One of my favorite parts of medicine is the experience of working across the continuum of care, with providers from a variety of backgrounds. Certainly, colleagues like nurse practitioners and RNs are deeply valued but people like orderlies and administrators are also passionate parts of the healthcare system that form key parts of the team.
In my practice, one of the most successful parts of the what we did was to demonstrate in word and action that every single person, who is part of the medical team, is deeply valued and has a unique contribution that only he/she can bring. This approach was brought into our lauded Cranio-facial Team, as well, through which providers from social workers to plastic surgeons to oral surgeons, each of whom collaborated on complex cases like cleft palate and cleft lip care. In short: much of the richness I find in medicine comes from the diversity in our medical teams.
That said, it can feel unmooring or even alarming to notice the ways that our medical teams are changing, especially when it comes to a relative decrease in the importance of physicians and the boom in numbers of providers like nurse practitioners.
A recent article in the New England Journal of Medicine, Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce, looks at the boom in advanced practice registered nurses (APRNs), relative to the almost imperceptible growth of physicians in the US.
To start, one simple fact stood out to me: “Throughout the history of modern medicine, physicians have made up the vast majority of professionals to diagnose, treat, and prescribe medication to patients.” This, of course is changing. An increasing part of healthcare is done by advanced practice registered nurses (APRNs), including nurse practitioners and physician assistants. Even with the current numbers, 41% of physicians work with nurse practitioners.
While the number of physicians in the US is growing very slowly (projected at 0.5% per year 2016-2030), the number of APRNs is growing quickly. Training times for these providers are shorter and there are fewer institutional constraints. The article authors did a rigorous projection of expected physician growth alongside expected APRN growth, based on census data, growth rates, and other key data. The result is that comparing 2001 to 2030, the percentage of APRNs relative to the pool of providers and APRNs together will go from 13% to 35%.
As doctors, we can bemoan these changes. We are all too familiar with the depth and rigor of the training we’ve received and it’s hard to fathom how an APRN can provide care that is as good as training that is less sophisticated.
But the reality is that, as the study authors assert, "These dynamics will have lasting effects on the composition of the health care workforce and working relationships among health professionals.” Our medical team is changing -- our choice is how we adapt our work so that our medical teams can be as effective and satisfying to us as possible.
The authors state unequivocally that “The changing composition of the workforce will have implications for provider teams.” They point out that primary care providers are tending to work in larger groups with varying backgrounds and types of training. But this doesn't always go smoothly. Alarmingly, a recent study of NPs and physicians working on primary care teams “found that physicians, other staff, and patients often confused the roles and skills of various providers and that these misunderstandings often led to practices undermining the productivity and efficiency of NPs.”
This is where I believe my colleagues who are innovating in the field of care coordination, medical collaboration, and hybrid store-and-forward telemedicine have some crucial insights to share. By using telemedicine-supported healthcare collaboration, we fundamentally change the orientation of medicine from a sole provider giving the best care she can to a team of providers offering the best care they can. If we are individual providers working on our own, APRNs are a threat to physicians, and vice versa. Further, their very existence muddles things, creating confusion in care plans and complicating care coordination. In many instances, this is how things are right now.
On the other hand, if we have a consistent system to use telemedicine-based healthcare collaboration to work as a team -- like iClickCare -- then APRNs and physicians can work together smoothly, each contributing his/her unique perspectives in a way that doesn't detract from the work of the other.
And ultimately, that's a more satisfying, effective, easeful way to work, regardless of what the healthcare landscape looks like now, or in the future.
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