Physician-led teams deliver the care patients deserve

Gerald E. Harmon, MD , Past President

Every team needs a leader—and in any team-based model of health care delivery, the most capable and most cost-effective team leader is a physician.

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The AMA helps physicians build a better future for medicine, advocating in the courts and on the Hill to remove obstacles to patient care and confront today’s greatest health crises.

This fact does not in any way diminish the tremendous contributions of nonphysician providers in caring for patients and restoring their health. This has been especially true over the last two years as our entire health care workforce has gone to extraordinary lengths to care for patients amid the urgent threat of COVID-19. The response of our health care community during this pandemic has been courageous and exceptional, and we all owe them our sincere gratitude.

The AMA strongly supports the team approach in which each member fulfills a clearly defined role based on his or her expertise and training. As a family physician, I depend on my fellow team members, day in and day out, to provide high-quality and collaborative care to patients that I could not possibly offer on my own.

Physicians bring unique skills, training and experience to bear in diagnosing and treating patients—and patients count on that expertise and expect that a physician will direct their care. Patients are at the center of everything physicians do, and ensuring their protection and well-being in the modern health care environment continues to drive our emphasis on physician-led teams, just as it has for the past 30-plus years.

And we must remember that physicians are trained to lead (PDF), with the highest level of education in organized medicine along with clinical judgment and medical decision-making skills honed by three to seven years of accredited residency and up to 16,000 hours of clinical training.

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Consensus is rare these days; it seems that even the most benign questions yield partisan splits. But on a precious few issues, there is broad agreement—and the role of physicians in health care delivery is a prime example.

Consider this: 95% of respondents said they believed it was important for a physician to be involved in diagnosis and treatment decisions, as recorded in a survey (PDF) of 1,000 U.S. voters conducted last year. That sentiment easily crossed party lines, with sizable majorities of Republicans, Democrats and independents agreeing that physician involvement was “very important.” Conversely, just 3% of respondents thought physician involvement wasn’t important for treatments and procedures such as anesthesia or surgery.

Patients want and deserve health care that is led by a physician, no matter where they live. One of the arguments put forward by proponents of independent practice by nurse practitioners and other advanced practice registered nurses is that patients in rural and underserved areas will benefit as a result.

To gauge the validity of this contention, the AMA undertook a comprehensive review (PDF, AMA members only) to map the geographic practice location of every single physician in the nation, and compared it a similar map of the practice areas of nonphysician providers. The result? Physicians and nonphysicians are largely practicing alongside each other in the same areas of each state—even in those states that have allowed independent practice by nonphysicians for a decade or more. It is even more interesting to note that states that require team care led by a physician often draw higher numbers of nurse practitioners than states allowing independent practice.

The AMA remains committed to expanding access to care to patients in rural areas and in historically marginalized communities. We are acting on that commitment through a broad range of initiatives, including backing robust expansion of telehealth services, persuading Congress to lift geographic restrictions on where patients can receive remote services, urging greater support for rural hospitals and launching vigorous outreach campaigns to bring physician-led team care to all.

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A study published this year in the Journal of the Mississippi State Medical Association that recounted the experience of AMA Health System Program member Hattiesburg Clinic in that state showed that care delivered by nonphysician providers treating patients on their own was more expensive than care delivered by physicians.

The higher costs resulted from several factors, the study found, including more tests ordered by nonphysicians, a greater number of referrals to specialists and higher emergency department use. Of the five highest-cost providers at the clinic, four were nurse practitioners.

This study and others like it demonstrate the cost-effective nature of skilled and experienced physician-led care that is accomplished through a reduction in unnecessary referrals and unneeded testing, among other factors.

Modern health care delivery is a complex undertaking that demands an interdisciplinary team of health professionals—physicians, nurses, physician assistants, case managers and others—working together to offer patient-centered and cost-effective care.

Physicians possess the training, experience, broad-based knowledge and expertise to draw out valuable contributions from each member of the care team. This approach taps the unique strengths and perspective of each professional on the team to provide the high-quality care patients deserve.