Table 1 Medical assistant desired career trajectories and recommended path for advancement by cluster

“Springboard” medical assistants

These individuals pursue an MA role as one step along a path to obtain a higher level license in healthcare

“I’m going to be going into nursing school, so I’m using medical assisting as a stepping stone, to get where I want to be, and also have a good resume. So, I really like it.

Facilitator: Because it’s hard to get into nursing school?

MA: Right. And also saving up money. (MA 4, FG 10)

“I know some people want to be nurses. They’re not quite sure that they want to be an RN and be that committed. So, they try to be a medical assistant, and if that goes well, they go to the next step.”(MA 7, FG 6)

“I actually want to become a primary school teacher, so this is just to save money for school. And then I’m going to go back to school… So I wanted to become an RN, but I kind of got sick of healthcare and I want to do something different.” (MA 5, FG 10)

Offer generous post-training work agreements for loan-forgiveness

Reported loan-forgiveness at one institution in evaluation

“MA9: There’s an agreement, where you have to stay with [health system], for a certain amount after, or you would have to pay them back…I would say three years… It’s like 1%.

Interviewer: Okay, so it’s 1% of tuition cost, but in order to not pay that back, you have to work for them for three years?

MA9: Right.” (MA9, FG10)

Work with local training programs to build work-study program

“…like even any leadership position or training position you have to have a BA or a BS or something like that to move up for those, so that’s where the struggle is for that, especially with the hours that we work it’s hard to do schooling to completely finish a program without leaving your job position.” (MA 2, FG 1)

“Career” medical assistants

These individuals are not interested in receiving additional training to move out of the MA role; some are interested in growing within their careers as MAs.

“MA2: I know I don’t want to be a nurse, so I’m not going to go to school for that. Would I love to make more money? Sure. Do I love my schedule here? Yes. I work four 10s, Fridays off, don’t work holidays, don’t work weekends. I don’t want to go to graveyard. I don’t want to go to weekends. I don’t want to be on call...I mean I know it’s not the best thing to do but right now I’m happy and comfortable. My bills are paid….

MA4: If you love the provider you work with, you have the perfect schedule and you’re not totally getting crappy pay then that’s a comfortable spot to be in.” (MA2, MA4, FG7)

“I actually literally got into a discussion with an RN who told me that us MAs are nurse wannabes that couldn’t cut it. I was like ‘How insulting’. First off, we do this for a reason…we love the clinic setting. I said ‘you couldn’t step into my clinic and do what I did no more than I could step in and run your machines…You just couldn’t, I don’t care what your degrees.’ It’s different but the pay differences is ridiculous but what we do is equally as important as what they do. We’re not nurse wannabes. I wouldn’t be a nurse over an MA.” (MA3, FG9)

Hire medical assistants into internal administrative roles

“I don’t know it was this year or last year, but I had heard that there was some clinic, somewhere, that [INSTITUTION] had actually hired a medical assistant as an assistant manager, and I think for a little while that was kind of motivating. Because you’re like, ‘Oh, we can actually do that?’… there’s a lot of people that are medical assistants that are actually striving to be management.” (MA3, FG4)

Offer medical assistants designated time to specialize in new responsibilities

“MA3: At my other clinic [prior to switching to current clinic] I very well would have been the managing MA that writes the schedule, covers the docs.

Interviewer: So that would have been motivating for you?

MA3: Oh, absolutely…Because with that came a pay raises as well.” (MA3, FG9)