Technology plays a role in evolving team approach to primary care

Physician shortages could be alleviated by using electronic communication and teams to manage patient panels, according to a research team's newly published study.

A trio of researchers, two from Columbia University’s business school and one from the University of Pennsylvania, created a simulation study to estimate patient panel sizes that are compatible with timely access to care and how management of those panels can be optimally achieved. Study results were published in the journal Health Affairs.

The simulation determined that pooling patients at least partially between two or three doctors and diverting as little as 20 percent of patient demand to non-physician professionals and/or using electronic communication with patients would eliminate “most if not all” of the projected primary care physician shortage.

“The idea is to have [nurse practitioners] and [physician assistants] and other non-MD professionals work as part of a team but supervised by a primary care physician,” said Linda Green, PhD, a professor at Columbia University’s business school. “It’s a matter of having the right care done by the right person at the right time. It’s really not unusual. For years and years, nurses have been assisting physicians and doing things like blood pressure and temperature, so it’s just a bit of expansion.”

While there is some reluctance right now by some physicians to embrace the team practice model, it is a practice approach that is becoming more common and it is inevitable that it will become the dominant practice model, Green said.

“[Medical school students] think this is a no-brainer. They are much more in tune with electronic communications, working as a team. They embrace it. They think it’s a good thing,” she said. “The obstacle is there’s going to be a generation of people who are just not going to feel comfortable with this. They’re not going to want to embrace technology, embrace a different model of practice. That will change over time.”

But changing the practice model to a team approach goes beyond the generational issue, she said. Doctors and their teams need to work out how to determine when a patient should be seen by a physician or by a non-physician professional; how to split the work between members of the team; how to share patients between physicians in the team; how to effectively use the electronic medical record; and how to make patients comfortable with possibly not seeing their doctor every time, or even not seeing a doctor.

“The key here is you use this team approach,” she said. “When you use a team of both physicians and non-physicians aided by electronic technology, you can really provide good quality care in a much more timely fashion at lower cost, and that’s what the country needs.”