A recent policy brief published in the Journal of American Board of Family Medicine (JABFM) reports that, although an increasing number of primary care physicians are incorporating nurse practitioners (NPs) and physicians’ assistants (PAs) into their patient care teams, there is still a long way to go to incorporate other healthcare professions, such as behavioral health specialists, psychiatrists, pharmacists, physical therapists, and occupational therapists.
Researchers analyzed 2014 American Board of Family Medicine data and determined that more than 50 percent of family physicians report working with NPs at their practice site, 40 percent with PAs, but only 20 percent with behavioral specialists, and only 12 percent with psychiatrists.
The JABFM article highlights how family physicians, NPs, and PAs are today working together in primary care and that these percentages may be related to their ability to bill for clinical services. But while increased NP and PA interactions is a promising indication and a step in the right direction toward team-based care, it also demonstrates that physician interaction with the other healthcare providers can be improved.
There is a recognition of the value and contributions of the behavioral specialists and the consulting psychiatrists in the delivery of team-based, integrated health care. These highly skilled health care professionals can provide patients with brief counseling and address specific needs that may go beyond the physician, NP or PA’s time allocation in a busy clinic or is outside their scope of practice.
The article also argues for the inclusion of other professionals, such as occupational therapists and pharmacists, as members of the health care team. I would also include peer specialists and recovery coaches as important components to a robust health care team. And don’t forget that family partners and peer networks can be an important part of the tapestry to strengthen the safety net.
The article concludes that the diversity of providers in family medicine (and, in my opinion, in health care) is critical to deliver effective, high quality team-based care to meet a person’s whole health needs: physical health, mental health and functional capacities. The workforce diversity and composition is essential but only one of the vital ingredients to establishing successful, team-based care. You can’t make a chocolate cake with the single or sole ingredient of chocolate, right?
If our aim is truly the Triple Aim (improving patient health, increasing patient engagement and reducing costs), primary care practitioners must have as varied a provider team as possible. It’s one of the keys. We know this through our collective experience in designing, implementing and evaluating integrated health care. Heath care reform is no longer coming; it’s here! How we design, deliver and finance health care in the future will likely be based on the tenants of the Triple Aim. We hold the key.