What is Rationalization?
According to sociologist George Ritzer, rationalization is making a system that optimizes the production of a product, whether it is a service or a good so that it is as close to perfection as possible. This is done by making the production of the product as efficient, predictable, calculable, and controlled as possible. Efficiency is making sure each task or part of creating the whole is done as quickly as feasible but still is of high quality. Predictability is making the product uniform no matter where you are. Uniformity ensures that the quality is at the same standard regardless of where it is from. Calculability is making it so there can be a quantifiable assessment of the quality of the product, using undebatable, concrete, numbers to determine its quality. Control is using human and non-human technologies to promote all the other aspects of rationalization. (Ritzer, 1-5)
The Precursor to Medical Assistants
For nearly thirty centuries, there have been many forms of medical assistants, but none of them fully resembled a modern-day medical assistant until the mid-19th century (Florida Academy). This was about a century before medical assisting’s closest ancestor began to enter the professional world -- nursing. The catalyst for this monumental change in healthcare was none other than Florence Nightingale. Nightingale established a high standard of care that required the patients to have basic needs met, such as being bathed, clothed, and fed. (Free and Garofalo 2011) She also put a very high emphasis on bedside manners, even walking around the ward at night to care for the patients, dubbing her the ‘lady with the lamp’ (Florence Nightingale). The changes she made took a foothold in Western medicine, even beyond wartime, setting a precedent for the quality of care that patients are to receive.
The Void on the Homefront
For doctor’s offices and hospitals to run smoothly, there needed to be many hands on deck helping. The nursing force back home during World War II was considerably smaller than it needed to be for things to keep functioning. Before the Second World War, nurses handled nearly everything that was outside of the scope of the doctor’s responsibility of making the diagnosis (American Nursing). Doctors still had medical assistants that might have handled bookkeeping and things of that sort. With the already persisting nursing shortage, the stigma surrounding the career, and a large chunk of all American nurses enlisting to help with the war efforts, there was a massive void in healthcare that needed to be filled.
With most of the men having enlisted, WWII created a massive shift in the labor work. Many more women joined the workforce to help fill the void that was left by the men (Women in the Work Force…). The percentage of women in the United States workforce increased from 27% to almost 37% throughout the war (American Women…). Despite this increase, the service industry, which primarily consisted of teachers and nurses, had a nearly 10% drop from January 1940 to June 1940 alone as seen in the picture above (Employment of Women…). Hospitals had to find a way to fix this without spending more money before the situation got too dire.
The solution that hospitals came up with was to hire volunteers and use what they already had at their disposal -- medical assistants (Taché and Chapman 2004). Assistants were never medically trained and held more of a secretarial and administrative assistant role in hospitals and doctor’s offices (Florida Academy). When the nursing shortage was exacerbated by WWII, assistants were taught basic medical skills to take pressure off nurses and help with the care of patients. This made doctors’ offices and hospitals alike move much faster. Nurses, doctors, and other healthcare professionals were able to perform their jobs more successfully and efficiently because they have someone else who is highly trained to take off some of the weight. (Chapman and Blash 2017).
The Need on the Frontlines
Great strides were being taken toward the medical assistant career coming to fruition on the homefront, but similar strides were being taken in the military. There was a lack of trained nurses and doctors that would treat the soldiers and other injured personnel. The shortage aboard spurred The US Army to create a fast-track version of their doctors' training program to ensure that they had enough adequately trained professionals to provide quality treatment to every single one of the thousands of patients they got. Those who completed were called physician's assistants, but the tasks that they were employed to do are very similar to what medical assistants today are expected to do. (Interservice Physician…)
After the War
After the war, hospitalizations were at an all-time high, hospital admissions rising by 26% from 1946 to 1952, and it was nearly leading to overcrowding as well. But the shortage of nurses that was already present worsened after the war (Where Did…). Many nurses decided to return homes to their families or to find better work, leaving a massive necessity that wasn’t being filled. At the annual American Hospital Association conference, hospital management decided to extend the responsibilities of the present nurses and stick with the medical assistants and volunteers they had, as well as hire more, which resulted in the expansion of the profession of medical assistants. The medical assistants were to take care of administrative needs and less advanced medical care needs. (Grando 1998)
Hospital Training to the Colligate World
There was a drastic shift in healthcare during WWII, especially because assistants started to receive medical training. But this training was provided directly by hospitals. The quality of service and what services to even expect from medical assistants would often vary greatly from place to place. Through the work of its members, the Kansas Medical Assistants Society created the first and only American association devoted to medical assistants in 1956, naming it the American Association of Medical Assistants. The AAMA grew into its goal of advocating for the education, certification, and career development of medical assistants.
Within a year of its creation, the AAMA designed educational sessions for MAs to help standardize the profession and make it more predictable. They first started by making educational sessions to make medical assisting more professional, then furthered it by creating a Certified Medical Assistant exam, the exam to become a MA.The AMA helped create a post-secondary training curriculum and five two-year medical assisting programs. Now, these programs can be found in most colleges and universities. This was a massive step in transforming medical assisting into a profession, and making it more predictable. (Florida Academy, About the Exam)
The Impact of Healthcare Corporations
To combat the overcrowding of hospitals right after WWII, the Hill-Burton Act was passed to provide funding to build new hospitals. While it is an incredible law that also requires hospitals to give fair and equitable care to everyone, Hill-Burton also allows healthcare companies to further expand and gain more power in healthcare.
Standardization
As the number of hospitals and other types of healthcare facilities grew within each healthcare corporation, there grew to be some glaring differences between each location. The care one would receive at one hospital would not be the same as that they would get at a different one, despite it being within the small healthcare corporation’s jurisdiction. Changes were made so that the care and its quality would be homogeneous and predictable across all facilities within their jurisdiction.
The Need for the Consolidation of Smaller Companies
When Hill-Burton gave the healthcare corporations more money, it helped already large corporations get even larger while smaller ones weren’t able to grow at the same rate. Many smaller hospitals and healthcare systems were swallowed up by larger ones. This was mostly meant to lessen the cost of materials to provide the patients with quality care, but these consolidations do not affect how expensive it is to get healthcare and allow for a patient's information to be shared with other hospitals in case they would have better-suited equipment to care for the patient (Great Consolidation… 2018). The consolidations had a great impact on healthcare workers at all levels, including medical assistants.
Business Forward
Healthcare corporations started running their doctor’s offices and hospitals like businesses -- the goal was oriented more towards fiscal profits than the care of patients or the healthcare professionals. The primary reason most doctor’s offices that are under the umbrella of large healthcare companies don’t often have many registered nurses is that RNs are more expensive when medical assistants can do a lot of the same work. With the focus being on the possible profit, there is less focus on the quality of the care for the patient or even the healthcare professional.
THE BURNOUT NEGATIVE FEEDBACK LOOP
Along with the emotional stress that has come from being in healthcare during the height of COVID-19, MAs and most healthcare professionals find themselves feeling burnout because of the high-stress environment and the long, dreary hours even before the pandemic (Miguel-Puga 2021). The increasingly high rates of burnout in the profession is resulting in a turnover rate in medical assistants of 59% in 2017, and it has only worsened since. Consistently losing employees is a huge financial risk, considering that the cost of turnover in one MA is 40% of their annual salary alone (Friedman and Neutze 2020). In trying to rationalize this aspect of the medical field, the employees won’t like their work environment, resulting in them leaving or possibly performing worse at the tasks they have been given.
The Creation of Electronic Medical Records
Before the 1960s, MAs had to file and keep track of everything on paper. It was long, tedious, and very inefficient. Then, Dr. Lawrence Weed proposed the idea of the ‘electronic medical record’. The EMR could be used to make a more readable and cohesive list of findings in both the patient's intake interview and physical examination. This would allow medical assistants to work much more efficiently and help them provide patients with better overall care. (Weed 1968) This helped greatly with the efficiency of medical assistants but also made their work more controlled.
What is to Come
The medical assistant profession is still growing to this day, but with advances in technology, the patient takes more of an active role in their care than before. With advancements in technology, most people can do some of the tasks for which medical assistants are responsible. While drawing one’s blood and administering one’s vaccines would be ill-advised, getting your vitals after being shown how would be very possible. People are taking more active roles in their healthcare and becoming prosumers every day. There is no guarantee on what will become of medical assisting, but as technology is more integrated into the workplace, having more complex and higher level skills is more valuable for the long term.
Final Thoughts
Medical assisting and healthcare have experienced so many changes over the decades. Medical assisting transformed from a clerical job to a medical profession. The medical assistant profession has experience many changes and taken many forms, and rationalization has always been the catalyst.
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