When physicians are diverted from activities that add the most value, patient care suffers. To reinvigorate primary care, there is a new team model in town. Shifting focus to advanced team care with in-room support can improve patient care and physician satisfaction, according to a recent commentary.

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The commentary, published in the journal Annals of Family Medicine, is co-written by Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA, and Thomas Bodenheimer, MD, MPH, an internist and founding director of the Center for Excellence in Primary Care at the University of California, San Francisco.

“The old mindsets that hinder primary care prevent teams from truly sharing the care,” says the commentary. “An advanced team care model with in-room support, emerging in a few primary care practices, has the potential to improve care for patients and satisfaction for clinicians and staff.”

Here are six commonly held mindsets that limit widespread adoption of advanced team care with in-room support.

This is often the mentality that, “If I don’t do it, it won’t get done.” For this mindset, only the physician and computer belong in the exam room with the patient. What is central to this mentality is the “self-sacrificing nature of the physician as hero.”

Organizations and physicians should share patient care with the team because “there is too much work to be done by one person,” the commentary says.

For many practices, only a small proportion of the work is shared with the team. If a practice needs more capacity, most turn to hiring more physicians rather than more team members.

A well-trained and mentored team of at least two medical assistants (MA) per physician is needed to fully leverage the skills of everyone. Care is better and more satisfying if the work is strategically delegated according to a person’s ability.

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In 2005, Rand Corp. researchers projected health IT adoption would save more than $81 billion annually, according to research cited in the commentary. However, there were no savings and new technology added work instead of reducing the amount physicians took on.

Technology does not replace people. Instead, the new mindset is that people provide health care while technology serves as a supporting role.

Health care has transitioned to a transactional model with a task-oriented mindset. Since patient information is stored in the electronic health record, it is expected that any physician can step in and pick up care for the patient.

To adjust this mindset, team members and physicians must remember that health care is a relational endeavor. It is founded on trusting and healing relationships. Continuity with the same people does make a difference.

Sharing care with the entire team can be difficult depending on laws and regulations, as well as policies within the health system. For example, some health systems forbid MAs from administering immunizations even though state regulations allow it.

The proper mindset to adopt is that if something is safe and helps patients, then teams should do it. And if each team member is trained, mentored and audited for a specific task within the bounds of government regulations, then the health system should let them.

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A focus on fiscal efforts for reducing overhead will minimize the number and level of training for team members. This directs work previously done by support staff to the highest-trained professionals. When physicians are managing 30% fewer patients because they spend hours on administrative tasks, it is a poor business model.

But reducing help from team members adds to physician burnout, which can increase turnover rates. Health systems can change this mindset by improving staffing ratios. For example, a staff ratio of three-to-one can increase the primary care team’s capacity to see patients.

The AMA’s STEPS Forward™ open-access modules offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These courses can help you prevent physician burnout, create the organizational foundation for joy in medicine and improve practice efficiency. One CME module specifically addresses how to implement team-based care.  

STEPS Forward is part of the AMA Ed Hub™, an online platform that consolidates all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.  


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