Table 3 Qualitative studies capturing psychosocial working conditions among medical assistants in Germany (2002–2022)

[51]

Ehlers-Mondorf et al.

2021

34

Qualitative, cross-sectional; semi-structured interviews

To present the experience of MA with the SARS-CoV-2 pandemic and address their suggestions for improvement of pandemic preparation

Teamwork

More workload and stressors for MA due to the SARS-CoV-2 pandemic. MA felt that their role as first contact persons for patients during the pandemic did not receive sufficient recognition

Billing issues

Unstructured information flow

Lack of appreciation

[52]

Gensinchen et al.

2009

26

Qualitative, cross-sectional; semi-structured interviews

To describe the perceptions and experiences of MA who provided case management to patients with depression in small primary care practices

Role perception

MA’s role as case managers was perceived as personally and professionally enriching. Integrating case management in daily work was difficult for many MA because of insufficient time, unexpected patient-related factors, and lack of understanding by colleagues and supervisors. Relationships with patients were especially important for MA and could be both a burdening and a relieving factor. The interaction with depressive patients was described as difficult and demanding. General practitioners support or lack thereof influenced the perceived stress. Incomplete knowledge on depression increased strain

Burdening and relieving factors

Interaction with depressed patients

Collaboration with doctor

Disease conception

[53]

Hoffmann et al.

2022

12^v

Qualitative, cross-sectional; semi-structured interviews

To present the qualitative results from the process evaluation of an intervention for COVID-19 surveillance and care for COVID-19 patients with increased risk used by VERAHs (specially qualified MA) and general practitioners

Sense of security

The implementation of the intervention gave MA a sense of security and support. MA emphasized additional workload as particularly negative because the intervention added additional tasks and strain in the already tightly organized daily practice. Fear for additional workload and overtime was uttered before the intervention was implemented. Some MA were overwhelmed by the workload during the pandemic, the time required to implement the intervention was considered a major problem

Workload and overtime

Job satisfaction

[54]

Kathmann et al.

2013

10

Qualitative, cross-sectional; semi-structured interviews with MA^a, expert interviews

To explore the degree of precarity of the MA job through an examination of working conditions

Precarious work

Low salary most central aspect in the precarity of the MA profession. MA dissatisfied with their low salary (main reason to quit the profession). Comparison with other professions (doctors, nurses) in terms of salary and social standing/ recognition leads to disappointment and dissatisfaction, also with their supervisors/employers. Overtime is considered to have a strong impact on private life, restricting MA’s social sphere and leisure time and leading to desire to have flexible working hours. MA reported a limited scope of action regarding negotiation of working hours and salary. Further qualifications considered to barely have an impact on salary or career prospects

[38]

Mergenthal et al.

2012

6

Qualitative, cross-sectional; semi-structured interviews

To explore the role of MA with a migration background in the general practices

Setting GP^rpractice (e.g. work and role distribution)

MA with migration background experience ad-hoc interruptions to take over unplanned activities such as translating. They assume the role of translators and cultural mediators. Help or translation is often requested by patients or physicians. The interviewed MA felt integrated into the family practice setting and reported no additional stress or resources emerging from the additional tasks they were assigned due to their migration background

Communication and interaction with patients

Language connection

[55]

Preiser et al.

2021

19^w

Qualitative, cross-sectional; participant observation, semi-structured interviews and focus group discussions

To answer how GP fulfill their role as entrepreneurs and leaders responsible for the occupational safety of their employees regarding the organization of working time, and what psychosocial demands and resources result from the way how working time for practice teams is organized

Work content and task

“Unplannable” events considered part of the daily routine during consultation hours and lead to perceived psychological stress for GP and the practice team. MA expressed satisfaction with the flexibility of different working time models and the GP’s overall willingness to adjust working time models and hours to their needs. The immediate treatment of patients was favored over predictable working times for MA and GP, as a result taking lunch breaks or finishing work on time was raised as challenging by MA. MA rarely took mini-breaks, the authors associated this observation not with a high workload, but with the design of the workplace. The practice staff described mutual social support when planning individual vacations

Organization of work

Working environment

New forms of work

[56]

Rothe, M.

2019

Qualitative (partly quantified), cross-sectional; semi-structured interviews

To examine the role understanding, perceptions, feelings and scope of action of MA dealing with “difficult” and psychosomatic ill patients in general practices

Stressors and facilitators

MA reported stress due to high workload, high time pressure, a high amount of administrative work and confidentiality. The behavior of colleagues, human resources planning complicating work (e.g. sick leave) and behavior of some patients were also considered stressors. A lower workload, structured work, support from supervisor, collegiality and nice patients were considered facilitators. High satisfaction (quantified) was reported for support from colleagues and support from supervisor. The latter was considered to be very important

Perceived support by supervisor and team

[57]

Tasrouha et al.

2020

1920

Qualitative, cross-sectional; participant observation and focus group discussions

To gain an in-depth understanding of psychosocial demands and resources in the primary care setting

Work content and tasks

The key psychological demands observed were incomplete execution of tasks, frequent interruptions, high levels of work intensity, simultaneous processing of several tasks, and tightly coupled work processes. Also noise, missing/ unsuitable/unused/incorrectly used equipment/software and the feeling of being under constant observation were important demands. Key resources mentioned were an appropriate scope of action though influence on the sequence of activities and sufficient patient-related information. The possibility to take mini-breaks and efficient communication and cooperation within the team (e.g. clearly defined responsibility areas in the laboratory) were important resources. A positively perceived teamwork and a supportive working environment (e.g. access to suitable workstations, equipment and software) were further reported as important resources

Organization of work

Working environment

New forms of work

[58]

Vu-Eickmann et al.

2017

26

Qualitative, cross-sectional; semi-structured interviews

To gain in-depth insights into MA^a work stress and resources, as well as prevention options for intervention needs

Key stressors

The perceived job-related stress is overall very high. Very quiet periods at work alternate with work-intensive periods. Factors contributing to (high) workload: high patient volume with a simultaneous shortage of staff, increased documentation effort, inefficient practice organization, inability to take breaks (leading to physical and mental strain), considerable overtime, which is not compensated. Unforeseeable events lead to low job control. These arise from frequent interruptions of work processes and the requirement of multi-tasking (e.g. through phone calls, physicians concerns or emergency patients, technical problems and missing materials). Collaboration can be a stressor (e.g. supervisor who interrupts work process of MA, unpredictable or emotionally short-tempered employer, lack of support within the team, negative change in patient attitudes and expectations) or a resource (positive patient interaction, interaction with colleagues and social support, a supporting supervisor). Everyday work (broad and varied range of activities, a certain scope of action in the own core areas) is considered a key resource. Desired improvement needs include: higher salary, greater recognition (by society, patients and supervisors), improvement of the staff: patient ratio, more regulated working hours, reduced documentation, lower hierarchical structure (with supervisor), continuing education and training opportunities for physicians (organizational leadership)

Key resources

Desired improvement needs

[59]

Werdecker et al.

2022

15

Qualitative, cross-sectional; semi-structured interviews and observations

To explore what contributes to the feeling of happiness among general practitioners’and their staff in the work context

Teamwork

Teamwork was observed to be important for physicians and staff in terms of work satisfaction, collegial support, broad scope of action to complete tasks are considered important for teamwork. Laughing together, trust shown for the design of one’s own working area in the non-physician team (e.g. laboratory, registration desk) was perceived as appreciative and contributed to a feeling of happiness. Team meetings were perceived as valuable instruments for strengthening collegial cooperation, as well as exchange within the team to handle difficult and stressful situations. Long-lasting intensive relations with patients and fitting between patient and team seemed to contribute to harmony in daily work. Feedback from patients on the effectiveness or the observation of a positive development as well as gratitude from patients also considered to contribute to the happiness and satisfaction of MA^aat work

Relationship with patients

Patient fit

Effectiveness of one’s own actions, success and recognition