title: Patterns of relating between physicians and medical assistants in small family medicine offices.
abstract: OBJECTIVE
  The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician-medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework.
  
  
  METHODS
  We conducted an ethnographic study of 5 small family medicine offices (having <5 clinicians) in the Cincinnati Area Research and Improvement Group (CARInG) Network using interviews, surveys, and observations. We interviewed 19 MAs and supervisors and 11 clinicians (9 family physicians and 2 nurse practitioners) and observed 15 MAs in practice. Qualitative analysis used the editing style.
  
  
  RESULTS
  MAs' roles in small family medicine offices were determined by MA career motivations and clinician-MA relationships. MA career motivations comprised interest in health care, easy training/workload, and customer service orientation. Clinician-MA relationships were influenced by how MAs and clinicians respond to their perceptions of MA clinical competence (illustrated predominantly by comparing MAs with nurses) and organizational structure. We propose a model, trust and verify, to describe the structure of the clinician-MA relationship. This model is informed by clinicians' roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs.
  
  
  CONCLUSIONS
  Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting.
authors.affiliation: University of Cincinnati Department of Family and Community Medicine, Cincinnati, Ohio.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Elder
authors.forename: C Jeffrey
authors.initials: CJ
authors.lastname: Jacobson
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Bolon
authors.forename: Joseph
authors.initials: J
authors.lastname: Fixler
authors.forename: Harini
authors.initials: H
authors.lastname: Pallerla
authors.forename: Christina
authors.initials: C
authors.lastname: Busick
authors.forename: Erica
authors.initials: E
authors.lastname: Gerrety
authors.forename: Dee
authors.initials: D
authors.lastname: Kinney
authors.forename: Saundra
authors.initials: S
authors.lastname: Regan
authors.forename: Michael
authors.initials: M
authors.lastname: Pugnale
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D017146:Models, Organizational; D009722:Nurse Practitioners; D010823:Physician Assistants; D010824:Physicians' Offices; D010821:Physicians, Family
keywords: Allied health personnel; interpersonal relations; medical staff; practice dynamics; practice-based research; primary care; teams; work relationships