Introduction - MAERB



IntroductionThis survey was administered in the spring 2019, and representatives, typically the Program Directors, from all CAAHEP-accredited programs, were required to respond to the survey. MAERB conducted this survey for a variety of reasons: A significant number of phone calls were received from Program Directors asking about the possibilities of incorporating apprentice-type models within their programs. On one hand, the apprenticeship questions were a direct result of the current political administration’s endorsement and support of apprenticeship. On the other hand, programs were also receiving questions from local employers, clinics and systems, on how to develop an employment pipeline from the educational program to the job site. MAERB has over the last five years significantly decreased in size due to voluntary program withdrawal. The significant shift that has occurred in for-profit institutions and enrollments has been one factor, but in the last two years, there have been many program and/or institutional closures due to low enrollment. In addition, Program Directors were anecdotally reporting concerns with enrollment. Despite the shifts in enrollment, the demand for medical assistants has increased rather than decreased, with Program Directors placing graduates in the traditional ambulatory healthcare environments as well as hospitals and other less-traditional sites. All of these factors inspired MAERB to conduct a survey of the CAAHEP-accredited medical assisting programs to, first, acquire the necessary data, and, second, to understand the different relationships that medical assisting programs were putting into place in order to both increase enrollment and supply the demand for medical assistants. The information below summarizes the information that was provided in response to this survey. As always, the detail and time spent by the Program Directors of CAAHEP-accredited medical assisting programs indicates the commitment of the participants to the education of their students and the profession of medical assisting. Enrollment OverviewTypical Annual EnrollmentAs the chart below indicates, almost half of the CAAHEP-accredited programs enroll 11-25 students annually. Out of 434 programs responding, 344 programs enroll 1-40 students on an annual basis, while 60 programs enroll 41-90 students annually. Thirty programs report an enrollment of over 90 students. Enrollment Trends Over half of the programs report that the demand for enrollment in the CAAHEP-accredited medical assisting program has decreased over the last five years. Roughly a quarter of the programs report an increase over the last five years, and slightly less than a quarter report that the demand has remained the same. Enrollment StatusIn considering the sponsoring institutions expectations and capacity and/or employer needs, 66% (287) of the CAAHEP-accredited medical assisting programs report that the program is under-enrolled, while 32% (138) of the CAHEP-accredited medical assisting programs report that the enrollment matches the program’s resources. Two percent (9) of the CAAHEP-accredited medical assisting programs indicate that they have a long waiting list. Options that medical assisting students exploreThe chart below indicates the environmental options that current medical assisting students explore prior to enrolling in their current CAAHEP-accredited medical assisting program, based upon Program Director assessment. Program Directors could check several items. This information provides a context for the choices that students make as they move forward in their career path. Comments about enrollment and employer needThe comments in this section illustrated the greet need for medical assistants. The demand for qualified medical assistant and a shortage of those qualified medical assistant characterizes several communities. At the same time, there were also the concerns about the diminishing enrollment and graduation rates. Please note that some of the comments contradict others, but this summary is designed to highlight the full range of comments. There is a high demand and competition for credentialed medical assistants, but some employers are hiring people without a credential, are hiring certified nursing assistants, or are offering their own in-house training programs. Employers are not able to find enough medical assistants to fill the positions, but the low starting salaries prevents people from entering into the profession.Programs are working closely with employers to aid students in getting hired after the practicum. There is a great need for marketing/recruiting/promoting for medical assisting education and for future medical assistants.There needs to be more education about the medical assisting scope of practice in communities. Educational institutions need to do more direct marketing about medical assisting. Students are choosing healthcare professions that pay more, such as nursing. Programs are exploring online options, hybrid programs, evening programs, and accelerated programs as a method of increasing enrollment.Students from CAAHEP-accredited programs are in demand, both for the practicum experience and employment. There is an increased interest in medical assistants who are trained as medical scribes. Because the economy is good and unemployment rates are low, enrollment is down. Work-force development apprenticeship programs and/or in-house clinic training are competing with the CAAHEP-accredited programs. Employers report high turnover in employment due to low salaries and other higher paying opportunities. Employers want the programs to be shorter, but they want the same quality of student. There is concern about confusion in the marketplace due to a few different medical assisting exams. A few programs commented that they would like to have the opportunity to offer paid internships. Suggestions for changesWorking with employers to raise the pay rates and create differentiated pay rates depending upon education and credential. Partnering with nursing programs or other healthcare programs to contact students on the waitlist to educate them about medical assisting Move to a one-year program rather than a two-year program. Dual Enrollment: Programs offering Dual Enrollment OptionsPrograms offering Dual EnrollmentAs the chart indicates, a little over a quarter of CAAHEP-accredited programs offer a dual-enrollment option. Percentage of the medical assisting program offered to dual-enrollment high school studentsOf the 108 CAAHEP-accredited medical assisting programs that offer a dual enrollment option, 80 of them offer less than 25% of the program to high school students, with much small numbers that offer more of the program. Description of Dual Enrollment ProgramPrograms described the general design of the dual enrollment program. As the later comments indicate, there is no one model for a dual enrollment program, as it is shaped by the local environment. Major DisadvantagesDue to the variety of structures of dual-enrollment programs, the disadvantages are often very specific to the particular program, but below is a summary of the comments. There were respondents who indicated that there were no disadvantages. OtherRemaining compliant with accreditation standardsDifficulty with communication and standardization between postsecondary institutions and high schools. Students are not necessarily committed to the medical assisting program, using the course as a stepping stone. The scheduling can be a problem between the postsecondary institution and the high school. Parents and students don’t always understand the postsecondary requirements. Finding clinical sites that will accept students under 18 as well as limits on what they are able to achieve. Length of program prevents completion on the part of high school students. Maturity level of the high school students. The major advantages of having a dual-enrollment programAgain, there is such variety in the design that the advantages are very specific. One respondent said that the design needs to be very carefully thought out. And another respondent commented that there were no advantages. But there were more general comments as well. OtherHelps high school students understand what the profession is and what it can offer. High school students are very motivated. The high school’s endorsement of the program is important. Earlier program completion for the students who continue. Percentage of dual enrollment high school students choosing to continue their studies in a post-secondary medical assisting program. The responses indicate that a dual enrollment program serving as a pipeline can vary significantly based upon the program. Number of high school students currently using the dual enrollment option within an individual programComments and helpful advice about Dual Enrollment ProgramsDual enrollment programs should offer training in professionalism, time management skills, and study skills. There needs to be a clear understanding about attendance policies. Having a clear cross referencing of the MAERB Standards with the Common Core Standards and the Health Sciences Core Curriculum would streamline the process. It is important to have an environment that helps the younger students develop their character, self-esteem, professionalism, and MA skill sets.A dual enrollment program can be a great service in providing access. Having a supportive cohort of high school students with a mentoring structure is very helpful. There needs to be clear communication with the Program Director and the high school. The high school needs to be informed when a student is not doing well. There are additional administrative details for a Program Director with a dual enrollment program and that should be acknowledged by the institution. Educating high schools and advisors about the value and importance of a community college is vital. High school students need to be screened carefully. Make sure that you check with state requirements and clinic policies about age requirements. Check in with the MAERB office to ensure that your design of a dual enrollment program follows accreditation requirements. High school students need to understand the commitment. Articulation agreements need to be clearly understood. It is helpful to start with a pilot program. Dual Enrollment: Programs without Dual Enrollment OptionsPrograms without dual enrollment optionsThe question focused on programs that currently do not have a dual enrollment options and those programs were asked if they had ever been approached about starting a dual enrollment option. As the responses indicate, out of the 326 programs in this category, the majority had not been approached. Impediments to beginning dual enrollment programsThe 35% of the programs that had conversations within their advisory committee and/or with local high schools outlined their concerns and their explorations.A number of programs reported ongoing and investigative discussions about the possibility of setting up a dual enrollment program. A number reported that their institutions put into place a pipeline for high school students that their program could benefit from such as “jump start” noncredit courses that introduce medical assisting or credit courses that focus on general topics (Digital Literacy, Culture of Health Care, Medical Terminology) in allied health. Concerns about accreditation standards and specifically retention, qualifications of teachers, psychomotor and affective competency achievement, and academic rigor inhibited the development of dual enrollment programs. A potential lack of control or oversight was also a big issue in regard to accreditation compliance. A lack of interest on the part of the institution’s administration. Logistical problems, such as location, potential financial investments, staffing, program director time, and transportation, college requirements impeded the development of these programs. The length of the program would prohibit high school students from entering to the medical assisting program. The maturity level of the high school students and the difficulty of placing them in a practicum, due to age or legal requirements, or having them achieve the practicum requirements was also a concern. Some programs reported trying a dual enrollment model and finding it unsuccessful due to logistical problems, maturity of students, student lack of preparation, scheduling conflicts, no effect on enrollment, and student lack of interest. Apprenticeship ProgramsBased upon our research and discussion, there are two types of apprenticeship programs: 1) “Relationship Apprenticeships”; in other words, the program has a relationship with a clinic, hospital, or system, and it has created an apprenticeship program as a supplement to the educational program, while simultaneously funding the students; 2) “Registered Apprenticeships, ” which are sponsored by the United States Department of Labor (), and they have very specific and formal requirements.??There are also programs that have funded partnerships in which a local organization supports specific students and specific expenses within the program.??It is very important to understand that there is no such entity as a CAAHEP-accredited apprenticeship program.? CAAHEP accredits educational programs.? There are, however, accredited programs that include an apprenticeship component.? In other words, the medical assisting program provides all the required components of a CAAHEP-accredited program: teaching and assessing the MAERB Core Curriculum; student achievement of the psychomotor and affective competencies; and the unpaid practicum.? In addition, the program has a relationship with a healthcare system, either informally or through a registered apprenticeship, in which students may, if they choose, participate in an apprenticeship.?? It is, however, an “add on” to the accredited program, not a substitution for any of the required components.Number of Programs with an apprenticeship or funded partnership programTypes of Apprenticeship ProgramsNote to MAERB Members and Sponsoring Organizations: I need to do further due diligence to verify these numbers. Design of Apprenticeship Component/Funded PartnershipThe apprenticeship component is part of a larger state grant that includes educational institutions, hospitals and clinics, and the registered apprenticeship is a component of the accredited medical assisting program.The partner is funding 100% of the student fees and costs, as the students are currently employed and desire to move up. The partner paid for half of the student’s tuition and the students worked 24 hours a week, with the pay ranging from $10 to $12 per hour, based upon experience. The partner interviewed the students to determine who would be sponsored. The students “paid back” the partner during their unpaid practicum hours. The apprenticeship students are first screened by the state organization and then coached on job skills such as professionalism, time management, and success planning. The specific health care system then interviews the students. The students enroll in classes and work with a supervisor to effectively schedule hours for the apprenticeship. At the end of the apprenticeship and the program, the graduates become full-time employees, with the requirement of remaining in the position for two years. A larger physician practice organization provides scholarship money for two MA students annually. An organization is providing a sponsorship to MA students who apply and are accepted, with a maximum of $8500 toward educational expenses; in return, the accepted students are required to work for the organization two years after graduation. A local system has developed a program in which they cover all the tuition, fees and books for a current employee who meets the requirements. The student/employee needs to maintain a 2.0 GPA. The graduate needs to commit to working for the system for three years. The program is in the midst of developing a partnership with a clinic on the advisory board. It is a non-registered apprenticeship, and it will be coordinated very closely with the curriculum. There is an institution that offers a scholarship, paying tuition, textbooks, and certification exam costs up to $10,000. The recipient needs to work for that clinic for three years. Constant communication is vitally important. Students participating in an apprenticeship component or a funded partnership programWhat types of funding do the students receiveThe programs were able to check all that apply. CommentsStudents earn an hourly wage working at the healthcare system, meeting the Department of Labor required number of hours. Students in the funded partnership receive money for tuition, fees, books, other supplies,The institution receives funds for student tuition. Students are paid for the job learning hours but not for coursework. Students are full-time, benefitted employees of the partnering facilities, and the employers pay 100% of the apprentices’ expenses for the education program. Advantages of having an apprenticeship or funded partnership programThe programs were instructed to check all that applied. Other responsesAdvisory Council relationships and community relationships are improved. The students connect with the field mentors.There are a lot of comments that the relationship is brand-new, so it is difficult to classify. Continual quality improvement of the Medical Assisting Program through constant communication with the health care system. Difficulties in implementing and maintaining an apprenticeship/funded partnership component The programs were instructed to check all that applied. Other responsesThe funding is a short-term grant, so sustainability is an issue. It has been difficult to create a manageable schedule, as the students have so many responsibilities. With funded partnerships, it is always a process to maintain the relationship. There has been a need to restructure the course layout. Programs with no apprenticeship/funded relationship programHas there been discussion with administration, advisory committee, or community partners about the possibility of an apprenticeship program?There is recent initiative within the state education system, but, at this point, the medical assisting program is not involved. It will be important to find alternate solutions, as there is so much competition for qualified medical assistants. There are concerns about having to reduce the number of instructional hours to support our state apprenticeship requirements. Adding an apprenticeship would be confusing for the students, as they are enrolled in a traditional learning program. There is the concern that the apprenticeship partner would want the program to be taught at their facility with their employees and not at the accredited campus. We want to make sure that we align with the current accreditation standards in what we would be able to provide. The fact that apprentices in a registered apprenticeship program are required to be paid makes it difficult with the CAAHEP requirement.There has been a discussion as our local organizations and partners would like to see this happen, but the resources involved and the requirements by MAERB and CAAHEP make it challenging. There is the concern that the CAAHEP-accredited program is accountable for all course objectives. We have had discussions with our local hospital about how to serve CNAs who would like to continue their education. There does not seem to be any advantage over the apprenticeship than the practicum. We were approached about an apprenticeship program, but the system decided to work with an unaccredited program. There is a concern that the students may be asked to do more than they are trained for. We are not sure how we would organize data or manage all requirements of an “add on.” Questions about Apprenticeships/Funded PartnershipsThere are a lot of logistical questions about the following:How are these established?What is the benefit? What are the problems? How would this be implemented? What responsibility does the program have in relationship to the apprenticeship? Would the program be responsible for a student legally while performing in an apprenticeship capacity? What methods work? Who precisely gets paid? How would this affect programs who partner with many local healthcare organizations? How does this affect the academics and the MAERB Core Curriculum? How can we maintain the same level of quality? When are the students in the apprenticeship? During the semesters or after the internship? Who supervises student apprenticeships? Are the competencies evaluated? Can the students perform competencies prior to being taught them? How does this affect the requirements and qualifications of faculty? Could other medical assisting programs that have this set-up share an example of their agreements? Are there any successful working models that benefit all the partners? How do we negotiate the unpaid practicum? Can a site pay a student after the unpaid practicum hours be meet? How would this affect the Annual Report form? How would an organization respond to an employee being gone for 160 hours for the internship?Does this affect the exam that the students might take? What have been some of the impediments/concerns about implementing an apprenticeship component? (Check all that apply)OtherBuilding that partnership is difficult.There is no interest from our administration and/or community partners. We are concerned about the quality of student learning. Students/employees may be utilized to use skills that they have not been trained in.It is a different vision/goal than an accredited program. It will cannibalize the current practicum sites. The time constraint would be a serious impediment.Graduates from an accredited program are job-ready. Why would they need an apprenticeship? There would be a potential conflict of interest between the employer’s ideas about the role of the medical assistant and their scope of practice/ Lack of availability of apprenticeship programs in the area. It is difficult enough to get practicum sites. It seems contradictory to have an individual employed without any credentials while they are attending a medical assisting program. Do not have enough knowledge about apprenticeships to have the discussion. I am not sure that this would work in my state. I have little interest in implementing it and/or it does not seem as if it is needed.I am concerned about the cost for the institution. We value education and skill demonstration prior to working with patients, so have resisted train-on-the job apprenticeships programs. The pressure ahs been high to entertain on the job training programsIt is hard to figure out how to make it work for all entities involved. Each of us have our own rules and regulations and it’s difficult to get these to agree/work together. The logistics would be a nightmare and we would not be able to manage with our staffing. The desire is for a fast-paced, condensed MA program. We could not fit all the competencies required in such a short time. The existing hiring practices in my community already take into account that new grads need specific training for the practice in which they are hired so there is little interest. The externship serves the purpose. What types of apprenticeship relationships or formal job pipeline relationships have you discussed either within your institution or with your advisory committee? The advisory committee has discussed the two different types of apprenticeships, but they are fairly new within our region. I have been contacted about this possibility, but the scheduling and time commitment on the part of staff makes it impossible to follow up on. There are numerous institutions in conversation with Workforce Development/Bureau of Apprenticeship departments. There are a number of programs who are in conversations with local clinics/systems. Many programs reported ongoing relationships with limited funding. Many programs reported that local clinics/systems established their own training programs. The college started a non-credit apprenticeship program, but it is not accredited. There is a lot of confusion about the two different programs. There are a lot of discussions about emerging relationships and partnerships. What questions, thoughts, ideas, and/or suggestions do you have for MAERB when considering some of the issues that were discussed in this survey. Explain to employers why they need to hire credentialed MasLet the students get paid for externship/practicum. Go into the high schools and target students who are not interested in a four-year degree. CAAHEP should require a certain number of instructional staff. It would be good to discuss the marketability of the profession and conduct a national campaign on the occupation of medical assisting. The low pay for medical assistants continues to be an issue. It would be good to see more advocacy with the clinics to increase the MA wage. Medical assisting programs tend to get the student who can’t get into nursing or respiratory therapy. We are finding that students are requesting online delivery, but we are not able to provide that. MAERB should cross-reference its curriculum with other standards to create articulation agreements. MAERB should not join in or encourage apprenticeships. We are always trying to come up with various and effective ways to offer program courses. What marketing or advertising strategies can CAAHEP/MAERB offer educational institutions to bolster enrollment?Is CAAHEP/MAERB willing to approach and partner with corporation to make the public aware of the need for talented medical assistants?If corporations are increasing the hiring of medical assistants, as compared to other nursing or allied health discipline, would their validation of the profession be helpful? Could there be some white paper published expounding upon the role of the medial assistant. Could corporations that foster medical assisting programs be allowed to offer and advertise tuition reimbursement or student loan dept pay off as an incentive to pursue medical assisting? It would be wonderful to have a list of questions to assist us in determining the applicability of a new relationship for our particular program? Enrollment is one issue, but retention is important as well and selective admission might be one option to increase enrollment. Because there are a number of exams that are allowed for the outcomes, there is confusion in the marketplace about the graduates. Is there a list of state contacts available for state funded/national apprenticeship programs? It is important to learn more about what employers really want with medical assisting. There is such a great demand, but the profession has evolved to focus primarily on the clinical skills. Decrease the competencies for administration and add more clinical based competencies. Has there been any discussion about forming a committee on wages?Has there been any discussion about on professional promotion/recruitment into accredited programs?There is the need for a clear definition of dual enrollment versus early entrance students. Our Advisory Board truly believes that medical assisting should become a licensed profession in order to be more seriously regarded by healthcare providers as well as by prospective students. We suggest that Medical Assisting become a career ladder to nursing by adding a bridge within the MAERB core curriculum such as general chemistry and organic chemistry. We would like to be able to attract more students coming straight out of high school, as the majority of our students are nontraditional. It would be nice if the AAMA could develop a video that explains and shows what CMAs do. Our admission standards have needed to change due to the smaller number of potential students and it would be good Some commercials spouting the labor departments numbers for increased demand would be very helpful. We are seeing our area discarding the requirement of the credential as there is such a great need. Make adjustments to policies within the CAAHEP Standards and Guidelines that will allow more relationships with external entities. The time needed to develop those relationships make it very difficult to move forward. Develop a shorter program guide that meets CAAHEP requirements and offers a quicker path for students to graduate from an accredited program, as we compete with much shorter programs. ................
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