• Team-based Care: Do What You Do Best

    Family medicine practices across the country are shifting to team-based care in an effort to improve the patient-physician relationship, increase efficiency, and support physician and staff well-being. Team-based care accomplishes these goals by more appropriately distributing the workload and capitalizing on team members’ strengths to maximize their contributions.

    “All members of the team play a very important role, working at the top of their license,” says Marie Brown, MD, senior physician adviser to the American Medical Association (AMA) on professional satisfaction and practice sustainability. “The entire team shares the responsibility to provide the best patient care.”

    Effective team-based care looks different for different practices, depending on factors including patient panel, available staffing resources, existing processes, and physician and staff preferences. But most models are based on the same fundamentals. Physicians are responsible for the work that requires their level of training and experience, such as performing exams, determining diagnoses, and establishing treatment plans. The work that doesn’t have to be done by a physician is delegated to well-trained clinical staff, which may include nurses, medical assistants (MAs), or nurse practitioners (NPs). Some practices may also have care coordinators, health coaches, social workers, and behavioral specialists as part of the care team.

    A Team-based Care Success Story

    In 2003, family physician Peter Anderson, MD, was struggling with an insurmountable daily workload, declining finances, changing government regulations and insurance mandates, the challenges of early electronic health record (EHR) implementation, and an aging patient population with complex problems. For his practice to survive, something had to change.

    Anderson identified the exam room as his practice’s primary bottleneck and focused on redesigning the patient visit. He trained his team of two registered nurses to serve as “team care assistants” in the exam room by handling six aspects of each visit:

    1. Collect initial medical data.
    2. Present data to the physician.
    3. Scribe the visit.
    4. Execute orders of the treatment plan.
    5. Close the visit.
    6. Control the visit.

    As a result, says Anderson, “I fell in love with medicine again. And the amazing thing is my staff loved it, too, and my patients loved it more than we did. Every stakeholder in this [came] out better.”

    Family Practice Management (FPM) features Anderson’s own account of implementing team-based care in his practice. The new approach worked so well for Anderson and his team that he started a practice transformation consulting firm called Team Care Medicine in 2010 to train others in this care delivery model. 

    Busting Myths About Team-based Care

    Three common myths prevent physicians from buying in to team-based care, according to Anderson.

    Myth: Staff can’t take on additional clinical skills. In reality, with adequate training, clear performance expectations, and ongoing communication, nurses or MAs can effectively handle tasks like collecting patient data and documenting the visit. Also, they can focus more of their time and attention on these tasks than a physician could.

    Myth: Having staff in the exam room will interfere with the physician-patient relationship. In reality, it strengthens the relationship by freeing the physician to focus completely on the patient without being distracted by documentation and other tasks.

    Myth: Patients don’t want staff in the exam room. In reality, patients appreciate the additional time and attention from the whole care team. 

    Benefits of Team-based Care

    Positive outcomes of team-based care include increased patient satisfaction, improved care quality, and additional access. Anderson says that once he began using his team care model inside the exam room, he had time available in his daily schedule for more patient visits, many of which were acute, or same-day, appointments. In family medicine, better access reduces the likelihood of patients going to urgent care or the emergency room, which, in turn, reduces the likelihood of repeat tests, misdiagnoses, or hospitalization.

    Team-based care also supports physician well-being by allowing physicians to focus their time and energy on the work they are uniquely qualified to do, reducing workload, and increasing practice efficiency and productivity. It helps make family medicine sustainable without cutting corners or sacrificing the patient experience.

    Brown notes that team-based care is not something that is achieved overnight, nor is it an approach that must be all or nothing. Delegation can require a big shift in mindset and processes, so it often works best to implement incremental changes over time.

    “The important thing is that the team has to come together,” Brown says. “Discuss where it makes sense for your team to start, then try something and see how it works. Don’t give up if you don’t succeed at first. Start with small changes and be sure to celebrate little successes.” 

    Written by AAFP editorial staff.

    Peter Anderson, MD, is the founder and president of Team Care Medicine. Anderson practiced family medicine at Hilton Family Practice in Newport News, Virginia, and was an assistant professor at University of Virginia School of Medicine, Charlottesville, and Eastern Virginia Medical School, Norfolk. He is the author of The Familiar Physician and co-author of Lost and Found: A Consumer’s Guide to Healthcare.

    Marie Brown, MD, FACP, is a practicing internist and assistant professor at Rush University Medical College in Chicago, Illinois. She is a senior physician advisor for the American Medical Association (AMA) and a physician lead for STEPS Forward™. She also is a former governor for the American College of Physicians (ACP) Illinois Chapter Northern Region.