Supply and Demand - Problem or Opportunity?

Team-based Care – Part I 

Are we facing a health care disaster due to an increase in demand for primary care and a decrease in availability of providers?  Should we be concerned that statistics from the Association of American Medical Colleges predict we will lack more than 60,000 physicians nationwide by 2015?  It is definitely true that the number of insured individuals is increasing due to the Accountable Care Act (ACA); baby boomers are aging and will require more medical attention; and the number of primary care physicians is decreasing.  But the prognosis isn’t necessarily grim as this imbalance of supply and demand creates opportunities for new health care delivery systems. 

Innovative hospitals and practices are exploring higher quality, lower cost delivery systems that involve other professionals including mid-level providers such as nurse practitioners (NPs) and physician assistants (PAs) to provide patient care.  These organizations are moving away from the traditional one-on-one doctor/patient relationship and moving toward physician-led team-based care.  The supervising physician provides oversight for the overall patient care, but the team relieves the physician of many of the responsibilities he or she would have handled previously. 

Health care organizations—and the physicians within them—must re-evaluate the way they work.  If the task does not require the level of training and knowledge of the physician then delegate it—realign duties to other members of the care team.  Use technology and office staff to complete clerical tasks.  Allow nurses to perform routine duties and complete necessary processes.  Capitalize on the education of NPs who have been trained in disease management and wellness.  Allow others on the team to order tests, prescribe medications, and manage chronic diseases.  In a nutshell, when the patient need doesn’t require a physician, let the team member best suited for the job address the need.

There are many delivery models being implemented that support a team-based care approach—accountable care organizations, patient-centered medical homes and retail clinics to name a few.  The challenge for hospitals and physician practices is to create a collaborative and highly communicative culture that best leverages all the skills on the team and allows team ownership of patient care. That’s the opportunity for building a healthier patient population, driving down the cost of care, and finding profitability in the new reimbursement models. 

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