Practice Notes

Do doctors support team-based care? It's complicated.

William Hudec

At its annual meeting in earlier this month, the American Medical Association (AMA) reaffirmed its support for team-based care. 

Despite conciliatory language, the AMA’s statement will likely receive renewed criticism from the American Association of Nurse Practitioners (AANP) for the AMA’s inclusion of a key qualifier – “physician-led.” The AANP has historically countered the AMA’s claim that physicians are best suited to lead care teams.

Disagreements between professional associations are nothing new, and the team-based care debate serves as a proxy of broader sentiments across advanced practitioner (AP) and physician provider groups. However, they can be a helpful indicator for medical groups faced with the challenges of a looming PCP shortage, an influx of millions of newly insured patients due to the Affordable Care Act, and substantial "scope of practice" barriers that prevent full utilization of the care team.

The argument against 'physician-led'

The AMA argues that team-based care should be "physician-led," but many of our most progressive members have identified effective strategies that are less hierarchical, including AP-led care teams and joint ownership of patient panels between APs and physicians.

In researching for our study, Realizing Full Value of the Care Team, we found that medical groups that struggle to incorporate APs effectively suffer from the same underlying issue: lack of consensus regarding the proper clinical and organizational role for APs.

Innovative medical groups are addressing this challenge by:
  • Determining the clinical functions that can be delegated to APs
  • Establishing clear rules for collaboration between physicians and APs
  • Realigning oversight structures to promote effective management of AP clinical performance.

Strengthening AP-physician relationships

In one notable example, Wenatchee Valley Medical Center, a 200-physician, 100-AP independent group based in Wenatchee, Wash., required PCPs and APs to jointly compose an annual formal supervision agreement. 

Unlike a collaborative practice agreement that prescribes the AP’s scope of practice, this document delineates the physician’s commitments as a manager, not as a clinician. The AP and physician collaborate to update the supervision agreement to ensure that supervision provisions continue to reflect the AP’s professional development.

When medical groups give APs more autonomous roles, physicians prioritize patients who need a higher level of clinical expertise and access improves across the practice. 

We suggest that medical groups implementing team-based care focus less on the type of provider best-suited for "leadership," and more on putting patients at the center of care.

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