This article touches on what I believe will be one of the biggest barriers to expanding primary care in the short term. Regardless of how many incentives are implemented to encourage more med students to become primary care physicians, this influx in the workforce won’t happen overnight. Hopefully in the long term a more equitable balance will be struck between generalists and specialists, but this outcome is years off in the best of scenarios. So focus has naturally shifted towards expanding the roles of non-physician providers, such as nurses, PA’s, and NP’s, to relieve some of the stresses on current PCPs and expand the availability these services. It seems like a fairly reasonable idea to me, but the response to this suggestion, particularly from physician groups, has largely been tepid. The position paper by the IOM and the response from the ACP provides a good snapshot of the ongoing debate. In many ways, it appears physicians want it both ways. Much has been made of the ever increasing demand placed on these providers, but many appear unwilling to relinquish some of their more basic duties to other providers. As we see in the ACP’s position, they support the idea of medical homes and increased utilization of support staff, but they do so with a myriad of caveats. Much of this debate has been conducted under the guise of maintaining and insuring quality of care for all patients, but I can’t help but wonder what role things like market share and preservation of superiority within the medical field have are playing when these groups express their concerns. No one is suggesting that NP’s or PA’s are as well educated or as thoroughly trained as doctors, although the ACP’s response does do a thorough job of clarifying this point. But I think the country as a whole needs to make an honest assessment of what exactly constitutes primary care what qualifications are best suited to providing it. In the presentation by Dr. Parkinson, he claimed that somewhere around 50% of all PCP visits are unnecessary. If this is case, why not allow non-physician providers, whose time is less valuable than a physician’s, to serve as the initial contact with the patient and potentially screen out some of these frivolous visits. Furthermore, much of primary care centers on behavior modification. I will once again cite Dr. Parkinson, who points out that this is not what doctors are primarily trained to do. The process of changing life-long bad habits is long , slow, and time consuming. A person going through this process needs many things, but the most important factor is likely just support. Should we really be paying PCP’s at the rate they feel they should be getting paid to be a cheerleader? Physicians are some of the most well-trained and best educated resources we have in our society. With this in mind, I believe that we should use this resource in the most efficient way possible. I believe enabling non-physician clinicians to have an expanded role in the delivery of health care will allow this to happen, thereby reducing health care cost, expanding access, and improving working conditions for PCP’s. As the ACP states, “Physicians, nurses, APRNs, and physician assistants need to be trained to know when they should refer or hand-off a patient to a clinician with a different level of skill and training.” The authors of this line were only referring to the referral of a patient upward, to a clinician with a higher level of expertise, but the exact same logic applies to the hand-off of straightforward patient to someone with less training and education. I’m sure this omission was just an oversight on their part… hopefully one that will be corrected in the future.
This article touches on what I believe will be one of the biggest barriers to expanding primary care in the short term. Regardless of how many incentives are implemented to encourage more med students to become primary care physicians, this influx in the workforce won’t happen overnight. Hopefully in the long term a more equitable balance will be struck between generalists and specialists, but this outcome is years off in the best of scenarios. So focus has naturally shifted towards expanding the roles of non-physician providers, such as nurses, PA’s, and NP’s, to relieve some of the stresses on current PCPs and expand the availability these services. It seems like a fairly reasonable idea to me, but the response to this suggestion, particularly from physician groups, has largely been tepid. The position paper by the IOM and the response from the ACP provides a good snapshot of the ongoing debate. In many ways, it appears physicians want it both ways. Much has been made of the ever increasing demand placed on these providers, but many appear unwilling to relinquish some of their more basic duties to other providers. As we see in the ACP’s position, they support the idea of medical homes and increased utilization of support staff, but they do so with a myriad of caveats. Much of this debate has been conducted under the guise of maintaining and insuring quality of care for all patients, but I can’t help but wonder what role things like market share and preservation of superiority within the medical field have are playing when these groups express their concerns.
(Continued from above) No one is suggesting that NP’s or PA’s are as well educated or as thoroughly trained as doctors, although the ACP’s response does do a thorough job of clarifying this point. But I think the country as a whole needs to make an honest assessment of what exactly constitutes primary care what qualifications are best suited to providing it. In the presentation by Dr. Parkinson, he claimed that somewhere around 50% of all PCP visits are unnecessary. If this is case, why not allow non-physician providers, whose time is less valuable than a physician’s, to serve as the initial contact with the patient and potentially screen out some of these frivolous visits. Furthermore, much of primary care centers on behavior modification. I will once again cite Dr. Parkinson, who points out that this is not what doctors are primarily trained to do. The process of changing life-long bad habits is long , slow, and time consuming. A person going through this process needs many things, but the most important factor is likely just support. Should we really be paying PCP’s at the rate they feel they should be getting paid to be a cheerleader? Physicians are some of the most well-trained and best educated resources we have in our society. With this in mind, I believe that we should use this resource in the most efficient way possible. I believe enabling non-physician clinicians to have an expanded role in the delivery of health care will allow this to happen, thereby reducing health care cost, expanding access, and improving working conditions for PCP’s. As the ACP states, “Physicians, nurses, APRNs, and physician assistants need to be trained to know when they should refer or hand-off a patient to a clinician with a different level of skill and training.” The authors of this line were only referring to the referral of a patient upward, to a clinician with a higher level of expertise, but the exact same logic applies to the hand-off of straightforward patient to someone with less training and education. I’m sure this omission was just an oversight on their part… hopefully one that will be corrected in the future.
This article briefly presents the statements and perspectives from the medical professionals toward the future role of nursing. It seems that the necessity and urgency of quality of care and the strong commitment to fulfill this mission are gradually elevating the thresholds of willingness of collaboration and respects within field of health care. Despite of the technical difficulties in implementation, the response itself is desirable and may be a good sign for better performance.
In the age of tremendous shortage of primary care physicians, which as Brian has indicated will not witness any one night dramatic improvement, it is reasonable to extend the role of other related professionals to reduce the gap and guarantee the comprehensiveness, patient-centered care by a qualified team work. However, this must be based on the corresponding enhancement of education as well as general consensus on the potential collaboration among traditional medical service providers. Make sure the real qualified will be recruited; then make a promise of harmonious and inspiring work environment. The other related health professionals such as different levels of nurses and PA’s or even social workers should not be only considered as substitutes for filling the gap where services are thought to be less skillful. I believe every stage of care deals with unique features and qualifications, and requires sufficient and thorough engagement to draw a whole picture of quality of care. They should not compete with each other, or underestimate the others’ values just because less of education and training in the field other than their own realm.
It is exciting to see that more and more physicians are aware of the importance and greater chances of success by effectively collaborating with other health professionals. But I am just worried about the implementation of such advocacy. First, both the government and public should be endeavored enough to continuously support the enlargement and enhancement of advanced education in these fields. Second, technically, schools of nursing should find ways to modify their education to meet with the new standards of quality of care in nursing. It is basically the graduate’s obligation to be capable enough to fulfill the new commitments. Third, there should be a favorable environment to build a stage for the full achievement of career commitments. This requires an adaptive system with great efficacy in absorption and integration of powers from different stakeholders to maximize the benefits. There should be modification of medical education as well. Medical students should be educated more in the importance of patient-centered care and team work. It will be dangerous if physicians were boiled to conceive themselves as the elite of the most superior hierarchy, though they deserve that. Many medical malpractices could have been prevented at the initial stage if suggestions from the other practitioners were taken seriously. Finally, there should be enough public trust toward the quality of medical care by these practitioners other than physicians. No single efforts can satisfactorily achieve any of the stage above. Introduction campaign by mass media, evidence-based research on quality of care by these practitioners, continuous postgraduate education in the clinical settings may all contribute to the successful team work practices.
It should be a long journey and challenging for both physicians and other health professionals to redefine their role of practice and find a way for both of them to feel comfortable to collaborate with each other. But the greater demand in chronic, comprehensive and coordinated care functions as a momentum for the reform and makes it deserve for the overall improvement of health system.
This article touches on what I believe will be one of the biggest barriers to expanding primary care in the short term. Regardless of how many incentives are implemented to encourage more med students to become primary care physicians, this influx in the workforce won’t happen overnight. Hopefully in the long term a more equitable balance will be struck between generalists and specialists, but this outcome is years off in the best of scenarios. So focus has naturally shifted towards expanding the roles of non-physician providers, such as nurses, PA’s, and NP’s, to relieve some of the stresses on current PCPs and expand the availability these services. It seems like a fairly reasonable idea to me, but the response to this suggestion, particularly from physician groups, has largely been tepid. The position paper by the IOM and the response from the ACP provides a good snapshot of the ongoing debate.
ReplyDeleteIn many ways, it appears physicians want it both ways. Much has been made of the ever increasing demand placed on these providers, but many appear unwilling to relinquish some of their more basic duties to other providers. As we see in the ACP’s position, they support the idea of medical homes and increased utilization of support staff, but they do so with a myriad of caveats. Much of this debate has been conducted under the guise of maintaining and insuring quality of care for all patients, but I can’t help but wonder what role things like market share and preservation of superiority within the medical field have are playing when these groups express their concerns.
No one is suggesting that NP’s or PA’s are as well educated or as thoroughly trained as doctors, although the ACP’s response does do a thorough job of clarifying this point. But I think the country as a whole needs to make an honest assessment of what exactly constitutes primary care what qualifications are best suited to providing it. In the presentation by Dr. Parkinson, he claimed that somewhere around 50% of all PCP visits are unnecessary. If this is case, why not allow non-physician providers, whose time is less valuable than a physician’s, to serve as the initial contact with the patient and potentially screen out some of these frivolous visits. Furthermore, much of primary care centers on behavior modification. I will once again cite Dr. Parkinson, who points out that this is not what doctors are primarily trained to do. The process of changing life-long bad habits is long , slow, and time consuming. A person going through this process needs many things, but the most important factor is likely just support. Should we really be paying PCP’s at the rate they feel they should be getting paid to be a cheerleader?
Physicians are some of the most well-trained and best educated resources we have in our society. With this in mind, I believe that we should use this resource in the most efficient way possible. I believe enabling non-physician clinicians to have an expanded role in the delivery of health care will allow this to happen, thereby reducing health care cost, expanding access, and improving working conditions for PCP’s. As the ACP states, “Physicians, nurses, APRNs, and physician assistants need to be trained to know when they should refer or hand-off a patient to a clinician with a different level of skill and training.” The authors of this line were only referring to the referral of a patient upward, to a clinician with a higher level of expertise, but the exact same logic applies to the hand-off of straightforward patient to someone with less training and education. I’m sure this omission was just an oversight on their part… hopefully one that will be corrected in the future.
This article touches on what I believe will be one of the biggest barriers to expanding primary care in the short term. Regardless of how many incentives are implemented to encourage more med students to become primary care physicians, this influx in the workforce won’t happen overnight. Hopefully in the long term a more equitable balance will be struck between generalists and specialists, but this outcome is years off in the best of scenarios. So focus has naturally shifted towards expanding the roles of non-physician providers, such as nurses, PA’s, and NP’s, to relieve some of the stresses on current PCPs and expand the availability these services. It seems like a fairly reasonable idea to me, but the response to this suggestion, particularly from physician groups, has largely been tepid. The position paper by the IOM and the response from the ACP provides a good snapshot of the ongoing debate.
ReplyDeleteIn many ways, it appears physicians want it both ways. Much has been made of the ever increasing demand placed on these providers, but many appear unwilling to relinquish some of their more basic duties to other providers. As we see in the ACP’s position, they support the idea of medical homes and increased utilization of support staff, but they do so with a myriad of caveats. Much of this debate has been conducted under the guise of maintaining and insuring quality of care for all patients, but I can’t help but wonder what role things like market share and preservation of superiority within the medical field have are playing when these groups express their concerns.
(Continued from above)
ReplyDeleteNo one is suggesting that NP’s or PA’s are as well educated or as thoroughly trained as doctors, although the ACP’s response does do a thorough job of clarifying this point. But I think the country as a whole needs to make an honest assessment of what exactly constitutes primary care what qualifications are best suited to providing it. In the presentation by Dr. Parkinson, he claimed that somewhere around 50% of all PCP visits are unnecessary. If this is case, why not allow non-physician providers, whose time is less valuable than a physician’s, to serve as the initial contact with the patient and potentially screen out some of these frivolous visits. Furthermore, much of primary care centers on behavior modification. I will once again cite Dr. Parkinson, who points out that this is not what doctors are primarily trained to do. The process of changing life-long bad habits is long , slow, and time consuming. A person going through this process needs many things, but the most important factor is likely just support. Should we really be paying PCP’s at the rate they feel they should be getting paid to be a cheerleader?
Physicians are some of the most well-trained and best educated resources we have in our society. With this in mind, I believe that we should use this resource in the most efficient way possible. I believe enabling non-physician clinicians to have an expanded role in the delivery of health care will allow this to happen, thereby reducing health care cost, expanding access, and improving working conditions for PCP’s. As the ACP states, “Physicians, nurses, APRNs, and physician assistants need to be trained to know when they should refer or hand-off a patient to a clinician with a different level of skill and training.” The authors of this line were only referring to the referral of a patient upward, to a clinician with a higher level of expertise, but the exact same logic applies to the hand-off of straightforward patient to someone with less training and education. I’m sure this omission was just an oversight on their part… hopefully one that will be corrected in the future.
This article briefly presents the statements and perspectives from the medical professionals toward the future role of nursing. It seems that the necessity and urgency of quality of care and the strong commitment to fulfill this mission are gradually elevating the thresholds of willingness of collaboration and respects within field of health care. Despite of the technical difficulties in implementation, the response itself is desirable and may be a good sign for better performance.
ReplyDeleteIn the age of tremendous shortage of primary care physicians, which as Brian has indicated will not witness any one night dramatic improvement, it is reasonable to extend the role of other related professionals to reduce the gap and guarantee the comprehensiveness, patient-centered care by a qualified team work. However, this must be based on the corresponding enhancement of education as well as general consensus on the potential collaboration among traditional medical service providers. Make sure the real qualified will be recruited; then make a promise of harmonious and inspiring work environment. The other related health professionals such as different levels of nurses and PA’s or even social workers should not be only considered as substitutes for filling the gap where services are thought to be less skillful. I believe every stage of care deals with unique features and qualifications, and requires sufficient and thorough engagement to draw a whole picture of quality of care. They should not compete with each other, or underestimate the others’ values just because less of education and training in the field other than their own realm.
It is exciting to see that more and more physicians are aware of the importance and greater chances of success by effectively collaborating with other health professionals. But I am just worried about the implementation of such advocacy. First, both the government and public should be endeavored enough to continuously support the enlargement and enhancement of advanced education in these fields. Second, technically, schools of nursing should find ways to modify their education to meet with the new standards of quality of care in nursing. It is basically the graduate’s obligation to be capable enough to fulfill the new commitments. Third, there should be a favorable environment to build a stage for the full achievement of career commitments. This requires an adaptive system with great efficacy in absorption and integration of powers from different stakeholders to maximize the benefits. There should be modification of medical education as well. Medical students should be educated more in the importance of patient-centered care and team work. It will be dangerous if physicians were boiled to conceive themselves as the elite of the most superior hierarchy, though they deserve that. Many medical malpractices could have been prevented at the initial stage if suggestions from the other practitioners were taken seriously. Finally, there should be enough public trust toward the quality of medical care by these practitioners other than physicians. No single efforts can satisfactorily achieve any of the stage above. Introduction campaign by mass media, evidence-based research on quality of care by these practitioners, continuous postgraduate education in the clinical settings may all contribute to the successful team work practices.
It should be a long journey and challenging for both physicians and other health professionals to redefine their role of practice and find a way for both of them to feel comfortable to collaborate with each other. But the greater demand in chronic, comprehensive and coordinated care functions as a momentum for the reform and makes it deserve for the overall improvement of health system.
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