Shortage of skilled labour among medical assistants: Which psychosocial working conditions contribute to leaving the profession? A mixed methods study

Status:

completed 03/2024

Aims:

Unfavorable working conditions in the healthcare sector are widespread and are related to the intention to leave the profession. Medical assistants (MA) report unfavorable working conditions, a strong desire for work-related improvements and often the intention to leave the profession. However, the intention to leave the profession is a proxy measure and does not provide any information about who actually leaves the profession. So far, it is unknown whether or which working conditions contribute to an actual turnover from the profession among MA.

The proposed study will address this knowledge gap. First, we will employ data from a cohort study among MA. This data provides the unique opportunity to examine to what extent psychosocial working conditions (assessed in 2016/2017) predict turnover during the Covid-19 pandemic (2021). In addition to the quantitative analyses, we will interview MA who quit their profession using a qualitative study design. Such a subsequent qualitative study facilitates a more profound understanding, in particular of the associations observed in the quantitative study. Accordingly, this information can be used to devise preventive measures aiming at curtailing the exit of MA from their profession.

Activities/Methods:

Prospective data from 456 medical assistants (MA) from a 4-year cohort study (baseline 2016/17, follow-up 2021) were available for quantitative analyses. The analyses built on data from participants who had worked as a MA at baseline. At follow-up, these participants worked either as a MA or in another profession. The exposures at baseline included:

1. psychosocial working conditions, assessed by the Effort-Reward Imbalance Questionnaire (17 items) and by a MA-specific questionnaire with 29 items categorized into seven subscales (e.g. work control, collaboration, practice organization) and
2. desired work-related improvements measured using a 12-item questionnaire with three subscales (e.g. working conditions, rewards from superiors, independence).

Associations of continuous (z-scores) exposures and exit from the profession were estimated by multivariable log-binomial regressions and reported as relative risks.

For the qualitative interviews we recruited individuals who used to work as a MA, but worked in another profession at the time of data collection. Recruitment built on the above-mentioned cohort study and on support of the MA professional organization (vmf e.V.). Twenty participants were interviewed between August and November 2023. Interviews were content-analyzed using MAXQDA.

Results:

Quantitative study: In the follow-up survey (mean = 4.4 years, standard deviation = 0.1), 48 of the 456 participants reported leaving the MFA profession. In particular, psychosocial working conditions and job-related needs for change in relation to interpersonal factors appear to predict leaving the profession (relative risk, RRs ≥ 1.33).

Qualitative study: The main reasons for leaving the profession were changing priorities over the course of their career (e.g. in terms of working hours and salary), a consistently high workload, few opportunities for further training and development and – as observed in the quantitative study – poor interpersonal relationships, particularly with superiors, but also with patients and colleagues. Measures that, according to MFAs, could motivate them to stay in the profession included higher salaries, more flexible working hours, better development conditions and more recognition from supervisors and patients.

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