the Central Institute for Statutory Health Insurance in the Federal Republic of Germany - ZI - with the necessary qualification requirements and the opinion on the specialist / 98 89 87 Summary It is important for the quality improvement of care in the ambulant medical care, that the doctors assistants are activily involved in steering instruments such as disease management, case management and quality management as well as in the organizational aspects of care. It is useful for the doctors assistant to have modern education, a well structured curriculum further vocational training and the possibility to apply the results within a system of personnel development for the doctors practice with the responsibility of the employer. In this case doctor assistant and practice manager are able to support the doctors with a step by step approach for successful implementation of the new management instruments such as disease management, quality management and general practice management. This will result in the development of a high quality patient care. Key Words Ambulant medical care, doctors assistant, education, further vocational training, patient care, disease management, case management, quality management, general practice management Introduction The professional group of medical assistants is not considered in the discussions and reform proposals on the health care system. Z. Allg. Med. 2003; 79: 553-558. © Hippokrates Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG, Stuttgart 2003 553 Determine integrated supply options Table 1: ZI study areas in need of (very) improvement (2). This investigation is intended to - In which areas do the skills and knowledge above all need to be expanded / the objective needs of doctors need to be improved? Approval in percent (N = 1580 doctors) and the requirements for the overall improvement improvement call of the medical assistant can be found out if need be. Practice organization 56.3 25.6 81.8 The results agree with dePsychosoz./Kommunik. 53.5 26.9 80.4 Competencies of the Mettin study (Table 1). Medical-technical knowledge 21.9 32.5 54.4 With these two extensive prevention 17.6 33.3 50.9 examinations for the first time practical knowledge in diagnostic 18.3 31.8 50.1 valid results are available, and therapeutic assistance that make it clear which KomTabl. 1 - ZI study, 2002 - Source: Deutsches Ärzteblatt 98, Issue 45 of November 9, 2001, page A-2928 plexity and heterogeneity the range of tasks of a medical assistant has. You also get information about the transparency of the employees' certification. This becomes visible in the distribution of tasks within a practice. the test results. Almost all of them as deficient An amendment to the training should therefore include the following areas classified as central work areas: te in a practice that is not exclusively, but rather secondary, carried out by trainees. Practice organization and practice management, as well as primarily the trained medical assistants in quality management in the areas of responsibility, e.g. B. Practice organization, medicine and prevention Practice management and prevention. The areas of communication and psychosocial competence Communication and social competence are key qualifications. In terms of content, the reorganization is now based on qualifications in patient care. such as medical assistance, patient care and communication, quality management, administration, assuming that the new training regulations for documentation and accounting but also health care come into force in 2004, it will take at least three years - i.e. summer 2007 - for the first trainees to value their health advice placed. The initial training will continue to pass a broad basic examination. The current requirements and changes in the various specialist groups and resident areas, however, require timely interfaces to various training and further education qualification diffusion of the practice employees. to enable applications in the healthcare sector. As the deficits of the current training can and didactic concept, as with the dental must, the action-oriented advanced training offers combined with guided training must be in the foreground through a structured and practice-oriented medical assistant1. This compensates for competence and practical goals. not only does the content change, but also the media. The status quo only marginally does justice to this. method of conveying content. The Mettin study, when examining the occupational title, analogous to the dental and further training opportunities, showed that the motivation to qualify medical assistants changes before specialist employees. The amended training regulations will presumably be found mainly in the personal area. The reasons mentioned were, for example: Self-esteem will come into force in mid-2004. strengthening, expanding knowledge, satisfying ambition and personal profiling. New qualification requirements Situation of further education and training due to a changed range of tasks and activities in the doctor’s practices and which may also result in a larger area of responsibility Respondents expressed. That coincides with emhaben. It can be concluded from this that not only the training experience of the professional association of doctors, content is judged to be deficient, but also advanced dentists and veterinary assistants eV - BdA - from surrounding and advanced training content, respectively the current high-quality surveys and working groups with medical assistants . Further education and training are generally 1 The amendment of the training regulations for dental assistants, primarily by medical assistants, often without a practice former dental assistant, took place in 2002 554 Z. General Med. 2003; 79: 553-558. © Hippokrates Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG, Stuttgart 2003 Integrated care context selected and self-financed. Given the known income structure, this must be classified as problematic. This clearly shows the further training problems of this occupation. If the motivation for further training lies primarily in the personal area and is not coordinated with the practical goals and the opportunities for further development in practice, qualified personnel will not be available in sufficient form. In the area of medical assistance, however, the first structured training opportunities can be found. The German Medical Association has currently issued five advanced training curricula that serve as orientation for the state medical associations and advanced training providers. These include pulmonology, dialysis, gastroenterological endoscopy, oncology and outpatient surgery (4). Further curricula such as outpatient surgery in ophthalmology and general medicine are currently being worked on. The qualification in these specialist areas is usually causally linked to the fee / service accounting. The service is only billable if the employee has completed the relevant training. The medical profession recognizes and supports the importance of medical assistance. Most of the funding for these special training courses is provided by the practice owners. However, there is a sectoral separation of the qualification options in medical practices. The main areas of responsibility in a practice are patient management on the one hand and practice management on the other. These two areas are closely linked. Practice management, however, forms the framework for patient management. Nevertheless, under the aspect of qualification, only one area, patient management, which includes medical assistance, is promoted. The reasons for this can lie in the different professional requirements between medical assistants. Practice management is to be assigned to the operational area and increasingly the primary task of the medical assistants in the management area as well. Whereby the practice owner has the leadership competence and the management function. In larger practice units in particular, management tasks are shifting towards medical assistants or practice managers. These include B. Personnel management, business administration, information management and quality management. The introduction of quality management instruments and systems in medical practices and the close connection to practice management have given this area the necessary importance. Patient-oriented and quality-enhancing care in the outpatient sector is only possible if both areas, patient and practice management, are supported and implemented by qualified staff. Another difficulty is found in the range of advanced training courses for medical assistants. There is an abundance of uncoordinated further education and training offers without a recognizable systematic qualification concept for the profession. So far, there have been two options for the further training regulated under Section 46.1 of the Vocational Training Act: the medical assistant and the practice manager (this, however, is still in a model phase). There is no nationwide regulation of the content and the formalities, as further training in the dual system is a matter for the federal states and therefore there are very different offers in the medical associations. The existing curricula of the German Medical Association are only recommendations. The further training to become a medical assistant currently has a scope of 400 hours, of which 280 hours are a compulsory part with, among other things, medicine, communication, trainer aptitude. The optional part of 120 hours can be selected depending on the chamber offer. The further training to become a medical assistant could not establish itself in the approximately 28 years of its existence (1500 participants up to 1999). The practical benefits of this additional qualification have not been adequately presented. As a result, the only way to qualify vertically in terms of advancement training is restricted. In addition, most of the medical assistants financed the further training themselves. The medical assistants can only occasionally contribute their qualifications in the practices and are also remunerated according to their services. The second possibility to qualify according to § 46.1, and this with a scope of 800 hours, is further training to become a practice manager. This corresponds to the master craftsman's certificate in craft or industry. However, the “Praxismanagerin model experiment” project - currently carried out by the Schleswig-Holstein Medical Association, accompanied by the German Medical Association, the Federal Institute for Vocational Education and the Professional Association of Doctors, Dentists and Veterinary Assistants e.V. is still in the second model phase. So far, 23 practice managers have successfully passed their exams. In terms of content, practical business management, operational accounting and finance, training of trainers, quality management, personnel management and information and communication technologies are conveyed. The aim of this model experiment is to meet the requirements in the health care system through networked systems, practice cooperations and complex tasks in the Z. Allg. Med. 2003; 79: 553-558. © Hippokrates Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG, Stuttgart 2003 555 Integrated care patient care. Whether and how the resident doctors will recognize and accept the need for a highly qualified practice manager is currently not foreseeable. Furthermore, there is a very heterogeneous training market across Germany with different offers for the professional group of medical assistants. Some state medical associations offer training and further education to practice staff. The professional association of doctors, dentists and veterinary assistants e.V. provides an extensive program for qualification with its own training center. Various training providers, management consultancies, but also the pharmaceutical industry have a wide range of offers. Table 2: Barriers to further training for medical assistants 1. The further training motivation of medical assistants is primarily in the personal area without coordination with the practical goals. 2. There is no systematic qualification concept for the professional group. 3. The continuing education offer is unstructured and for the most part without regulated qualifications. 4. The further training offers do not correspond to the current requirements in the health care system. 5. Further education and training are often financed by the medical assistants themselves. 6. The practice management offers only marginal support in the area of personnel development. 7. The area of medical assistance is supported more than the area of practice management. Influence of medical assistants on the implementation and sustainability of control instruments such as quality management, disease management and case management New control instruments are permeating the outpatient healthcare system. Disease management programs, guidelines, quality management, case management change the framework conditions and the range of tasks of the practice team. The new instruments cooperate with two main tasks - patient management and practice management. Practice management is closely linked to quality management. Many of the quality management tools, e.g. B. from EN ISO 9000: 2000 or EFQM, are already taken for granted working techniques in well-structured practices with qualified employees. However, these techniques are applied in fragments and not in practice in an overall system. The introduction of quality management requires a change in the thinking of all those involved. All of the practical tasks are structured and assigned clear responsibilities. The managerial tasks of the practice owner are decisive for the implementation of the system. For the first time, many practices will work together on their individual practice goals. Without the responsibility of the management and the shared responsibility of the entire team, no quality management system can be introduced. Central tasks in the operational area are the tasks of the medical assistants. The core area of responsibility of quality management lies with the practice staff. A medical assistant trained to become a quality management officer can permanently control and accompany the process in close coordination with the practice owner and motivate and support her colleagues. This creates a new hierarchy level in the practices, which should be recognized and promoted by the management. The tasks and responsibilities of a quality management officer differ from those of a medical assistant. The requirements for the introduction of quality management systems in practices inevitably increase the demands on the practice staff. Quality management only fulfills its purpose if the entire practice team, including the practice owner, recognizes and uses the benefit, transparency and added value for the practice's own organization and for the insured and patients. The quality of care in a doctor's practice is supported and stabilized by goal-oriented practice management.The main actors in practice management are the qualified medical assistants who have geared their advanced training to the practical goals. In this context, the implementation of disease management programs and thus the structured care of certain patient groups is another central element in promoting quality in outpatient care. The medical assistants need general information and training tailored to their professional group on disease management and disease management programs. All operational tasks such as patient information, recall systems, documentation and patient training can be carried out by trained medical assistants. Often, patient contact, especially with chronic patients, is expanded to include important information and support aspects through the involvement of the practice staff. This is particularly the case in the general practice of 556 Z. Allg. Med. 2003; 79: 553-558. © Hippokrates Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG, Stuttgart 2003 Integrated care Case where the continuity of patient contact, especially in the case of chronic diseases, makes a decisive contribution to compliance. DMPs should therefore be implemented with the involvement and intelligent division of tasks of qualified employees in the practices. Case management can build on this directly. The interlinking of disease management and case management in multimorbid patient groups with high care costs will gain in importance in future care. In particular, the medical assistants in the general practitioners' practices, who have close patient ties and who have been trained in the methodology of case management elements, can also play a decisive role in the care and support of these patient groups. Central to these control elements is, on the one hand, the medical context, which lies in the assessment spectrum and in the area of responsibility of the doctors, and, on the other hand, the organizational and operative patient-centered area, which is the responsibility of the medical assistants with a structured distribution of tasks. This redefines the importance of interdisciplinary patient care within the doctor's office and can relieve the doctor. Another, quite controversial, new development in practices is the offer of individual health services. By selling individual health services directly to patients and insured persons, a direct flow of money takes place for the first time, which is visible in the practices. The economy becomes transparent and does not remain hidden, as it usually does. the cash accounting is. The role relationship between doctor and medical assistants changes due to the private offer. Various IGeL consultants recommend that one of the main rules is to involve the practice staff in the selection of offers, in the sale of services and, if possible, in the implementation. Due to the increase in responsibility in this business area of a practice, the importance of qualification of employees in communicative, psychosocial, selling, but also in business areas is demonstrated economically by the IGeL turnover. Only a qualified and motivated doctor's assistant sells the services in a way that suits the target group. The large proportion of IGeL services in the practices also leads to a change in the professional ethos of the medical assistants. There is a change from an originally helping profession to a selling profession in the IGeL business area. The »individual« IGeL offer in the individual practices should be coordinated with the practice goals in the entire practice context in order to present the patient with an authentic picture of the practice. The professional association of doctors, dentists and veterinary assistants - BdA - has drawn up a position paper in close coordination with medical assistants from practice. Table 3: BdA position paper on IGeL services - 2003 Individual health services - IGeL The BdA supports individual health services under the following conditions: 1. The IGeL services offered are medically meaningful. 2. The individual practice IGeL offer has been decided in the team. 3. The IGeL offer is offered and carried out in a patient-oriented manner. 4. The medical assistants who carry out IGeL services are qualified and specially trained. 5. The medical assistants participate in the IGeL turnover. Consequences An out-of-date training and an inconsistent qualification concept for individual specialist groups and ranges of tasks hinder the possibility of practice- and patient-oriented work by medical assistants. In addition, there is a lack of data that shows the influence that medical assistants have on patient care. In health services research in the outpatient area, it makes sense to include the entire practice in the examination context. Another importance that should not be underestimated is the managerial responsibility and the ability of the practice owner to delegate. The perception and recognition of the entire practice team in their complex tasks and the support and advancement of the employees are necessary in order to cope with the internal and external requirements of the health system. These are key elements for successfully securing the future of the practices. It is necessary to develop a modular training concept based on the health policy framework and the effects on the practices. On the one hand, this concept covers the area of practice management and quality management with the administrative, organizational, business management and controlling elements at the operational level. Patient management with elements of medical assistance, patient care, patient coordination and patient training and with instruments for disease and case management is the Z. Allg. Med. 2003; 79: 553-558. © Hippokrates Verlag in MVS Medical Publishers Stuttgart GmbH & Co. KG, Stuttgart 2003 557 Integrated supply second major area. The current and future practice landscape must be considered. The amendment to the training is the first step. With a clever training strategy, the medical assistants can be qualified for medium-sized areas of responsibility in which there is a high demand. Practice management in the middle management area, which relieves the practice owner, is not offered sufficiently and in a practice-oriented manner.Therefore, the qualification of the middle management level for medical assistants with a modular and flexible offer for the current variety of practices is serious for quality promotion in care. Through the targeted use of professional staff and a clear division of responsibilities and tasks in practice, performance-based remuneration can be achieved, the attractiveness of the profession is increased and the dead-end character is lost. In larger practice units or new forms of care, the practice manager will be of decisive importance for the higher management level in the future. Control and steering tasks, as well as personnel management and marketing in particular, cannot be managed on the side in large practice units. This requires highly qualified employees who take into account the entire practical context in all its diversity and who work in an interdisciplinary manner. The medical assistant of the future is predestined for this position with the right training, the support of the practice owner and a corresponding database that proves her influence on the patient care process. Literature 1. Mettin, G .: Labor market - further education - professional development: Professional further education of medical and dental assistants, in: Meifort, B. et. al. (Ed.): Vocational training and employment in the personal service sector - professions and vocational training in health and social services between change and reform backlog; Berlin 1999 2nd Central Institute for Statutory Health Insurance in the Federal Republic of Germany: Qualification requirements for medical assistants, employer survey on future medical assistant training, final report; Cologne 2002 3rd professional association of doctors, dentists and veterinary assistants e.V. (Ed.): Further training for medical assistants - The chance for the future, Starnberg: R.S. Schulz Publishing House; 2001 4th German Medical Association (Ed.): Texts and materials for advanced training, advanced training curriculum for pneumology, Cologne 2002; Advanced training curriculum "Dialysis" for medical assistants, Cologne 2002; Advanced training curriculum "Gastroenterological Endoscopy" for medical assistants, Cologne 2000; Advanced training curriculum "outpatient surgery" for medical assistants, Cologne 1997; Further training for medical assistants in oncology, Cologne 1996 5. Gerlach, M. Ferdinand: Quality promotion in practice and clinic: an opportunity for medicine, Stuttgart: Thieme Verlag 2001 About Nicole Schwäb, graduate health economist, medical assistant. Current activities: Consultant for advanced training of medical assistants at the professional association of medical, dental and veterinary assistants e. V. Worked for several years as a management consultant specializing in new forms of care and control instruments in outpatient health care. Lecturer at the University of Applied Sciences Hamburg, Department of Health 558 Z. Allg. Med. 2003; 79: 553-558. © Hippokrates Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG, Stuttgart 2003
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