New health care model emphasizes team work

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Today's rapidly changing health care marketplace is increasing focused on providing team-based care – health care that is developed, coordinated and delivered by a team of clinicians including physician assistants and nurse practitioners.

The days of the autocratic top-down physician-driven world are at an end, and a new care model that involves physicians working in partnership with other clinicians is replacing it.

However, health care workers are still adjusting to these changes learning how to define their new roles on a more level playing field. As health care becomes more team-based, how can members develop relationships with their colleagues that will result in better patient care?

Jane Mohler, RN, MPH, PhD, an associate professor at the University of Arizona Colleges of Medicine, Pharmacy, Public Health and Nursing, in Tuscon, Ariz., considers herself an expert on interdisciplinary health care teams. “The new word in health care circles is interprofessional. Physicians, physician assistants, and nurse practitioners are all talking to each other to plan and coordinate care.”

Building effective healthcare teams across disciplines should start when physicians and clinicians are still in training. “In the 21st century, most healthcare will be delivered in the community and the home, and yet we're still doing most of our professional training in hospitals. When you train people in the team, then they're accustomed to working in the team,” Mohler said.

Mohler also emphasized the importance of communication and respect across the various disciplines in a healthcare team. “It's important that the physicians and clinicians understand each others' roles, as well as who is in charge of what care at what stage of the process and coordinating communication along the way,” she said. “Without openness and respect, you won't have a good relationship with your colleagues.”

Ellen Rathfon, senior director of professional advocacy at the American Academy of Physician Assistants (AAPA), told Clinical Advisor that she hears about the PA/MD team relationship frequently from AAPA members. “Most often problems stem from poor communication and/or unrealistic expectations between the physician and the PA. Good and clear communication is key to building and maintaining good collegial relationships,” she said.

This includes being aware of what state and local laws, as well as institutional policies, allow when it comes to physicians delegating responsibility to PAs. This will enable both professionals to work at the top of their games. “The physician and the PA have to be available to one another,” Rathfon said.

Charles Benoit, MD, a cardiothoracic surgeon at Geisinger Health System in Danville, Penn., has worked closely with physician assistants for more than 30 years. “Geisinger was very ahead of the curve when it came to employing PAs in the surgical suite,” said Benoit. “When I was first starting out there as a young surgeon I had not encountered PAs before. It took me a while to get used to them and to appreciate what they had to offer, but after three or four years, I became quite enlightened.”

Benoit gives the PAs on his surgical care team an enormous amount of credit. “The PAs were very flexible and collegial while I became accustomed to learning about everything that they could do,” he said. “The PAs in my unit really work at the absolute top of their profession. They take call, they assist in the operating room, analyze each patient's case and communicate those analyses to me.”

PAs are essential to his own success, Benoit added. “My PAs are a quintessential part of my team. They enable me to be in two places at once, essentially, which is a tremendous gift to any surgeon.”

Jill Elaine Hughes is a freelance medical writer.

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