Supervision of Medical Assistants and their Scope of Practice in the USA

Please Note: the information contained on this page is provided for information purposes only and should not be considered legal advice, nor is it a substitute or interpretation of regulations established by authorities having jurisdiction over practicing doctors, nurses and their medical assistants in your state. Please contact your State Board of Medical Examiners directly for specific advice, official business, or consult with your attorney. We cannot provide this information to you.

Medical assisting as an occupation remains loosely regulated in the United States. Most states lack specific medical assistant certification and training requirements and licensing for medical assistants still does not exist.

Too many doctors, supervisors, co-workers and even the medical assistants themselves are confused about how to properly utilize and supervise medical assistants within their practice. Many are unsure which tasks can be assigned to them, and wonder what the medical assistant can and cannot do while they are out of the facility. Unfortunately there is no universal answer, since there is no single definition of a medical assistant's scope of practice that uniformly applies to each and every state, however, rule of thumb is that a medical assistant must work under the direct supervision of the doctor.

Medical assistants aren't licensed,
but they can handle specific duties, which is equally important to the medical office workflow.

Who Regulates the Medical Assistant Occupation?

Most surprisingly, not all states in the USA have specific laws directly addressing and outlining the responsibilities and duties of medical assistants. This is not to say that there aren't any laws that apply to medical assistants and that they aren't bound by certain rules, regulations, ethical and moral standards, however, many existing laws that regulate the medical assistant are vague and hard to find, mostly because of the absence of state licensing requirements for medical assistants.

Since medical assistant work as an extension of the doctor who hired them, the most pertinent laws that apply are the Medical Practice Laws established by the State Medical Board/Board of Medical Examiners; however, even these laws can vary from state to state.

Rule of thumb is that physicians are accountable for the actions of medical assistants under their employ and responsible for their supervision. Properly trained medical assistants can perform a medical act that a reasonable and prudent physician would find within the scope of sound medical judgment to delegate, and provided that there was initial and ongoing direction, procedural guidance, observation and evaluation of the medical assistant. Doctors must be in reasonable proximity on the premises when their medical assistant performs any kind of direct patient care hands-on procedures, regardless of amount of training, or having done the same task many times before (see Supervision).

Clearly Stating Responsibilities in the Job Description

By law, whenever a medical assistant provides ANY type of direct patient care the supervising doctor, or licensed healthcare professional in charge MUST be physically present in the medical office, or building! This rule applies in every US state regardless of how well trained the medical assistant might be, what his/her credentials are and how many years of experience he/she has.

Sound policy is that as new medical assistants are hired it should also be made clear, either verbally or in writing, what a medical assistant can and cannot do while under their employ, which typically includes (not!) making any medical assessments, independently triaging patients, dispensing medications, or medication samples without explicit orders, or independently giving any type of medical advice. Their job description should spell out specific tasks, such as "responsible for administering immunizations by injection". This rule also applies to certified medical assistants who often are held to higher standards, especially if they are medical assistants who specialized in a specific field in healthcare.

Medical Assistant Supervision

The State Medical Board makes provisions on how doctors must supervise and may utilize non-licensed allied health professionals under their employ, including their medical assistants. The doctor assumes responsibility for the medical assistant's actions under their employ and must therefore determine each medical assistant's abilities and skill level before delegating tasks. It is good policy to assure that everybody in the medical office knows what a medical assistant is and does so that each one practices strictly within their discipline's scope of practice.

South Dakota's legislation is a good example of a state that recognizes and regulates the activities of medical assistants. South Dakota Legislature spells out the medical assistant's duties and requires their registration with the Board of Medical and Osteopathic Examiners and Board of Nursing. The application process for registration is stringent and requires renewals and fees. On the flip side, certification is not a requirement in South Dakota.

Some State Board of Nursing have also added text into their rules, i.e. the nurse practice act, on how registered nursing staff can utilize and delegate tasks to medical assistants under their supervision, such as published by the State Board of Nursing of New Hampshire, the Board of Nursing of New York, and again, South Dakota, to name just a few.

In most of the remaining states that have no specific laws or regulations directly addressing the medical assisting discipline, or physician's delegation of clinical tasks to unlicensed personnel, it can generally be assumed that medical assistants may, under proper supervision, perform duties which

1. they are adequately trained to perform
2. are not prohibited from performing under state medical and nursing practice laws

But again, some states, notably New York, Connecticut and Nevada are not clearly expressing what they expect of medical assistants, for example when it comes to administering inoculations via non-intravenous injections.

CAREFUL! Certain US states mandate that medical office staff who perform phlebotomy, ultrasound procedures, EKGs, or X-rays* must have a specific limited license to do so. When performing simple laboratory screening tests on the medical practice premises (STAT tests) it must be done in accordance with CLIA regulations.

Medical Assistant Legal Limitations

Medical assistants who disregard established professional standards, attempt to perform procedures beyond their training, capabilities and scope of practice, or decide to act independently without the doctor's orders, or in the absence of a licensed supervising healthcare provider are in real danger of exposing themselves, the patients, business, employer and supervisors to serious situations and law suits that can carry far reaching consequences should any injuries occur.

 Examples of specifically prohibited activities medical assistants are NOT
      allowed to do: What Medical Assistants Can and Cannot Do

 Links of online resources that specifically mention medical assistant's scope of practice by State: Medical Assistant Scope of Practice by State

AGAIN! If you are researching laws that pertain to the medical assistant profession your first stop should be the State Medical Board, or Board of Medical Examiners of your state, since this is the authority that regulates the practice of medicine in the USA.

If you go to the American Association for Medical Assistants (AAMA) website, scroll down on that page until you see "About the Profession" and "AAMA Role Delineation Study", look for "Occupation Analysis for the Medical Assisting Profession" for further research of this topic.

AAMA's Medical Assistant Role Delineation Study

 AAMA Library and Form Center
Scroll down to "About the Profession" AAMA Role Delineation Study,
then look for "Occupational Analysis of the Medical Assisting Profession"

AMT's Administrative Medical Assistant Scope of Practice

 AMT's Administrative Medical Assistant Scope of Practice