The Doctor’s Team Will See You Now

A visit to the doctor may mean seeing someone else instead.

An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases.

“I can’t possibly do everything that needs to be done for our patients as a single human being,” says Kirsten Meisinger, supervising physician for a team of between nine and 11 medical professionals at the Union Square Family Health Center in Somerville, Mass., one of 15 primary-care centers run by Harvard Medical School-affiliated Cambridge Health Alliance. For example, Dr. Meisinger says she may see a diabetic patient once every three months. But nurses on her team generally see the patient more frequently and for longer visits. And patients are likely to feel more comfortable telling a nurse than a doctor if, for instance, they haven’t been taking their medication, she says.

The new approach, called team-based care, comes amid a shortage in many parts of the U.S. of primary-care physicians, a situation expected to worsen as the number of new patients obtaining insurance under the federal Affordable Care Act rises. Pervasive chronic diseases such as diabetes also are straining the health-care system.

“In many primary-care practices today, physicians are doing a great deal of work that could be done by others on the team,” says Don Goldmann, chief medical officer of the Institute for Healthcare Improvement, in Cambridge, Mass., a nonprofit that works with medical practices to improve delivery of health care. Dr. Goldmann expects that within 10 years team-based care “will be the norm.”

Team-based care is also becoming more common as large health-care providers increasingly purchase private physician practices and shift from traditional fee-for-service payments to other models, such as those that provide fixed payments to care for patients over a set time.

Lucas Calixto, a 24-year-old software-implementation engineer, ended up in the emergency room with a pulmonary embolism, a blockage in a lung artery caused by a blood clot last summer. He is now on blood-thinning medication and needs close monitoring to prevent a recurrence. On his regular visits to the Union Square clinic, he often doesn’t see the doctor. Instead, another member of the medical team, clinical pharmacist Joseph Falinski, who has a doctor of pharmacy degree, monitors the levels of medication in his system and adjusts the dose as needed. Mr. Calixto also meets with registered nurse Amberly Killmer, who talks to him about how his condition is affecting his life and whether he is adhering to his diet and exercise regimen.

Dr. Meisinger says she diagnoses and treats patients like Mr. Calixto initially, then gives guidance to the team for follow-up. Mr. Calixto feels confident in the care he receives from other team members. “To be honest, unless it is an emergency, they can address whatever issue I’m having and they always seem to do a good job,” he says.

The idea of team-based care is to allow the team members to practice at the highest level allowed by their training and medical license. Physician assistants, for example, complete graduate-level programs lasting on average 27 months and do clinical rotations in different specialties. They can examine patients, diagnose injuries and illnesses, provide treatment, prescribe medications and perform some surgical procedures. But they must be under the supervision of physicians, and the care they can provide varies widely by state and by health-care provider.


About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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