Fam Pract Manag. 2003 Nov-Dec;10(10):55.

Hiring an office assistant


We need to hire an office assistant for our practice. Is it better to hire a medical office assistant (MOA) or a nurse? What kind of education, training and certification should we require for the position?


When hiring an office assistant, finding the right person often has little to do with specific training or certification. There are some advantages to experience and formal training, but we have had success with employees we have trained ourselves. The characteristics that great MOAs have in common are a caring personality, interest in people, industriousness and reliability. There are no specific educational or certification requirements for MOAs in Colorado.

Our MOAs have been a mix of those trained in formal programs, those with experience in other offices and those with no experience whom we have trained on the job. I have hired registered nurses (RNs), licensed practical nurses (LPNs), certified MOAs, uncertified MOAs, certified nursing assistants (CNAs) and people with minimal medical backgrounds. Although RNs don’t require the same training and monitoring as candidates without medical backgrounds, they often are not satisfied with the salary or job challenges of general office work. LPNs have worked well in our experience but are always in short supply. Our salaries for them can be competitive, and they come with many clinical skills.

Dictation islands


Our practice is considering putting “dictation islands” in hallways so physicians can dictate charts without having to return to their offices. Since these areas are patient hallways and are not secure, is this permitted under the Health Insurance Portability and Accountability Act (HIPAA)?


HIPAA does not include a specific rule about dictation islands, so the answer depends on where the hallways are in relation to unauthorized individuals who might inadvertently overhear sensitive, private information. Since HIPAA requires you to exercise reasonable control over the disclosure of information, having dictation islands in areas where patients are waiting in the halls or sitting in nearby exam rooms with open doors is not a good idea. However, if the dictation islands are in areas where patients would only pass by for one or two seconds and would have no reason to linger where they could hear, the risk is likely insignificant.

Delegating to MAs


As a physician, what duties can I legally delegate to my medical assistants (MAs)?


You can delegate administrative duties (e.g., scheduling and managing appointments, performing billing and collection procedures and processing insurance claim forms) and some clinical duties (e.g., taking vital signs, obtaining and recording patient histories, performing venipuncture and electrocardiograms, preparing patients for and assisting with examinations and treatments, and preparing and administering oral and parenteral medications). State law varies as to which procedures can legally be delegated to MAs, so check your state’s requirements and ensure that the MA is competent in any procedures you delegate. You should not delegate anything that requires the knowledge and professional judgment of a physician, such as diagnosing and prescribing medications. For more information, visit the American Association of Medical Assistants Web site at

Re-signing bonuses


Is it common for a hospital-employed physician to receive a re-signing bonus (i.e., a retention bonus) when renegotiating a contract?


It is not common, but if you’re renegotiating a contract, it usually does not hurt to ask. Hospitals typically do not want to give the appearance of favoring one physician over another, and they don’t want to set a precedent that other physicians would expect them to follow. In my experience, hospitals are negotiating tougher compensation packages with physician employees, more often offering “at-risk” compensation based on productivity and overhead as opposed to guaranteed salaries.

* Denotes member of FP Assist, the AAFP’s online clearinghouse for consultants and attorneys.


Copyright © 2003 by the American Academy of Family Physicians.
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