Elevating an invisible role: co-designing solutions to optimize medical office assistants in primary care

Medical Office Assistants (MOAs) play a vital but often underrecognized role in primary care, managing administrative and clinically-adjacent tasks, allowing the office to run efficiently and effectively. Little is known about how to optimize these team members for the best possible patient and team outcomes. We sought to: (1) explore MOAs' current roles and experiences; (2) identify barriers and enablers to their work; and (3) co-design scalable solutions to support them in their work.

This multiprong multi-method study was guided by co-design principles and employed a combination of MOA co-creation workshops, a two-part Delphi survey, and a multi-stakeholder co-creation workshop. MOAs were recruited from a province-wide survey in Ontario, Canada. Four structured workshops with MOAs explored their experiences, challenges, and ideas for improving their work (N = 9). We conducted a thematic analysis to identify patterns in participants' experiences with MOAs. Solutions emerging from the workshops were rated through a two-round Delphi survey with MOAs, clinicians, researchers, and health system leaders (n = 32). Solutions were evaluated using the APEASE framework (Acceptability, Practicability, Effectiveness, Affordability, Safety, Equity). Lastly, a multi-stakeholder workshop brought 18 participants together to discuss prioritized solutions and future scaling strategies.

Nine MOAs participated in the co-creation workshops (all female, mean age 43, half identified as racialized). They emphasized their central role in team-based patient care, clinic flow, and health system navigation. Key challenges included a steep learning curve, lack of formal training, frequent workflow changes, emotional strain, and a perception of not being valued by patients or other team members. Staffing shortages and fragmented systems compounded these pressures. The top-rated solutions included creating a professional MOA association, expanding training and safety protocols, defining best practices for MOA roles, and streamlining referrals through centralized systems. Final discussions emphasized the need for leadership engagement, clinic and system-level buy-in, and dedicated funding to support implementation.

The challenges experienced by MOAs may require policy attention to better define and support their role. Targeted investments in training, professionalizing the MOA role, and embedding MOAs more meaningfully in team-based care has the potential to help primary care teams more effectively achieve the quintuple aim.