The next time your turn comes up at the doctor’s office and you are told that “The doctor will see you now”, don’t be surprised if this turns out to mean that “The nurse, doctor, pharmacist and dietitian will see you now”.

We are currently living in an era where the conventional role of a doctor has started to be refined and redefined. Healthcare appointments have increasingly become a team sport rather than a one-man show. Duties normally expected to be performed by a doctor have now begun to be delegated to other members of the medical team – e.g. nurses, medical assistants, pharmacists and nutritionists. While it is still the professional that makes primary medical decisions, the doctor of the future is someone who also oversees the work of a team of other medical professionals.

The new team-based healthcare model

The new model of a physician-led healthcare team is based on the premise of deploying medical professionals more efficiently, while avoiding unnecessary services and errors. Delegating work across members of the healthcare team can cut costs, reduce doctors’ typical daily workload as well as keeping the productivity of team members going. Based on the new model, a patient who comes in for an appointment might first sit down with a nurse or medical assistant who would ask questions about symptoms or medical history – a routine normally performed by the doctor, himself. When the doctor arrives, the medical assistant would be responsible in taking notes and orders for tests and services, such as physical therapy, and finally ensures that the patient understands the doctor’s instructions.

This is the routine for patients who see Dr C.T. Lin, who works at a clinic in Denver, United States. The work delegation allows Lin to stay focused on his primary job – listening to patients and solving problems. “Now I’m just left with the assessment and the plan – the medical decisions – which is really my job,” said Lin.

In a team-based approach, patients will interact with personnel that are specialised in their scope of medical field, such as clinical pharmacists who would monitor the patient’s medication or nutritionists and dieticians who would provide consultation on proper nutrition and diet.

The slippery slope

Needless to say, the idea of different personnel working together and contributing their own skills and expertise definitely has its pluses and gains. However, how conveniently would doctors and patients adapt to this evolutionary model?

Results from the 2012 American Medical Colleges’ Consumer Survey showed that 50% of the patients who participated preferred to see the physician, while only 25% preferred to see physician assistants or nurse practitioners.

The shift to a team approach is not necessarily easy for doctors, either. Dr Lin who is also the Chief Information Officer for UCHealth, the University of Colorado-affiliated system where he works, understands that change is hard. It took him some getting used to having his assistant, Becky Peterson in the examination room. “Like many doctors, I have a fear of letting go of all the things I traditionally do,” he said.

Yet, another concern is the risks that may arise when patients are handled by less-experienced personnel. Dr Prakash Masand, a board-certified psychiatrist based in New York and also the CEO of Global Medication Education, criticised the increasing role of physician assistants in mental health care, where they receive only six to 12 weeks of psychiatric training in school. “This is one of the reasons misdiagnoses, under-diagnoses and the over-prescription of antidepressants have flooded the mental health system. Until PAs (physician assistants) receive more specialised training, they shouldn’t handle patients who need a much more experienced doctor.”

According to the 2012 American Medical Colleges’ Consumer Survey, 50% of the patients who participated preferred to see the physician, while 25% preferred to see physician assistants or nurse practitioners. Photo credit: Politico
According to the 2012 American Medical Colleges’ Consumer Survey, 50% of the patients who participated preferred to see the physician, while 25% preferred to see physician assistants or nurse practitioners. Photo credit: Politico


Striking a balance for efficiency

In reality, as with other evolutionary shifts that have occurred in various fields, keeping proper check and balance is the key to ensure efficiency. Careful coordination is vital to avoid conflicts and mismanagement. In the case of UCHealth, patients seem to be fine with the change employed through the new model. Although a few will seek to speak privately to their doctor, others are more open with the medical assistant than the doctor. “Sometimes, they don’t feel as judged,” said Peterson.

There is no guarantee that implementing this new approach is going to be easy. However, as the dynamics of the healthcare system are only expected to accelerate in the future, change is almost inevitable and this has to be acknowledged by the medical community. “We’re all challenged to recognise some new truths. I was a solo family physician in a small town called Trenton, Georgia, and there’s a badge of honour about that. But the reality is that no one in our current health care system is truly solo or truly independent anymore,” echoed Dr Reid B. Blackwelder, president of the American Academy of Family Physicians. MIMS

Read more:
4 essential tips for a successful medical team meeting
4 reasons teamwork is so crucial in a healthcare setting
When doctors and nurses collide: How can the differences be resolved?

Sources:
http://www.politico.com/agenda/story/2017/10/25/role-of-physician-in-healthcare-000554
https://www.huffingtonpost.com/entry/team-approach-to-health-care-means-new-role-for-doctors_us_59f09780e4b02ace788ca8fb
https://www.nytimes.com/2014/08/03/education/edlife/the-physician-assistant-will-see-you.html
http://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1150