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Team approach to health care means new role for doctors

Sophie Quinton, Stateline.org on

Published in Health & Fitness

DENVER -- When patients go to see Dr. C.T. Lin for a checkup, they don't see just Dr. Lin. They see Dr. Lin and Becky.

Becky Peterson, the medical assistant who works with Lin, sits down with patients first and asks them about their symptoms and medical history -- questions Lin used to ask. When Lin comes into the room, Peterson stays to take notes and cue up orders for tests and services such as physical therapy. When he leaves, she makes sure the patient understands his instructions.

The division of labor lets Lin stay focused on listening to patients and solving problems. "Now I'm just left with the assessment and the plan -- the medical decisions -- which is really my job," Lin said in a quiet moment after seeing a patient at the Denver clinic where he works.

These days, many Americans who visit the doctor's office often sit down with a physician assistant or nurse practitioner instead of their family physician. Or they'll spend a large part of their visit talking to assistants like Peterson, who take care of a growing number of tasks doctors used to handle.

Doctors increasingly oversee care plans that are executed by a team, from nurses who sit down with patients to discuss diet and exercise to clinical pharmacists who monitor a patient's medication.

Lin's clinic has roughly twice as many medical assistants today as it had a year ago, plus a social worker and nurse manager. The configuration has cut the amount of time patients spend talking to their doctor and allowed doctors to see more patients each day. The extra visits bring in enough money to cover the cost of adding more employees.

 

The team approach also reduces stress on doctors.

"The reason a lot of this happened is physician burnout was significant, especially in primary care," said Dr. Carmen Lewis, the medical director of the clinic.

The evolution of the doctor's role comes as insurers -- including state Medicaid programs -- put hospital systems, doctors' offices and providers under pressure to provide better care at a lower cost. And it's expected to accelerate in the coming decades, as the patient population grows older. Many older patients suffer from chronic diseases that need monitoring but not necessarily the expensive attention of a physician at every visit.

This isn't the job many physicians trained for -- or that some want. Even doctors who support team-based care have trouble adjusting to the new workflow. Others, sick of the industry pressures, are opting out and setting up independent practices that don't accept health insurance.

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