Table 2 Direct and implied MA recommendations for improving career ladders

Clear and transparent expectations for advancement, regularly communicated

“[We need] a better understanding of the tiers of how you become an MA 2? How you become MA 3? What are they basing that on? What skill set? You know, because a lot of us have been doing this for like 10 years plus. So what experience skills is necessary for…And it would have to be consistent from every [health system] clinic…cause it’s not [currently].” (MA 4, FG 3)

Consistent recognition of training, experience and work responsibilities, despite variation across backgrounds and clinic location

“So, I don’t think it’s fair to be categorized under the whole [health system] because we really do more than other MAs do at other locations. I think that for our location, we should be categorized separately because we do a lot more than they do at regular [clinics].” (MA9, FG6)

Ability to advance without waiting for a role opening

“MA 1: Yeah, I would have to leave this clinic in order to just to become an M.A. 2, one level up…

MA2: Yeah, cause I started at [clinic] as an M.A. 2, and I came here cause it was like less of a commute for me, and the only available spot they had was an M.A. 1, and now I’m doing so much more than I was doing over there but it’s still M.A. 1. And I have the experience, well, we all have the experience of like an M.A. 3.” (MA1, MA2, FG 3)

Ability to advance while specializing in certain tasks

“Yeah, I just know of other medical companies, very close to us, that have MAs who function as MAs, and room the patients and take care of the patients, and they have other people in their buildings who do the referrals, and do the faxes, and do the paperwork. That’s what I came from. ... So it’s separate, and it’s not merged into one position. So having it separate, and not putting all the pressure and responsibility on one person, seems to be a better...Instead of so much responsibility on one person, and then we all have burnout and don’t want to come to our job… “(MA7, FG10)

Individual career counseling

“MA1: I think they should individually sit down with you and talk to you where each of you are at, individually, that way we know where to grow, and where to become a better MA. We have our ‘yearlys’ [annual review], but it has nothing to do with this [career ladder].

MA4: I don’t have a yearly. (MA1, MA4, FG5)

Direct payment for educational opportunities out of educational funds

“I want to do my certificate, but the money is a barrier. We have the $2000 [in education credit] that we all have, but instead of [the health system] paying the money towards that, they want us to pay it directly and then they’ll refund it. I think if they can pay them directly, it will make it a little bit easier for us to do the certification for MA. Or go back to school, get the online courses, go in to become and RN or whatever someone would like to be.” (MA1, FG5)

Demonstration of appreciation from health system and local physicians

“But there’s no promotion, even if you do a perfect job, you don’t have a promotion with that. Okay. No we don’t have anything, we don’t have an employee of the month, or anything like that as this office.” (MA 1, FG 2)

“You know, it’s really not just about the money, but we do so much more than a lot of our other clinics…I feel that it would be awesome to have that [increased compensation] though, and title change just to show the appreciation for the medical assistants and for how much they do.” (MA 4, FG 3)