Medical assistants are the fastest growing segment of primary care teams. Remarkably little is known about this emerging workforce. In this report, we present information based on a literature review, analysis of secondary workforce data, and interviews with key experts in the field that aim to highlight the basic aspects of medical assistants and discuss issues that need to be addressed in this rapidly growing occupation in the allied health workforce. Critical policy issues are raised about the future impact of a largely unregulated workforce as well as the potential impact of this field on other allied health professions. J Allied Health 2006; 35:233-237.

MEDICAL ASSISTANTS (MAs) represent a large component of the health care workforce in the United States, with an estimated 376,300 individuals occupying positions in outpatient clinics and private physician offices.1 MAs are integral to outpatient health care because of their presence in large numbers and their role in medical office administration. Despite the steady increase in the number of MAs in recent years, little is known about the pathway of entry into the field, the extent and depth of training, the variety of tasks performed in different practice settings, the rates of turnover, and the reasons for exiting the field. As MAs become an increasingly significant component of the health care team, it will be important to define their skills, experiences, and clinical roles more clearly and to advance their occupational activities and contributions in systematic ways.

This report summarizes current information and knowledge in the field of medical assisting and raises critical policy issues and implications for the workforce. To study some of the trends in the MA workforce, we undertook a literature review of published articles on the role of MAs using the MEDLINE database from 1970 to 2004, interviewed key experts in the field of medical assisting, and reviewed workforce data from a variety of national sources. We identified 18 articles describing the role MAs play in particular practice settings where added benefits to having such assistants were noted.2-19 We examined six issues most relevant to the field of medical assisting: scope of practice, training pathways, certification requirements, accreditation requirements, economic incentives, and regulatory mechanisms. We argue that given the rapid growth of MAs in the health care workforce, the lack of standards and consistency in training and scope of practice as well as the potential need for certification and licensure should be addressed.

Over recent years, medical writing has become an integral activity in drug development through the production of high-quality regulatory documents, thus expediting the approval process. In a similar vein, the importance of statistical considerations in drug development has also been increasingly recognized. In particular, the development of a study-specific statistical analysis plan (SAP) is now perceived as best practice for regulatory (and other) studies and is required in many instances. There is a clear need for medical writers and biostatisticians to work closely together during the course of a project; thus, it is advantageous for the medical writer to make a contribution to the development of the SAP. The aim of this article is to detail the benefits to both medical writers and biostatisticians of the project medical writer reviewing the SAP and to highlight the specific issues that should be addressed during the review process. We recommend that this re-view become a routine activity in all pharmaceutical companies and contract research organizations.

The U.S. Department of Health and Human Services (HHS) has initiated two new steps in building an electronic health care system that will allow patients and their physicians to access their complete medical records as needed, leading to reduced medical errors, improved patient care, and reduced health care costs.

HHS Secretary Tommy Thompson said HHS has signed an agreement with the College of American Pathologists (CAP) to license the college’s standardized medical vocabulary system and make it available without charge throughout the country.

He said this action opens the door to establishing a common medical language as a key element in building a unified electronic medical records system.

HHS also has commissioned the Institute of Medicine to design a standardized model of an electronic health record. The health care standards development organization, known as HL7, has been asked to evaluate the model once it has been designed.

HHS will share the standardized model record at no cost with all components of the U.S. health care system and expects to have a model record ready in 2004. It estimates that the free system will reduce medical errors and reduce health care costs by about $100 billion per year. However, many health care institutions will need to invest in computers and train staff.

Welcome to the lazy days of summer! I guess hat is a saying that doesn’t pertain to dental offices, because I don’t seem to remember any summer lazy days in dentistry. Do you?

Like busy dental office schedules filling so quickly, so go the number of new choices dentists have to make when it comes to light curing units. Once again, it’s that constant change in technology.

New technology has once again arrived in the light curing unit arena. The newest trend in curing lights is LED–light emitting diode. Before we review the LED lights, let’s just take a minute to review our curing light options.

QTH–Quartz-Tungsten-Halogen

Quartz-Tungsten-Halogen lights seem to be the most common light cure source in today’s dental practice. Not only have they been used in the dental industry for many years, they are proven and relatively inexpensive.

Most commonly referred to as halogen lights, they are excellent for curing resins and have become a real workhorse in dentistry. Halogen lights produce a blue light by passing current through tungsten filament in a quartz bulb that contains halogen gas. We could really get into it, but this is not a research paper. The light is reflected and then goes through filters, producing a broad wavelength of light to cure resins. Due to the broad wavelength produced, halogen lights also produce some extra heat, but they always cure everything. Have you ever put the light guide on your fingernail? It gets very hot, fast.

The saying, “If you want something done right, do it yourself,” doesn’t apply when it comes to ensuring clean claims.

One person-even one department-is hard pressed to take on this challenge in today’s environment, where the task of coding and billing claims gets more difficult every quarter, possibly every month. That’s how often payers update the rules that govern coding and compliance.

To keep up with ever-changing regulations, patient financial services departments are reaching out to other departments and experts within the hospital to ensure claims are sent correctly the first time. Today, each functional department along the revenue cycle is sharing in the responsibility for reducing the number of days a claim remains in accounts receivable-a difficult task, to say the least.

In part 2 of this series on applied medical informatics for the chest physician, we will examine in detail the key reasons for the current low adoption and effective use of the electronic medical record. (CHEST 2006; 129:777-782)

Key words: computer, informatics; quality of care

Abbreviations: AMI = applied medical informatics; CPOE = computerized physician order entry; EMR = electronic medical record

In the First installment (1) in this series on applied medical informatics (AMI) for the chest physician, we reviewed the structure and basic function of the electronic medical record (EMR). Even to the casual observer of the technology of the EMR in American medicine, the following two realities are manifest: (1) recently, there has been a great deal more discussion in the medical literature, in national medical organizations, and in the lay press on the benefits and risks of the EMR; and (2) there has been a great deal more talk about the EMR than has been actual use and availability of these tools in daily practice. In this, part 2 of the series on AMI, we will examine the reasons for this important and frustrating conundrum, and how to understand and realize the benefits of the EMR and avoid its drawbacks.

In his 2005 “State of the Union” message, President George Bush stated: “By computerizing healthcare records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” Juxtaposed with this statement are the following findings from the survey of American Hospitals in 2002: of all US hospitals, only 9.6% of them (60 hospitals) have the computerized physician order entry (CPOE) component of the EMR completely available for use. In about half of these hospitals, > 90% of orders are entered with CPOE by physicians; in about another third of the hospitals, 90% of the orders are entered with CPOE by nonphysician staff. (2)

PURPOSE. To compare the Nursing Interventions Classification (NIC) interventions used in two countries, Korea and the United States.

METHODS. Data were collected from 167 nurses working in eight hospitals in Korea and analyzed with descriptive statistics.

FINDINGS. Korean nurses selected 202 interventions, nine of which were used by more than 50% of nurses surveyed. In comparison, the Academy of Medical-Surgical Nurses (AMSN) in the United States identified 68 interventions as core interventions. Among the top ranked 68 interventions selected by Korean nurses, 29 (43%) matched those selected by U.S. nurses.

CONCLUSION. The nursing interventions selected by Korean nurses were more heavily focused on the physiologic domain than those selected by the U.S. nurses.

PRACTICE IMPLICATIONS. The identified intervention lists can be used to develop nursing information systems, staff education, competency evaluation, referral networks, certification and licensing exams, and educational curricula for nursing students.

Background and Purpose. Little quantitative research exists describing the effectiveness of instructional strategies for developing medical screening and patient referral abilities of physical therapist (PT) professional degree students. The purpose of this study was to compare the effectiveness of 2 patient case-based instructional strategies designed to promote these abilities: (1) a traditional lecture (TL) format and (2) student/faculty role-playing (RP) sessions.

Methods/Model and Description and Evaluation. Fifty-one first-year Master of Physical Therapy (MPT) students enrolled in a cardiopulmonary course volunteered to participate in the study. Four patient cases were presented in either a TL or RP format. After completion of the instructional unit, students took a written examination, rated their levels of confidence in medical screening and patient referral abilities, and completed a unit evaluation assessing the instructor’s behavior and teaching methods.

The phrase “economy class syndrome” has been used to describe the onset of deep vein thrombosis (DVT), or blood clotting in the legs from sitting for hours in the more restrictive seating in coach class. Actually, according to a Civil Aerospace Medical Institute (CAMI) brochure, the expression “Traveler’s Thrombosis” may be more accurate. DVT is not limited to coach seating, and in fact occurs whenever one’s activity is limited for long periods, to include not only long flights but also a long automobile or train ride. From “Deep Vein Thrombosis and Travel,” CAMI (copies may be obtained by calling 405/954-4831).

When it comes to plain speaking, astrophysicists claim bragging rights.

The chief merit of language is clearness, and we know that nothing detracts so much from this as do unfamiliar terms.

–Galen (A.D. 129-ca. 216)

Do you know what term medical doctors have for one of the bones in your big toe? Ungual phalanx of the hallux. Do you know the official term that astrophysicists use for the beginning of the universe? Big bang. Why does it take nine syllables to name a bone in your toe but only two syllables to name the origin of all the space, time, matter, and energy in the cosmos? Something is wrong.

Doctors are not uniquely guilty of sesquipedalian transgressions, but they certainly lead the way. The community of astrophysicists, however, proudly wields simple words, even for our most complex concepts. Not only do our terms typically have few syllables, they also tend to be descriptive and, in some cases, just fun to say. Medicine and astrophysics are probably polar opposites in the name game, with other professions filling in the middle.

Despite the scowls of my geologist colleagues, I have not managed to remember what plagioclase feldspar looks like, and I am still wondering what’s so friendly about migmatitic gneiss. Perhaps geologists should pass a law against words of more than eight syllables. That way, I would never have to pronounce “uniformitarianism” whether or not it’s an important doctrine.

When ichthyologists go home at night, do they see Carassius auratus instead of goldfish swimming in their fishbowls? Can anyone get more obscure than biologists and paleontologists, who reflect for thirteen syllables on whether or not ontogeny recapitulates phylogeny? In such cases, you feel especially ignorant, because you trip over the words just trying to pronounce them. Should I confess to the authorities, here and now, that I have occasionally snorted oxymetazoline hydrochloride? Yes, I inhaled all ten syllables as the active ingredient in my nasal decongestant spray.

And how about those dozen roses I just gave my wife? Do botanists give each other a dozen Rosa nutkana instead? One of the best known lines in Shakespeare is the romantic utterance of Juliet, who declared that a rose by any other name would smell as sweet. True, but what she neglected to mention is that a rose by a five-syllable botanical classification scheme rarely makes its way into iambic pentameter.

The parade of extinct species, with names from Archaeopteryx to Zalambdalestes, would leave most heads spinning, although one of the great mysteries of the universe is how eight-year-old kids seem to have no trouble with the taxonomy of extinct ferocious beasts.

Sociologists, professional educators, and literary critics are just as bad (or perhaps worse) than scientists. Is there some tablet in the sky upon which is inscribed a commandment requiring sociologists to refer to your neighbor as a residential propinquitist? Accuse someone in New York City of being one, and you might suffer a bruised jaw–or would that be a mandibular contusion? When I was a schoolboy, the one-syllable word “test” did the job. Today you can hardly find the term in the discourse of professional educators. A test has become “an assessment instrument.” And much as I have tried, I still cannot understand the following randomly chosen passage in the 1991 book Deconstruction: Theory and Practice, by Christopher Norris, a British professor of English:

But the point of these metaphors is not to reinstate a thematics of
presence or expression, as opposed to the differance of structural
inscription. Rather, it is to demonstrate that structuralism itself arises
from the break with an attitude (the phenomenological) it cannot reject but
must perpetually put into question.

Maybe it’s not a beginners’ book on deconstruction. Maybe beginners’ books don’t exist on the subject. Or maybe I’m just stupid, and all the people who speak this way are brilliant thinkers. If not, then their work is easier to understand than they let on, and their jargon erects a downright opaque psychological boundary between those who know and those who don’t.

The renowned physicist Richard Feynman, in an essay entitled “What Is Science” written for a 1969 issue of The Physics Teacher, recalled a childhood conversation with a friend:

We were playing in the fields and this boy said to me, “See that bird
standing on the stump there? What5 the name of it?” I said, “I haven’t got
the slightest idea.” He said, “It’s a brown-throated thrush. Your father
doesn’t teach you much about science.” I smiled to myself, because my
father had already taught me that … “even if you know all [the] names for
it, you still know nothing about the bird…. Now that thrush sings, and
teaches its young to fly, and flies so many miles away during the summer
across the country” … and so forth. There is a difference between the
name of the thing and what goes on.

Feynman’s dad was basically right, but if we take his argument to the extreme, we would all stare at each other, mute in the forest. So we obviously need words for things before we can communicate ideas that relate to them. And in the sciences, words for things can be precise, historical, and even illuminating. But I remain intrigued that in social settings such as cocktail parties, you will impress people more with the obscurity of your vocabulary than with your actual command of a body of knowledge.