In the discussion about the expanding roles of nurse practitioners (NP) and physician assistants (PA) in medical practices, there's little agreement that any one level of education, supervision requirement or scope of practice for any particular type of nonphysician practitioner (NPP) is the best approach to ensuring high-quality, cost-effective patient care.
But amidst debate over these details, healthcare organizations risk getting lost on their way to achieving team-based care. In a recent post for Physicians Practice, for example, blogger Jennifer Frank, M.D., described a dilemma that is hardly unique.
"I have no concerns with one of the advanced practitioners seeing one of my complex patients as I trust their medical judgment," she wrote. "However, we don't coordinate or collaborate on care as well as we should; they function more like a physician colleague than a team member. As such, I suspect we lose some of the potential power in their role. Patients would likely feel more confident about seeing them instead of me if they knew that we worked closely together."
Meanwhile, an article from Medscape Business of Medicine not only explores many policy-level issues surrounding NPPs in depth, but also offers insights into how practices can overcome turf battles and work together more productively. For instance:
- Frequent facetime. Although physicians are expected to lead the clinical teams at Group Health Cooperative, a healthcare system in Seattle with 1,100 physicians, members are taught to value one another's expertise, according to David Kauff, M.D., who is in charge of team building within the group. Teams are therefore instructed to huddle one to two times daily to share concerns about patients. "It's an egalitarian way for each member to have a say," Kauff said. Moreover, these valuable interactions need only consume five to 15 minutes of office time per day.
- Divide, conquer and communicate. While some practices give NPPs their own patient panels, others prefer to match providers according to the type of care needed. At Group Health Cooperative, for example, PAs might be in charge of tasks such as stitching lacerations or building casts, while physicians handle care that requires their specific expertise. Regardless of your approach, make sure to define and communicate such roles clearly to team members.
- Choose productive language. At a 2008 meeting in which the American College of Physicians (ACP) invited the American Association of Nurse Practitioners to discuss common goals, all participants agreed to avoid words like supervision, autonomy and independence, according to Yul David Ejnes, M.D., an internist in Cranston, Rhode Island, and a past ACP chair. "Those words make everything grind to a halt," he said.