In Florida, Advanced Practice Registered Nurses (APRNs) can now practice medicine independently, without the supervision of a physician, within certain parameters. Prior to the passing of scope of practice expansion legislation, only an MD or a DO were permitted to practice medicine independently.
When non-physician medical associations lobbied to expand their scope of practice, one of their central arguments was allowing independent practice would bring patients increased access to health care in a time when our country is experiencing a physician shortage. The American Medical Association and American Academy of Family Physicians carefully examined this claim.
The AMA reported in a recent study of health care in Mississippi, a state which allows non-physicians to practice independently, that cost data revealed that care provided by non-physicians was more expensive than care delivered by physicians. Another retrospective study by the AAFP examined the impact of scope expansion legislation on the health professional shortage in Washington, another state that allows nurse practitioners to work independently. The study revealed a continued health professional shortage in 27 out of 39 counties.
Furthermore, these studies went on to find care led by a physician resulted in fewer emergency room visits, fewer hospital admissions and readmissions, shorter hospital stays and overall lower healthcare costs for the patient.
When a physician is the lead of the patient care team and all members are working together according to their qualifications, that team can more effectively deliver high-quality, efficient care for the patient’s benefit.
Why should the physician be at the lead of a patient’s care? It comes down to a physician’s clinical training and education.
MD/DO medical students spend four years focusing on learning concepts regarding the entire human body before undertaking three to seven years of residency training in their chosen specialty to further develop and refine their ability to safely evaluate, diagnose, treat and manage a patient’s full range of medical conditions. When their training is all said and done, they undertake at least seven years of training after college, and a total of more than 15,000 hours of medical clinical training.
In contrast, an APRN is required to complete an additional two to three years of training after nursing school, with 500-720 total medical clinical training hours prior to being allowed to practice in Florida.
Taking into consideration the differences in clinical training and education, we can examine the most appropriate, safe, affordable care setting for patients — and that’s a physician-led, team-based approach to care.
In my 14 years as a physician, I worked in a physician-led team environment with a physician assistant at one point, and a nurse practitioner during another. My practice was the first in my practice group to earn the certification of a Patient-Centered Medical Home, mostly based on our ability to get the right patient to the right clinician at the right time.
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My front office staff was well-versed in protocols to vet and risk-stratify patients to the appropriate member of our physician-led team.
For example, the 22-year-old healthy female patient calling to be seen same-day for sinus pressure and a headache was scheduled with my PA, while the 64-year-old diabetic with a history of recurrent skin infections and brittle control of her blood sugars who called at the same time was scheduled with me based on her increased medical complexity.
Following the PA’s visit with the patient facing sinus pressure, we discussed the diagnosis, and a treatment was identified. In this situation, the PA was ready and available, freeing me up to see the more complex diabetic patient.
Working side-by-side allowed our team to communicate well and double-check the care we each provided for our patients. Medicine is a team sport, with clear roles delineated by our respective levels of experience and education. Everyone, both the team and the patients, benefited from the increased access to care our clinic was able to provide.
Both medical research outcomes and anecdotal feedback show us the physician-led team approach works. Our goal, to do good by our patients every day through our physician-led team, fostered a dynamic culture of making sure the patient saw the right clinician at the right time, right away.
When you are in need of medical care, be sure to insist on a physician to lead your medical care team.
John A. Gross is a family medicine/sports medicine physician at JAG Medical, a direct primary care practice in St. Petersburg. He is the past president of the Florida Academy of Family Physicians.