ClickCare Café

Your Medical Team is Changing, Whether You Like It or Not

Posted by Lawrence Kerr on Tue, Jul 31, 2018 @ 07:00 AM

rawpixel-577480-unsplashOne 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.

You can try iClickCare without cost or implementation challenges. Get it free here:

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Tags: nurse practitioners, care coordination, telemedicine technology, Physician Assistant, healthcare collaboration software

Why Physicians Assistants Are Key to Medical Collaboration

Posted by Lawrence Kerr on Tue, Oct 14, 2014 @ 08:17 AM

PA Week photo resized 600

One of the fundamental values of ClickCare is that all parts of the medical team -- the patient, the family, and medical providers across the spectrum of care -- are crucial to healing and good care.

So as Physician Assistants Week wraps up, we wanted to take a moment to congratulate all physician assistants for the job that they do, day in and day out.

Physicians Assistants understand the need to collaborate as well as anyone. As they grow and expand from office to community and integrate and coordinate care, they are increasingly burdened with time wastage and hassle when medical providers don't communicate.

So thank a Physicians Assistant today. In doing so, remember that the medical team is a team made up of many kinds of providers. And we all need to work together for any of us to succeed.


Wondering whether you can use your smartphone in the medical setting? Get our free guide to secure "Bring Your Own Device (BYOD)" policies here:

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Image courtesy of marine_corps on Flickr, used under Creative Commons rights.

Tags: telemedicine, collaboration, healthcare provider burnout, care coordination, healthcare collaboration, store and forward medical collaboration, Physician Assistant

ClickCare Lauds PA Week: Medical Collaboration Everyday.

Posted by Lawrence Kerr on Mon, Oct 07, 2013 @ 07:18 AM

iClickCare  fetes PA Week

Physician Assistant Week is October 6-12, 2013. We are reminded of a most remarkable case that originated with a Physician Assistant (PA), as so many remarkable stories do.

A retired man balanced carefully on a ladder. He was changing a garage door spring. The tensioned spring was one of those very strong springs that lift the door. He lifted his arms to position the spring. The spring snapped and dragged a large hook through his arm. The man lived 40 miles from the nearest hospital, a critical access hospital. The emergency room was staffed by a PA. We have worked with this PA over the years in many roles. He is a smart and dedicated man with good judgment. He was being supervised by local primary care physicians.

The consultation began as a phone call. Thanks to an Appalachian Regional Commission Grant, an early form of iClickCare® was installed in this emergency room. How quaint it seems now - not only not on a mobile device but there was no cell service. Yet, how effective this store-and-forward telemedicine was, even “back in the day.”  After a brief telephone conversation during which the indescribable was halfway described; pictures were taken, a brief history noted, a button clicked, and the hand surgeon was virtually in the emergency room within a few seconds at a hospital over one hour away. 

Care was begun.

  • First, tell the patient an amputation was not necessary. It had been considered.
  • Second, the Emergency Department was notified by a second click. The department was prepared for the patient's arrival. “Throughput”, not a term at the time, was 17 minutes.
  • Third, a click, and the Operating Room was prepared. The anesthesiologist was informed. Equipment, tables, sutures, and personnel were assembled. 

Two hours of surgery (the case went well), another hour in recovery, and the patient went home. Hand therapy followed. Other PAs and students shared the case for learning, months and years later. A short video, securely stored in iClickCare, shows full function.

So who won here?

  • The Patient received ACCESS to the proper care at the proper time. Moreover, he spent the entire trip in the ambulance during transfer, not looking at the roof and mourning the loss of his arm, but knowing the plan for repair. And he was back home in bed the same day. A video conference was not needed with the suffering patient holding his hemorrhaging arm up in front of a face-to-face video conference camera in a special room with expensive equipment.
  • The Emergency Room COLLABORATED by anticipating and enabling the proper triage, orders and flow without making the patient wait for re-examination, wound observation and chasing down the specialist.
  • The Operating Room spent the transfer time quietly preparing without stress of the unknown.
  • The Anesthesiologist, who wishes only to relieve pain, did not have to inflict pain to examine the wound. 
  • The surgical Specialist battened down the hatches, saved hours of visits, assessment, rounds the next day. He was not paid for the consultation. He would not have been anyway, but, he was paid for the surgery.
  • The Originating Hospital provided good care, with good supervision, and allowed the Physician Assistant to practice medicine in a legally compliant, and even more importantly, a confident and comfortable way.
  • The Accepting Hospital provided coordinated, cost effective care on a Saturday afternoon. If collaborative care is cost effective, which it is, the Hospital made out in spades!
  • The Hand therapist also had benefit of an intra-operative photograph. She knew what was strong, what was weak, and her treatment plan was adjusted accordingly.

The Physician Assistant is the hero of this story.
He began, and eventually followed, the patient’s journey. Because he bothered to care, and not ship, because he took an extra minute or two for medical collaboration, because he was doing his everyday job with everyday excellence, he helped everyone. Since he then could follow the results, he could go home after his long shift, weeks later, satisfied and knowing, instead of worrying and wondering. EDUCATION.

ClickCare recognizes and congratulates all Physician Assistants. We hope that PAs will learn more about iClickCare so that they may, as the American Academy of Physician Assistants defines, be “health professionals licensed or, in the case of those by the federal government, credentialed, to practice medicine with physician supervision."

Access, Collaboration, and Education. We all need it.

Be sure to visit the ClickCare Homepage to find out about Healthcare Community Events you might want to attend, and to read the latest in telemedicine in this week's American Telemedicine Association (ATA) Newsbrief.

Try the iClickCare 14-day evaluation

If you are a PA, and have your own story to tell, please let us know. If there are topics you would like to see us cover as a blog article, or have opinions about this blog article, please DO comment.

Tags: hybrid store and forward medical collaboration, medical collaboration software, store and forward medical collaboration, Physician Assistant, PA

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