The most effective way to maximize the complementary skill sets of all health care professionals is to work as a team. Depending on the specific practice needs, a team-based approach can include various combinations of physicians, nurses, physician assistants, pharmacists, social workers, case managers and other health care professionals. The unique strengths and perspectives of each clinician are an asset when providing the safest, best possible care to patients.
However, these teams require leadership, just as teams do in business, government and sports. Physician expertise is widely recognized as integral to quality medical care in the United States. With 7 years or more of postgraduate education and an average of 10,000 hours of clinical experience through training, physicians are the natural leaders in the overall delivery of health care.
Physicians should maintain authority for patient care in any team care arrangement to assure patient safety and quality of care, since the ultimate responsibility for each individual patient’s medical care rests with the physician. In addition, physicians must be responsible and have authority for initiating and implementing quality-control programs for non-physicians delivering medical care in team-based practices.
Each health care team is unique; no specific model of care delivery is appropriate for all physician practices or clinical situations. Each physician practice should design its team-based model according to its needs, the population served and relevant state laws.
Team-based health care commonly includes:
- Collaboration among team members, the patient and family
- Shared goals within and across health care settings
- Coordinated, high-quality, patient-centered care
Medical schools, part of a recent AMA initiative, are also developing ways to give medical students exposure to working as physician leaders with other health care professionals.
Benefits of physician-led team-based care
Achieving the quadruple aim of providing better patient experience, better population health, lower overall costs and improved professional satisfaction is becoming more difficult as the population ages, chronic conditions become more prevalent and newly insured patients enter the health care system.
Physician-led team-based care can help achieve these goals and is consistent with the American Medical Association’s long-term strategic effort to shape innovative payment and delivery models, prepare future physicians to work in interprofessional teams and improve health outcomes.
In addition to having the support of the AMA and some of the nation’s leading health care systems, patients also support physician-led team-based care. A 2012 survey found that patients overwhelmingly want a coordinated approach to health care, with a physician leading the health care team.
Guiding principles for physician leaders
In the context of team-based care, physician leadership is the consistent use of a physician’s leadership knowledge, skills and expertise necessary to identify, engage and elicit from each team member the unique set of contributions needed to help patients achieve their care goals.
Physician leadership of the health care team does not mean that physicians must have all the right answers for every task the team needs to accomplish. Rather, it requires physicians to ask the right questions, invite participation, communicate clearly, promote a culture of respect, reward excellence and ensure accountability, among other important leadership skills.
The AMA has established best-practice guidelines for physician leaders to follow when they are working with health care teams:
- Focus the team on patient- and family-centered care.
- Collaborate with team members to provide quality patient care.
- Identify to patients the roles and responsibilities of team members.
- Make clear the team’s mission, vision and values.
- Promote clinical collaboration, coordination and communication within the team.
- Encourage the sharing of professional insights, information and resources.
Clinical roles and responsibilities
- Review relevant measures of population health.
- Review team members’ clinical work and documentation.
- Be accountable for clinical care, quality improvement and efficiency of care.
AMA advocacy in support of physician-led team-based care
AMA supports legislation that maintains the authority of physicians in patient care.
- AMA opposes legislation that would allow for the independent practice of advanced practice registered nurses.
- AMA assists state and specialty medical associations that seek to enact legislation that supports dynamic, flexible, physician-led team models of care.
- The AMA creates evidence-based tools for medical associations and policymakers seeking to expand the health care workforce.
Draw on issue briefs and other resources for background on major topics related to physician-led, team-based care.
Those looking to enact team-based care reforms in their state can use the following model bill as a starting point in the law-making process.
Draw on additional resources as you pursue physician-led, team-based care legislation in your state and across the country.