Supporting the Face of Primary Care: Building the Capacity of Medical Office Assistants Across Canada

On June 1, 2023, the Government of Canada announced $9 million in research funding from the Canadian Institutes of Health Research (CIHR), the Fonds de recherche du Québec – Santé, the Ontario Ministry of Health, ResearchNB, and the Saskatchewan Health Research Foundation. 

With this investment, 60 research teams will conduct research to generate evidence-informed policy solutions to transform our health systems.

A team from Women’s College Hospital (WCH) received $170,000 to inform national and provincial policies that can better support the administrative staff in primary care clinics, or Medical Office Assistants (MOAs), a role they coin as the “face of primary care.” 

With study partners from across Canada, the team will develop an evidence-informed plan for government funders, regulators, and professional associations to identify policies that could help MOAs working in primary care reach their full potential.

We spoke to Dr. Jennifer Shuldiner, research lead at WCH, and Dr. Noah Ivers, family physician and scientist at WCH, to learn more about their plans with this grant and the importance of supporting the “face of primary care.”

Why is this research important?

Dr. Shuldiner: Primary care is struggling right now and there is a lack of primary care clinicians. As we know, there are a lot of patients that don’t have a primary care provider in Ontario.

As we think about improving primary care efficiencies, we start with the clinic operations – which made us think of MOAs, an umbrella term that encompasses a range of administrative staff. Anecdotally, we know these people play a key role in primary care and nearly all Canadians have interacted with them at some point.

But we also realized that we know very little about them. We know very little about the types of work they’re doing throughout the day. What are their struggles? How are they being supported?

Dr. Ivers: MOAs participate in core tasks that often go unnoticed. From ensuring office supplies are available to greeting the patient, to booking them in appropriately – it can all have an impact on health outcomes. I’ve been blessed to work with MOAs that can quickly recognize, even on the phone, that somebody’s worse than their norm. Relaying that information to the clinician they’re working with – it can change the trajectory of care.

What do you hope to achieve with this grant?

Dr. Shuldiner: We want to determine how we can best support MOAs. Our partners across Canada and from other countries want to pursue policy options to enable high performance of MOAs in primary care. These policy options could include regulatory changes, training requirements, financial requirements, or practice supports.

We will organize a workshop with policymakers, develop the policies and complete a policy report to be sent to funders and regulators.
Dr. Ivers: Our goal is to be interactive and collaborative. We want to ensure that the people directly affected by policy changes are sitting at the table – including MOAs and the clinicians that they work with.

And if we’re going to make change happen, we need to include policy members and representatives from all the relevant organizations, including patient associations, that have a stake in this. We’ve been working to build the necessary relationships to collaboratively come up with evidence-based policy solutions that can move this agenda forward.

Can you talk about any examples of policies or evidence that have helped enable high performance by MOAs?

Dr. Shuldiner: In the United States, there are some practices where MOAs are trained to use technology to do proactive, preventative care, such as reaching out to patients, letting them know when they’re due for screening, or even to coach patients through their chronic disease management.

Dr. Ivers: Policy-wise, there are jurisdictions internationally where primary care clinics are accredited – which means a person comes in and determines if the clinic is following best practices. There may be bits and pieces to learn from processes like that.

How will this project help improve the patient care experience?

Dr. Shuldiner: MOAs are the first point of contact at a clinic. By providing them with the tools to enable them to excel at their job, they can better support patients, triage their concerns, and help a patient who may be in distress. And if they’re helping the clinic perform more effectively, the primary care physician has more time to spend with patients and clinical encounters.

Dr Ivers: Primary care clinicians are functioning at full capacity. We can’t ask them to work harder, but maybe we can help their office to work smarter. Right now, there aren’t standards in place for what the role of their front office staff looks like.

Every Canadian has interacted with front office staff in a primary care clinic. We want to optimize their role to ensure the best possible patient care experience.

What excites you most about this project?

Dr. Ivers: We know very little about what’s going on in Canada for these essential healthcare workers – to start building work in this area could be extremely meaningful in terms of filling a gap in knowledge. We see this particular project as the first step of many.

From my own clinical experience, when you have an amazing team member that you’re working with – it enhances your work life and makes you more effective as a clinician.

Dr. Shuldiner: This is an untapped area of research in Canada – going into the topic blind is exciting because there’s a great opportunity to learn. This is an area that impacts so many individuals. If we can think of policies that can be implemented throughout Canada to better support MOAs, the impact will be felt by primary care and patients throughout the country.

Thank you Dr. Ivers and Dr. Shuldiner!