When stepping foot into a physician’s office, a patient’s first and last encounters are often with a medical assistant. Medical assistants may greet and check in a patient, take a patient’s vitals, administer an ordered vaccine, and schedule the patient’s next appointment. For many practices, the medical assistant is a crucial member of the healthcare team and plays a vital role in carrying out a variety of routine tasks that keep your office running smoothly. Yet medical assistants may also represent an underappreciated source of risk for your practice. Physicians must assure the medical assistant is working within their scope to minimize potential liability.
Medical assistants are unlicensed individuals who perform basic administrative, clerical, and non-invasive routine technical supportive services in a medical office or clinical setting under the supervision of a physician or other licensed healthcare providers.¹ An unlicensed person may not diagnose, treat, or perform any task that is invasive or requires assessment.² Certification is not required, unless a physician wants a medical assistant to train other medical assistants.³ In this case, the medical assistant trainer must obtain certification through one of the “Board Approved Medical Assistant Certifying Organizations” listed on the Medical Board of California website.4
Medical assistants must be at least 18 years of age, have received training pursuant to the standards established by the Medical Board of California, and they must be supervised.5 Prior to performing technical supportive services, a medical assistant shall receive training as, in the judgment of the supervising physician, podiatrist, or instructor of an approved school, is necessary to assure the medical assistant is competent in performing a service at the appropriate standard of care.6
A medical assistant gains experience by training in one of two ways:7
- Training under a licensed physician or podiatrist, who shall ascertain the proficiency of the medical assistant; or under a registered nurse, licensed vocational nurse, physician assistant, or a qualified medical assistant acting under the direction of a licensed physician or podiatrist who shall be responsible for determining the content of the training and proficiency of the medical assistant, except that training to administer medication by inhalation shall be provided by a licensed physician or respiratory care practitioner; OR
- In a secondary, postsecondary, or adult education program in a public school authorized by the Department of Education, in a community college program provided for in the Education Code, or a post-secondary institution accredited or approved by the Bureau for Private Postsecondary and Vocational Education in the Department of Consumer Affairs.
If the training is being provided in the physician’s office by the supervising practitioner, there is no specific document or form required to be used to record the medical assistant’s training. However, there should be documentation that outlines the specific training, tasks and/or services, dates and/or hours of training, and the physician’s signature attesting to the competency
of the individual.
Per Title 16 of the California Code of Regulations, section 1361.1, if the medical assistant will be administering medications by intramuscular, subcutaneous, and intradermal injection, or performing skin tests, or venipuncture for the purpose of drawing blood, they are required to have at minimum the following training:8
- 10 hours of training in administering injections and performing skin tests; and/or
- 10 hours of training in venipuncture and skin puncture for the purpose of withdrawing blood;
- At least 10 of each intramuscular, subcutaneous, and intradermal injections and 10 skin tests, and /or at least 10 venipuncture and 10 skin punctures; and
- 10 hours of training in administering medication by inhalation (training must be provided by a licensed physician or a respiratory practitioner).
All training shall include instruction and demonstration of pertinent anatomy and physiology appropriate to the procedure; equipment used; proper technique; hazards and complications; post treatment patient care; emergency procedures and California law and regulations for medical assistants.
All clinical services provided by the medical assistant must be under the supervision of a physician, or podiatrist, nurse practitioner, physician assistant, or certified midwife. When the medical assistant is performing their duties, the supervising practitioner must be physically present in the treatment facility during the performance of those duties.
A quick reference guide regarding scope of practice for medical assistants is below.9
| Specific Procedures | MA | Additional Information |
|---|---|---|
| Perform nasal smears | Yes | Limited to the opening of the nasal cavity |
| Perform nasal smears and “finger sticks” | Yes | After proper training |
| Swab throat to preserve specimen in a throat culture | Yes | After proper training |
| Take patient vitals | Yes | |
| Administer narcotic injections. (Injection by intradermal, intramuscular, or subcutaneous routes) | Yes | Once the licensed person has verified the correct medication and dosage |
| Administer flu shots and other vaccines | Yes | After proper training, and supervising practitioner presence in office/facility |
| Call in new prescriptions, or changes to prescription | No | May refill medications with no changes in dosage levels under direct supervision of physician |
| Start or disconnect IVs or administer injections or medication into an IV | No | |
| Administer anesthetic agents (topical or injection) | No | |
| Apply orthopedic splints | No | May remove casts, splints, and other external devices |
| Insert urine catheters | No | Considered an invasive procedure |
| Independently perform telephone triage | No | Cannot legally interpret data or diagnose symptoms |
| Inject collagen | No | |
| Inject Botox | No | |
| Use lasers or intense pulse light devices to remove hair, wrinkles, scars, moles, or other blemishes | No | |
| Interpret the results of skin tests | No | May measure and describe test reaction and record in patient record |
Ensure that the staff you supervise are competent, qualified, and knowledgeable. Understanding their clinical limitations helps build a strong foundation for excellent care and safety and ultimately, is your responsibility.
Deborah Kichler, RN, MSHCA, is a Risk Management and Patient Safety Specialist. Questions or comments related to this article should be directed to DKichler@CAPphysicians.com.
References
¹Medical Board of California. https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Practice-Infor…. Accessed February 2024.
²16 CCR § 1366.3 (a)(1)(2)
³Medical Board of California. https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Practice-Infor…. Accessed February 2024.
416 CCR § 1366.3 (a)(1)(2)
5Medical Board of California. https://mbc.ca.gov/Licensing/Physicians-and-Surgeons/Practice-Informati…. Accessed February 2024.
6Medical Board of California. https://www.mbc.ca.gov/FAQs. Accessed February 2024.
7Ibid.
8Ibid.
9Ibid.